AccessMedicine's Case of the Week: Posttraumatic Stress Disorder

From: Case Files Psychiatry

Sep 05, 2019
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Case

A 34-year-old married woman comes to an intake appointment with a psychiatrist with a chief complaint of "I've been depressed recently." One year ago she was raped by an unknown assailant in the parking lot of a grocery store, and, since that time, "things just have not been the same." She describes becoming irritable and angry with her spouse for no apparent reason and feels disconnected from him emotionally. In fact, she feels "numb" most of the time, having "lost the joy from life." Her sleep is restless, and she is having trouble focusing on her work as a laboratory technician. She has nightmares about the rape in which the event is replayed. The patient admits that she has told very few people about the rape and tries "not to think about it" as much as possible. She avoids going anywhere near the location where the event occurred and remains anxious when shopping at a supermarket.

On mental status examination, her appearance, behavior, and speech are all unremarkable. Her mood is "depressed," and her affect is congruent and restricted. Her thought process is linear and logical. She denies suicidal or homicidal ideation, although wishes her attacker would "die a horrible death." She denies paranoia, delusions, or perceptual disturbances. Her cognition is grossly intact. Her judgment and impulse control are not impaired.

Questions:

1. What is the most likely diagnosis?

2. Should this patient be hospitalized?


Click HERE to answer the questions and complete the case!

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Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education

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