Coentre and Power Journal of Medical Case Reports 2011, 5:97 http://www.jmedicalcasereports.com/content/5/1/97 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access A diagnostic dilemma between psychosis and post-traumatic stress disorder: a case report and review of the literature Ricardo Coentre1,2,3*, Paddy Power1,2 Abstract Introduction: Post-traumatic stress disorder is defined as a mental disorder that arises from the experience of traumatic life events. Research has shown a high incidence of co-morbidity between post-traumatic stress disorder and psychosis. Case presentation: We report the case of a 32-year-old black African woman with a history of both post-traumatic stress disorder and psychosis. Two years ago she presented to mental health services with auditory and visual hallucinations, persecutory delusions, suicidal ideation, recurring nightmares, hyper-arousal, and initial and middle insomnia. She was prescribed trifluoperazine (5 mg/day) and began cognitive-behavioral therapy for psychosis. Her psychotic symptoms gradually resolved over a period of three weeks; however, she continues to experience ongoing symptoms of post-traumatic stress disorder. In our case report, we review both the diagnostic and treatment issues regarding post-traumatic stress disorder with psychotic symptoms. Conclusions: There are many factors responsible for the symptoms that occur in response to a traumatic event, including cognitive, affective and environmental factors. These factors may predispose both to the development of post-traumatic stress disorder and/or psychotic disorders. The independent diagnosis of post-traumatic stress disorder with psychotic features remains an open issue. A psychological formulation is essential regarding the appropriate treatment in a clinical setting. Introduction Post-traumatic stress disorder (PTSD) is defined as a mental disorder that arises from the experience of trau- matic life events. Documented symptoms include re- experiencing the traumatic event, hyper-arousal and avoidance of stimuli associated with the trauma [1]. None of the Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-IV-TR) diagnostic cri- teria refers to psychotic phenomena such as delusions or hallucinations. Research has shown a high incidence of co-morbidity between PTSD and psychosis; for exam- ple, psychosis with PTSD and vice versa [2]. The emer- gence of psychosis in PTSD raises important nosological questions about the disorder. In our case report, we describe the case of a patient with PTSD who later * Correspondence: Ricardo.Coentre@netc.pt 1Lambeth Early Onset (LEO) Service, Lambeth Hospital, South London and Maudsley NHS Trust, 108 Landor Road, London SW9 9NT, UK Full list of author information is available at the end of the article developed psychotic features. We will also discuss and review the nosological and treatment implications of this co-morbidity. To the best of our knowledge, we report the first case of PTSD with psychotic symptoms in a pregnant woman treated with trifluoperazine. Case presentation We present the case of a 32-year-old black African, muslim woman with a history of both PTSD and psy- chosis. She presented to mental health services for the first time two years ago with a history of auditory and visual hallucinations, persecutory delusions, suicidal ideation, recurring nightmares, hyper-arousal, and initial and middle insomnia. She reported seeing blood on the walls, men in white following her and hearing voices saying that some men were coming to get her. These symptoms were worse at night. She became very dis- tressed and troubled to the point of wanting to end her life. © 2011 Coentre and Power; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.