A 30-year-old woman is evaluated in the clinic 2 weeks after surviving a severe house fire. She reports experiencing frequent, distressing nightmares about the fire, hypervigilance, and a new inability to experience positive emotions. She actively avoids anything that reminds her of the event, including cooking and candles. Her past psychiatric history is significant for Bipolar I disorder, which is currently stable, and a history of treatment-resistant depression for which she takes phenelzine. She asks what can be done to manage her current distressing symptoms. Which of the following are the most appropriate management steps for this patient? (Select two)
- Provide education and reassurance about common acute stress reactionsAnswer
- Initiate trauma-focused cognitive-behavioral therapyAnswer
- CInitiate fluoxetine monotherapy to rapidly treat the trauma symptoms
- DPrescribe paroxetine to be taken concurrently with her current medication
- EDiagnose brief psychotic disorder since the symptoms have lasted less than one month
Answer
The most appropriate management steps are to provide education and reassurance about common stress reactions, and to initiate trauma-focused cognitive-behavioral therapy.
This patient's presentation of intrusive nightmares, hypervigilance, and active avoidance 2 weeks after a life-threatening trauma is classic for Acute Stress Disorder (ASD). The cornerstone of initial ASD management involves non-pharmacological approaches, specifically trauma-focused cognitive-behavioral therapy and psychoeducation to reassure the patient that these are common, expected reactions to extreme stress. Routine pharmacotherapy is not first-line for ASD.
Step-by-Step Solution
Key Concept
First-line non-pharmacological management of Acute Stress Disorder and critical pharmacological contraindications in psychiatric comorbidities.