Question

You are working the afternoon shift in an inpatient psychiatric unit. The patients are in the day room
watching a movie when suddenly someone starts yelling. You and other staff rush to the day room to find
J.J., a 48-year-old male patient, crouched in the corner behind a chair, yelling at the other patients, "Get
down. Get down quick." You and the other staff are able to calm J.J. and the other patients and take J.J. to
his room. He apologizes for his outburst and explains to you that the movie brought back memories of
the Gulf War. He had forgotten where he was and thought he was in combat again. He describes to you
in detail the memory he had of being ambushed by the enemy and watching several of his comrades be
killed. You remember hearing in report that J.J. is a Gulf War veteran admitted with posttraumatic stress
disorder (PTSD ).
1. What are common causes of PTSD, and what is the most likely cause of J.J.'s condition?
2. Name three criteria that must be present for a diagnosis of PTSD.
3. What is the difference between PTSD and acute stress disorder?
4. Which symptom(s) of PTSD did J.J. most likely experience?

5. What therapeutic measures can be done to help J.J. during your shift this afternoon?

While you are in J.J.'s room, he states that he would like to rest for a while, and he requests something to
"calm his nerves." You check his medical record see these PRN (as needed) medications listed.
Chart View
PRN Medications
Acetaminophen (Tylenol) 650 mg PO every 6 hours prn pain or fever
Alprazolam (Xanax) orally dissolving tablet, 0.5 mg by mouth every 4 hr prn anxiety
Zolpidem (Ambien) extended release, 12.5 mg PO at bedtime if needed
6. Which medication is most appropriate to administer at this time? Explain.
7. What are the adverse effects of long-term use of benzodiazepine anxiolytics?
8. You decide to notify J.J.'s physician about his reaction to the movie. The physician writes an
order to start paroxetine (Paxil). How does this medication differ from alprazolam?

9. Which of these are potential side effects of paroxetine? Select all that apply.
a. Nausea
b. Constipation
c. Postural hypotension
d. Headache
e. Tinnitus

J.J. asks you whether there are other things he can do, in addition to medications, to help his anxiety. He
tells you that he's heard about relaxation therapy and wants to hear more about it.
10. What would you discuss with J.J. about relaxation therapy?
11. To what other treatment modalities could J.J. be referred after his hospitalization to help treat
his PTSD and related problems?

Answer 1

1.Common causes of PTSD-

• War and Conflict
• Mental and physical torture
• Sexual assault
• Dangerous accidents
• Losing a dearone
• Serious health issues
• Hospital fear specially in ICU
• Domestic violence childhood abuse

The cause of J.J's health condition is Gulf war in which several comrades killed by the enemies infront of him.

2. Three criterion for the diagnosis of PTSD are

• Stressor- The patient witnessess the whole scenario, there will be a direct exposure to the situation.
• Encroachment- The patient will suffer with night mares, flashbacks, reminds the past episodes.
• Alterations in arousal and reactivity- The patient shows aggression, irritability. His/her behaviour will be destructive, there will be a lack of concentration and lack of sleep.

3. Difference between aPTSD and acute stress disorder are-

ACUTE STRESS DISORDER- It develops immediately after some traumatic event. It lasts for 3-4 days to several weeks.Patient may suffer with nightmares, difficulty in concentration, sleeping difficulty, flashback episodes, Avioding the situation and people, Self isolation.

PTSD- Direct or indirect exposure to traumatic events cause PTSD to develop. Patients experience negative thoughts/ feelings after the incidence.

4.J.J experiences Flashback experiences. He goes in the flashback episodes where he was in the Gulf war and the enemies killed his comrades infront of him.

5. Therapeutic measures to help J.J -

• First of all calm down the patient. Relieve his anxiety.
• Provide a calm and peaceful environment.
• Divert the mind of the patient.
• reassure him.
• We can help him to gain control over his fear.
• Try to restore self esteem.

6. Alprazolam orally dissolving tablet 0.5 mg every 4 hrly PRN anxiety.I think alpraz should be given this time to the patient to calm him down, as he is said that he want some rest, and wants something to calm down his nerves.

7. Adverse effects of longterm use of benzodiazepines are -

• nausea
• headache
• lethargy,
• cloudy memory
• dizziness
• sleeping difficulty
• agression
• depression

8. Alprazolam treats short term anxiety and panic attacks but paxil treats depression and anxiety. it is very fast effective and long acting also.

9. Possible side effects of paxil are-

Nausea and constipation.

10. Relaxation therapy helps the patient to relax the patient voluntarily. To attain a peaceful mind, and to relax the body and soul, to relieve muscle tension which is caused by depression, to reduce anxiety and anger relaxation therapy is done. Advice the patient to do relaxation techniques regularly for better results and for a fast recovery

11. Other treatment modalities forJ.J to be referred after his hospitalization-

• Cognitive behavioural therapy
• Eye movement desensitisation and reprocessing
• Group therapy