Case Study: 12
A 24-year-old woman comes to a psychiatrist with the chief compliant of a depressed mood and anxiety. She states that one year ago she was in a multiple car accident on I75 near Oakland Mall on her way to work. She was trapped in the car until the Jaws-Of-Life pulled her out and later spent several weeks in the hospital recovering from broken bones. Since that time “things just have not been the same.” She finds herself getting anxious and crying when she is getting ready to go to work. She frequently avoids the freeway in that area where the accident occurred which adds more time to her commute. She finds herself short tempered and irritable towards her husband and children on the mornings she has to go to work. She prefers to stay at home as much as possible and will turn down offers from friends to go out on the town. Her sleep is restless, and she is having trouble concentrating on her work as an executive secretary at the Chrysler Tech Center. She has nightmares about the accident in which the event is replayed. She states she tries not to think about the incident, never talks about it and wishes she could erase it from her mind.
On mental status examination, her appearance, behavior, and speech are all unremarkable. Her mood is described as depressed, and her affect is congruent and restricted. Her thought process is linear and logical. She denies any psychotic symptoms or suicidal or homicidal thoughts. Her cognition is grossly intact. Her judgment and impulse control are not impaired.
1. What is the most likely diagnosis? Please provide support for your answer by giving DSM criteria.
2. What differential diagnoses would you want to rule out in this patient? Please list and contrast.
3. Severity of illness and intensity of care: What type of treatment setting would be best for this patient?
4. Provide 4 priority nursing interventions with rationale (and reference)
5. What likely medications may be prescribed for this client, if any? And provide benefits vs risk ratio of proscribing medication. Provide full coverage of MED FACTS and nursing implications.
6. What are the most effective therapeutic techniques when working with this client? What would be the best type of psychotherapy for this patient?
7. What other type of teaching would be beneficial for this client?
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