Psychiatric Assessment and Fundamentals Q 26
Nurse Penny is aware that the symptoms that distinguish post-traumatic stress disorder from other anxiety disorder would be:
A. Avoidance of situation & certain activities that resemble the stress.
B. Depression and a blunted affect when discussing the traumatic situation.
C. Lack of interest in family & others.
D. Re-experiencing the trauma in dreams or flashbacks.
Correct Answer: D. Re-experiencing the trauma in dreams or flashback
Experiencing the actual trauma in dreams or flashbacks is the major symptom that distinguishes post-traumatic stress disorder from other anxiety disorders. The symptoms of PTSD include persistently re-experiencing the traumatic event, intrusive thoughts, nightmares, flashbacks, dissociation(detachment from oneself or reality), and intense negative emotional (sadness, guilt) and physiological reaction on being exposed to the traumatic reminder.
Option A: Problems with sleep and concentration, irritability, increased reactivity, increased startle response, hypervigilance, avoidance of traumatic triggers also occur. There is a significant impairment in social, occupational, and other areas of functioning. However, the symptoms of PTSD overlap with acute stress disorder. For a patient to be diagnosed as PTSD, the duration of the symptoms must be more than one month.
Option B: Posttraumatic stress disorder is a complex phenomenon, and it is necessary to evaluate for any co-existing psychiatric illness in the patient. After a detailed history is obtained, the next step is to have a thorough mental status examination, which helps confirm the behavioral, emotional, and cognitive aspects of PTSD. On the mental status examination, the patient would likely mention poor sleep and concentration, frequent nightmares and flashbacks related to the event, guilt or negative emotions associated with the reminder, avoidance, and increased vigilance.
Option C: The initial step in the diagnosis of posttraumatic stress disorder is to obtain a detailed history. It is challenging for the patient at times to describe the nature and severity of the traumatic event, and they may choose to avoid mentioning it. However, the presentation and the duration of the symptoms are useful in making an accurate diagnosis. The health care workers must inquire about any depressive or anxiety symptoms, suicidal ideation or previous attempts, substance abuse, access to firearms.