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Zorluk: KolayAnxiety, OCD, and Trauma-Related Disorders

A 33-year-old woman comes to the clinic reporting sudden-onset episodes of chest tightness, palpitations, and sweating. These episodes started 3 weeks ago after she survived a severe multi-car collision. The episodes are triggered whenever she attempts to get into a vehicle. She reports having recurrent nightmares about the crash, avoids driving completely, and feels detached from her husband and children. Physical examination and an electrocardiogram are unremarkable. Which of the following is the most likely diagnosis?

  1. A
    Adjustment disorder
  2. B
    Brief psychotic disorder
  3. Acute stress disorderCevap
  4. D
    Panic disorder
  5. E
    Post-traumatic stress disorder

Cevap

Acute stress disorder
The patient experienced a life-threatening traumatic event (severe car collision) and now exhibits a classic cluster of post-traumatic symptoms: intrusion (nightmares), avoidance (refusing to drive), dissociation/negative mood (feeling detached), and arousal (panic-like symptoms). Because these symptoms have been present for less than 1 month (currently 3 weeks), the precise diagnostic classification is acute stress disorder.

Adım Adım Çözüm

1
Identify the nature of the precipitating event.
The patient survived a severe multi-car collision, which qualifies as a life-threatening traumatic event.
Establishing the presence of a severe trauma is the first step in differentiating trauma-related disorders from general anxiety disorders.
2
Analyze the patient's symptom profile.
The patient has intrusive symptoms (nightmares), avoidance (refusing to drive), negative mood/dissociation (feeling detached), and arousal (palpitations, sweating).
These specific symptom clusters confirm a full syndromal response to the trauma rather than a simple stress response or adjustment issue.
3
Evaluate the timeline of the symptoms.
The trauma occurred 3 weeks ago, meaning the symptoms have been present for less than 1 month.
The duration of symptoms is the critical distinguishing factor between acute stress disorder and post-traumatic stress disorder.
4
Synthesize the findings to make a definitive diagnosis.
Trauma exposure plus characteristic symptoms lasting between 3 days and 1 month confirms acute stress disorder.
Applying the DSM-5 criteria strictly based on the timeline leads to the correct diagnosis.

Anahtar Kavram

The primary clinical distinction between acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) is the symptom duration: ASD applies when symptoms last between 3 days and 1 month, whereas PTSD is diagnosed when symptoms persist beyond 1 month.
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Anxiety, OCD, and Trauma-Related Disorders

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