Case Study: Multidisciplinary Management of Post-Traumatic Stress Disorder (PTSD) Following a Road Traffic Accident

Abstract

This case study presents a 34-year-old male who developed Post-Traumatic Stress Disorder (PTSD) following a severe road traffic accident that resulted in multiple fractures and prolonged hospitalization. The patient exhibited intrusive flashbacks, nightmares, hypervigilance, and social withdrawal beginning two weeks post-discharge. A multidisciplinary management plan involving psychiatry, psychology, physiotherapy, and social work was initiated. Treatment included trauma-focused cognitive behavioral therapy (CBT), pharmacotherapy with sertraline, relaxation training, and gradual reintegration into daily activities through structured counseling. Over six months, the patient achieved substantial improvement in mood, sleep quality, and coping ability. This case highlights the significance of early psychological intervention, collaborative care, and long-term follow-up in mitigating the disabling effects of PTSD after physical trauma.

Introduction

Post-Traumatic Stress Disorder (PTSD) is a chronic, often debilitating psychiatric condition triggered by exposure to traumatic events such as accidents, natural disasters, or violence. In trauma survivors, especially accident victims, PTSD prevalence can reach up to 25–30%. Persistent re-experiencing, avoidance behaviors, negative mood alterations, and heightened arousal are hallmark symptoms that interfere with recovery and rehabilitation.

Comprehensive management requires early identification, psychotherapeutic intervention, pharmacologic support, and multidisciplinary rehabilitation. This case demonstrates how integrating psychiatry, psychology, physiotherapy, and social services facilitated functional and emotional recovery in an accident survivor suffering from PTSD.

Patient Information

Age / Gender: 34-year-old male
Occupation: Mechanical engineer
Marital Status: Married, one child
Medical History: No prior psychiatric illness; mild hypertension
Surgical History: Multiple orthopedic surgeries following accident (tibia and femur fixation)
Family History: Non-contributory
Social History: Non-smoker, occasional alcohol use
Current Medications: Amlodipine 5 mg daily
Chief Complaints: Persistent nightmares, flashbacks of accident scene, irritability, and insomnia

Clinical Findings

Symptoms:

• Recurrent intrusive memories and nightmares of the accident

• Avoidance of driving and highways

• Irritability and exaggerated startle response

• Emotional numbness and detachment from family

• Sleep disturbances and fatigue

Mental Status Examination:

• Mood: Anxious, irritable

• Affect: Restricted

• Thought Content: Preoccupation with trauma, guilt about survival

• Cognition: Intact

• Insight: Partial

• PTSD Checklist (PCL-5) Score: 58 (Severe range)

Timeline

Accident (January 2024):
Sustained bilateral leg fractures and chest contusion; hospitalized for 4 weeks.

Post-Discharge (February 2024):
Reported nightmares, flashbacks, and emotional withdrawal. Initial denial of psychological issues.

Referral (March 2024):
Primary care physician referred to psychiatry after persistent sleep disturbances and anxiety.

Diagnosis (March 2024):
Based on DSM-5 criteria, diagnosed with Post-Traumatic Stress Disorder (PTSD).

Intervention Initiation (March 2024):
Started on combined psychotherapy and pharmacologic management.

Follow-Up (June 2024):
Marked symptom reduction; improved sleep and social engagement.

Six-Month Review (September 2024):
Sustained recovery with mild residual anxiety; resumed driving and work.

Diagnostic Assessment

Psychological Assessment:

• PTSD Checklist (PCL-5): 58 → reduced to 22 by 6 months

• Beck Depression Inventory: Moderate depression (Score: 18)

• Hamilton Anxiety Scale: 16 (mild anxiety)

Medical Evaluation:

• No neurocognitive deficits on screening

• Stable orthopedic recovery

Differential Diagnosis:

• Acute stress disorder (ruled out - symptoms >1 month duration)

• Major depressive disorder (secondary features present)

Therapeutic Intervention

Step 1 – Acute Phase Management

• Psychoeducation about PTSD symptoms and normalizing stress response

• Introduction of relaxation techniques (deep breathing, guided imagery)

• Initiation of sertraline 50 mg/day, titrated to 100 mg/day after 2 weeks

Step 2 – Psychotherapy and Behavioral Interventions

• Weekly trauma-focused Cognitive Behavioral Therapy (CBT) sessions

• Exposure-based therapy to reduce avoidance (gradual reintroduction to driving)

• Cognitive restructuring to address guilt and self-blame

• Sleep hygiene education and mindfulness-based stress reduction techniques

Step 3 – Multidisciplinary Rehabilitation

• Physiotherapy for lower limb strengthening and mobility restoration

• Occupational therapy to regain workplace confidence

• Family counseling sessions for emotional support and communication

• Social worker involvement for reintegration and workplace accommodations

Challenges Faced

• Stigma: Initial reluctance to seek psychiatric help

• Nightmares and Insomnia: Required dose adjustment and relaxation training

• Avoidance Behavior: Patient resisted exposure exercises initially

• Emotional Numbing: Required sustained counseling and family engagement

Follow-Up and Outcomes

1 Month: Improved sleep, reduced nightmares, continued mild anxiety
3 Months: PCL-5 score reduced from 58 to 32; resumed partial driving
6 Months: PCL-5 score 22; full return to work, improved family interaction
1 Year: No relapse, on maintenance dose of sertraline (50 mg), CBT discontinued after 12 sessions

Discussion

This case highlights the pivotal role of early recognition and multidisciplinary management in PTSD following physical trauma. The combination of pharmacotherapy (SSRI) and trauma-focused CBT remains the gold standard in PTSD treatment, effectively reducing symptom severity, improving emotional regulation, and preventing chronic psychological disability. The inclusion of physiotherapy and occupational therapy supported both physical and psychological recovery, while family counseling strengthened emotional resilience and promoted supportive communication at home. Early psychoeducation helped the patient understand his symptoms as part of a treatable condition, thereby improving adherence, reducing stigma, and encouraging proactive self-care.

Studies demonstrate that untreated PTSD can lead to chronic anxiety, depression, sleep disturbances, and substance use disorders, affecting up to 50% of accident survivors. Evidence suggests that early intervention within three months post-trauma significantly enhances long-term functional outcomes, work reintegration, and overall quality of life. In this case, timely screening, coordinated multidisciplinary care, and structured follow-up led to near-complete psychological recovery, restored occupational functioning, and sustained social reintegration, underscoring the importance of integrated trauma-informed rehabilitation in clinical practice.

Key Takeaways

• Early identification and multidisciplinary intervention are vital in PTSD management.

• Trauma-focused CBT and SSRIs are first-line treatments with proven efficacy.

• Family involvement and psychoeducation enhance adherence and emotional recovery.

• Physical rehabilitation and psychological therapy must proceed in tandem.

• Long-term follow-up is essential to prevent relapse and ensure full reintegration.

Patient’s Perspective

“After my accident, I couldn’t sleep without reliving the crash. I avoided people and even driving. When the psychiatrist explained what was happening, I finally understood it wasn’t weakness - it was PTSD. The therapy sessions and breathing exercises helped me regain control. My family stood by me, and with their support, I returned to work and my life feels normal again.”

Conclusion

This case underscores that integrating timely psychological intervention, pharmacotherapy, and coordinated rehabilitation offers the best outcomes for patients with Post-Traumatic Stress Disorder (PTSD) following physical trauma. Success depended on early diagnosis, multidisciplinary collaboration, and patient-centered care involving psychiatry, physiotherapy, and family support.

The prompt identification of psychological distress after the accident was crucial in preventing chronic PTSD. Early intervention through trauma-focused cognitive behavioral therapy (CBT) helped the patient process the traumatic memories in a controlled, therapeutic environment. Pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) provided additional symptom relief, stabilizing mood, improving sleep, and reducing hyperarousal. Physiotherapy not only aided physical recovery but also enhanced mental resilience by re-establishing a sense of control over the body.

Equally vital was the role of family education and social support in maintaining emotional stability and encouraging treatment adherence. Structured psychoeducation sessions helped relatives recognize early signs of relapse and fostered a supportive environment conducive to healing. Regular multidisciplinary team meetings between psychiatrists, psychologists, physiotherapists, and social workers ensured synchronized care, addressing both physical and emotional recovery milestones.

By combining evidence-based psychotherapy with medical and social support, this model demonstrates how PTSD can be effectively managed, reducing chronic disability and restoring social and occupational function. Incorporating mindfulness-based therapies, group counseling, and vocational reintegration programs further strengthened coping mechanisms. Ultimately, multidisciplinary frameworks emphasizing communication, empathy, and follow-up represent the cornerstone of modern trauma recovery care, transforming post-traumatic stress into post-traumatic growth and long-term psychological resilience.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th Edition, 2013.

2. NICE Guidelines (2023). Post-traumatic Stress Disorder: Management.

3. Bisson JI, et al. (2019). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev.

4. Shalev AY, et al. (2017). Prevention of PTSD by early treatment: Results from the Jerusalem Trauma Outreach and Prevention Study. Arch Gen Psychiatry.

5. Foa EB, et al. (2009). Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies.

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