A 26-year-old woman, G1P0 at 14 weeks gestation, is evaluated in the outpatient psychiatry clinic. Three weeks ago, she was the victim of an armed robbery in a parking garage. Since the incident, she has experienced severe insomnia, recurrent nightmares about the robbery, and feels emotionally detached from her husband. She completely avoids going near parking garages or driving alone. Vital signs are temperature 37.0°C (98.6°F), blood pressure 110/70 mm Hg, pulse 88/min, and respirations 16/min. Recent routine prenatal laboratory studies are unremarkable except for a mild, compensated respiratory alkalosis. When recounting the robbery during the interview, she becomes tearful and visibly distressed. She has a history of bipolar I disorder but discontinued her mood stabilizer prior to conception. She works as a hospital administrator and explicitly asks the physician not to document the visit in her medical record, fearing her employer will find out and terminate her. Which of the following is the most appropriate next step in management?
- Refer the patient for trauma-focused cognitive behavioral therapyAnswer
- BInitiate citalopram monotherapy to manage her trauma-related symptoms
- CNotify her employer's occupational health department due to potential workplace safety risks
- DOrder a computed tomography pulmonary angiogram to evaluate her respiratory alkalosis
- EDiagnose brief psychotic disorder and initiate a low-dose atypical antipsychotic