Phase-Based Treatment of a Complex Severely Mentally Ill Case Involving Complex Posttraumatic Stress Disorder and Psychosis Related to Dandy Walker Syndrome

Abstract

For patients with comorbid complex posttraumatic stress disorder (PTSD) and psychotic disorder, trauma-focused therapy may be difficult to endure. Phase-based treatment including (a) stabilization, (b) trauma-focused therapy, and (c) integration of personality with recovery of connection appears to be the treatment of choice. Objective: The objective of this article is to describe and evaluate the therapeutic process of a single case from a holistic perspective. Method: We present a case report of a 47-year-old woman treated for severe complex PTSD resulting from repeated sexual and physical abuse in early childhood and moderate psychotic symptoms stemming from Dandy Walker Syndrome with hydrocephalus. Results: The patient was treated with quetiapine (600–1,000 mg) and citalopram (40 mg). Stabilization consisted of intensive psychiatric nursing care in the home and stabilizing group treatment for complex PTSD. After stabilization, the following symptom domains showed improvement: self-regulation, self-esteem, assertiveness, avoidance of social activities, and negative cognitions. However, intrusions and arousal persisted and were therefore subsequently treated with prolonged imaginary exposure that also included narrative writing assignments and a final closing ritual. This intensive multidisciplinary, phase-based approach proved effective: All symptoms of complex PTSD were in full remission. Social integration and recovery were promoted with the reduction of polypharmacy and the provision of social skills training and lifestyle training. Conclusion: The present case shows a phase-based treatment approach with multidisciplinary collaborative care to be effective for the treatment of a case of complex PTSD with comorbid psychotic disorder stemming from severe neurological impairment. Replication of this promising approach is therefore called for.

KEYWORDS:

• severe mental illness
• psychosis
• Dandy Walker Syndrome
• function assertive community treatment
• nursing
• child sexual abuse
• complex posttraumatic stress disorder phase-based treatment
• stabilization
• group therapy
• prolonged exposure

ACKNOWLEDGMENTS

This case report was conducted as part of an internal project at GGNet Mental Health Center to improve the treatment of complex trauma-related disorders in severe mental illness.

This patient gave written informed consent for the publication of these data. Her identity has been disguised by omission and alteration of noncrucial information.

No conflicts of interest are declared.