Reference no: EM133286043

History

A 28-year-old single woman presents to her general practitioner and explains that she has been experiencing recurrent nightmares over the past two months. She was involved in a road traffic accident four months ago. The car that she had been driving crashed on the motorway, killing a colleague who had been her passenger. She also sustained injuries which required a 2-week stay in the hospital. She works as a manager in a building company, and her job requires her to travel to different sites in her car. Since the accident, she has been off work. She says that the nightmares are related to the accident. She is unable to get the memories of the accident out of her mind and can experience very vivid images of the events, even during the day. She struggles with persistent anxiety and has poor sleep and concentration. She now stays at home most of the time and finds it difficult to travel by car, even as a passenger. Her mood and behavior can fluctuate rapidly during the day, and she has recently started self-harming by making cuts to her forearms. She lives alone but has support from friends and family who live locally. There is no history of mental illness in the family. She has no previous psychiatric or medical history apart from a history of overdose with paracetamol eight years ago. At that time, she had split up with her boyfriend and took the overdose while intoxicated with alcohol. She is a non-smoker and has used cannabis in the past when she was at university. She does not use any drugs now. She used to drink alcohol socially but recently has started drinking every day. She says that she drinks one bottle of wine a day.

Mental state examination

She makes good eye contact. She appears to be anxious and has tremors in both hands. She is reluctant to speak about the road traffic accident and starts shouting, becoming verbally aggressive when questioned about the accident. There is no pressure of 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 had died instead of her colleague. She has thoughts that life is not worth living but states that she would not commit suicide because of her family. Her mood is labile. There is no evidence of delusions or hallucinations. She has good insight into her difficulties.

Physical examination

Physical examination is unremarkable.

Questions

1. State the likely diagnosis and give the evidence that supports your choice.

2. What are the differential diagnoses, and what evidence from the case study disproves each?

3. Explain appropriate interventions for a client that avoids stimuli.

4. What are the benefits or drawbacks to having a client give details of events?