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PATIENT PRESENTATION

Chief Complaint

“I thought I was strong and would be over this, but I can’t take it anymore. I have nightmares and flashbacks of that day. I’m afraid to go to sleep, and every loud noise sends me through the roof. Drinking and cannabis were helping, but not so much anymore.”

History of Present Illness

I.V is a 42-year-old woman who witnessed a mass shooting 6 months ago. She was in a local shopping mall when the perpetrator started shooting. She suffered a mild shrapnel injury but witnessed 6 victims being shot and the shooter killed by the police. She has received previous diagnoses of post-traumatic stress disorder (PTSD) and depression

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Missing Information?

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Patient Database

Drug Therapy Problems

Care Plan (by Problem)

TARGETED QUESTIONS

  1. What signs and symptoms of PTSD does this patient have?

    Hint: See Treatment: Posttraumatic Stress Disorder in PPP and reference 1 below

  2. What non-pharmacological interventions might be useful for this patient?

    Hint: See Treatment: Posttraumatic Stress Disorder in PPP and references 1 and 2 below

  3. Why would an antidepressant medication be a good pharmacologic option for this patient?

    Hint: See Treatment: Posttraumatic Stress Disorder in PPP and references 1 and 2 below

  4. What adverse effects of your chosen pharmacotherapy regimen would you discuss with the patient?

    Hint: See Treatment: Posttraumatic Stress Disorder and chapter 39 in PPP

  5. What therapy may have some efficacy for the patient’s nightmares

    Hint: See Treatment: Posttraumatic Stress Disorder in PPP

FOLLOW-UP

The patient returns to the clinic 6 weeks later. She thinks there may be some improvement in her PTSD symptoms, but that the medication she takes in the morning makes her feel “weird”, and since she started taking it she has lost all interest in sex with her husband. She would like to try a different medication What alternative pharmacotherapeutic options exist for this patient?

CASE SUMMARY

Global Perspective

There is a high prevalence of PTSD and major depression in war-surviving populations. Surveys of war survivors show a PTSD prevalence of 26% and 23% for major depression. Of those with PTSD, 52% had comorbid major depression. Prevalence rates were not significantly associated with war intensity and length or time since the war. Extrapolation of these data from 1989-2019 yielded 316 million adult war survivors globally residing in 43 war-ridden countries who suffer from PTSD and/or major depression. PTSD and major depression were associated with approximately 3 million and 4 million disability-adjusted life years, respectively. Virtually all the war ...

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