GP CCE Cases · mental-health
PTSD masked at a repeat-script visit — CCE clinical encounter
CCE-style clinical encounter: a 31-year-old retail manager attending for antidepressant renewal whose dispensed history and brief screening reveal four years of undiagnosed PTSD after an armed robbery. The candidate must surface the trauma sensitively, diagnose, and negotiate first-line trauma-focused therapy.
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Target exams
RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 31-year-old retail manager attends for a repeat sertraline prescription. Dispensing records show 100 mg daily for two years. She sleeps poorly, avoids the shopping-centre complex where she now works 'because of parking', startles badly when customers drop things, and feels distant from her partner. Four years ago she was held up at knifepoint at her previous workplace. She has never told a doctor about it.
Objectives
- Convert a script-renewal consultation into a structured mental health review without losing the patient's trust. [1]
- Elicit the trauma history and map symptoms onto the four DSM-5 clusters. [2]
- Explain why two years of sertraline alone has not treated her disorder, using honest evidence framing. [3]
- Negotiate referral for trauma-focused therapy (TF-CBT or EMDR) with realistic outcome expectations. [4]
- Safety-net: assess suicide risk, alcohol use, and arrange review. [5]
References6ShowHide
- [1]Phelps AJ, et al. Australian guidelines for the prevention and treatment of posttraumatic stress disorder: Updates in the third edition. Aust N Z J Psychiatry, 2022.PMID 34448406
- [2]Bisson JI, et al. Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Syst Rev, 2013.PMID 24338345
- [3]Cusack K, et al. Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clin Psychol Rev, 2016.PMID 26574151
- [4]Mavranezouli I, et al. Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychol Med, 2020.PMID 32063234
- [5]Williams T, et al. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev, 2026.PMID 42206608
- [6]Milligan T, et al. Loss of PTSD Diagnosis in Response to Evidence-Based Treatments: A Systematic Review and Meta-Analysis. JAMA Psychiatry, 2025.PMID 40397424