Post-Traumatic Stress Disorder Handout
30 August 2013
Case #1
35-year-old dependent female presenting to clinic for “emergency department follow up.” When questioned she states that she had been physically and sexually assaulted three weeks ago by her husband, after which she sought medical care at your local emergency department. She was treated and released with multiple contusions to her face, head, chest, and arms. She states that she does not drink and had had no alcohol prior to the assault and thus seems to recall the entire event. She shares her story openly but states that she is having nightmares every night that are affecting her sleep; both falling and staying asleep. She is also “jumpy” with fast-moving stimuli (cars, driving, etc…) and feels palpitations any time she sees anything that reminds her of her husband.With that, she feels on edge almost all the time right now. Despite this, she has gone back to her house with a friend to stay while her husband remains in jail; she states she is planning for divorce now. She denies SI/HI and although has a handgun at home that belongs to him. She states that she takes great comfort in her family and friends nearby and she wants to get back to cycling when she heals completely. For now, doing her normal tasks remains somewhat difficult.
What is her diagnosis and by what criteria are you making it?
Describe your general approach to this patient’s care.
What treatment(s) or service(s) will you offer her now and why? How would your plan change if she is active duty (if at all)?
Case #2
40-year-old single male SSG presenting to clinic with sleeping concerns. He states that he has had sleeping trouble off and on over the past two years but now is becoming more and more prominent and frequent. He has extreme difficulty both falling asleep and staying asleep. The patient states that he was involved in a mortar attack that killed numerous fellow soldiers and wounded many others. He had helped to remove killed soldiers and states that he remembers body parts being “all over the place.” He states that he is so tired all the time but has some fears of sleeping because he frequently dreams of carrying bloody bodies away. He states that he feels guilt that he survived while others died. He denies reliving the event while awake, although he does not like to talk about anything from his deployment because it makes him think of the event. He feels withdrawn from friends and colleagues outside of work, rarely attends any activities, and mostly keeps to himself now.He states that he just no longer enjoys being with other people. He seems blunted during his interview with a flat affect and minimal eye contact, although he gets tearful when details of the trauma are discussed. He denies SI/HI. Additionally, he appears to be proud of his service, especially as the Army was his choice as a second career. Although, he is ashamed now because he can no longer focus on assigned tasks, making life somewhat difficult for him at work.
What is his official (and unofficial) diagnosis and by what criteria are you making that diagnosis?
What is your approach to this patient and what are your treatment recommendations?
**Time permitting** Share your “script” dialogue with group members to discuss the diagnosis and treatment. You may use the following chart to guide you:
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