The patient presents to a health clinic two weeks post-event, reporting recurrent nightmares, intrusive thoughts, exaggerated startle response, difficulty sleeping, and avoidance of returning to the office. She states, “I wasn’t shot, but I can’t stop reliving the sound of gunfire. Every time I hear a loud noise, I panic.” She denies suicidal ideation but endorses feelings of guilt for surviving when some colleagues were killed.

Clinical Findings:

• Appearance: Anxious, restless, tearful at times
• Speech: Rapid, pressured when describing the event
• Affect: Constricted, fearful
• Thought Content: Intrusive trauma-related thoughts; survivor’s guilt
• Sleep: 3–4 hours/night with nightmares
• No substance misuse reported

Questions:

1. Which diagnosis is most appropriate for this patient at two weeks post-event?

A. Post-Traumatic Stress Disorder
B. Acute Stress Disorder
C. Generalized Anxiety Disorder
D. Adjustment Disorder with Depressed Mood

2. Which intervention is considered first-line psychotherapy for trauma-related disorders?

A. Trauma-focused Cognitive Behavioral Therapy
B. Psychoanalysis
C. Dialectical Behavior Therapy
D. Electroconvulsive Therapy

3. What is the primary goal of psychoeducation after trauma?

A. Eliminate all anxiety symptoms immediately
B. Promote emotional suppression
C. Encourage avoidance of reminders
D. Normalize reactions and provide coping strategies

Answers:

1. B. Acute Stress Disorder
Rationale: PTSD cannot be diagnosed until symptoms persist for at least 1 month. At 2 weeks, acute stress disorder (ASD) is the most appropriate diagnosis.

2. A. Trauma-focused Cognitive Behavioral Therapy
Rationale: Trauma-focused CBT has the strongest evidence base for acute stress disorder and PTSD.

3. D. Normalize reactions and provide coping strategies
Rationale: Psychoeducation helps survivors understand that trauma reactions are common and teaches healthy coping.