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A 28 year old single woman presents to her GP explaining that she has been experiencing recurrent night mares over the past 2 months. She was involved in a road traffic accident 4 months ago. The car she had been driving crushed on the motorway killing a colleague who had been her passenger. She also sustained injuries which required a 2week stay in hospital She works as a manager in a building company and her job requires her to travel to different sites. She struggles with persistent anxiety, has poor sleep and concentration.
Mental state examination:
She make good eye contact.,appears to be anxious and has tremors in both hands. She's reluctant to speak about the road traffic accident. There's no pressure on speech She describes experiencing the accident as recurrent intrusive imagery. She feels guilty about surviving the accident and States that it would have been better if she died instead of her colleagues. Physical examination is unremarkable.
a) What is the differential diagnosis
b) How would you investigate and manage this patient IN GENERAL PRACTICE.
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