A nurse comes to home after a war finished. After 3 months she has stressful events, insomnia, depression, loss of appetite. The nurse may suffer from?

1. A

   Post Traumatic Stress Disorder (PTSD)

2. B

   Severe depression

3. C

   Adjustment disorder

4. D

   Acute Stress Reaction

Appeared in: KGMU 2023

Explanation

• Post Traumatic Stress Disorder (PTSD) develops after exposure to a severe traumatic event, such as war.
• The core features include intrusive memories (stressful events), negative mood changes (depression), and alterations in arousal (insomnia).
• A key diagnostic criterion is that symptoms must persist for more than one month after the trauma.
• The nurse's symptoms have been present for 3 months, which fits the timeline for a PTSD diagnosis.

Why Other Options Were Wrong

• Option B: While depression is a prominent symptom, this diagnosis alone does not account for the full symptom cluster, particularly the intrusive thoughts and hyperarousal (insomnia) directly related to the traumatic event.
• Option C: Adjustment disorder is a response to a stressor, but typically one that is not as severe or life-threatening as war. Furthermore, when symptoms meet the criteria for a more specific disorder like PTSD, that diagnosis is used instead.
• Option D: The timeline is incorrect. Acute Stress Reaction (or Acute Stress Disorder) is diagnosed when symptoms last from 3 days up to a maximum of one month after the trauma.

Related Visual

• Visual 1: Flowchart: A visual flowchart differentiating Acute Stress Disorder, PTSD, and Adjustment Disorder based on two key questions: 1) What was the nature of the stressor (traumatic vs. non-traumatic)? 2) How long have the symptoms lasted (<1 month vs. >1 month)?
• Visual 2: Infographic: An infographic summarizing the four main symptom clusters of PTSD: Intrusion, Avoidance, Negative Alterations in Cognition/Mood, and Alterations in Arousal/Reactivity, with examples for each.

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Differential diagnosis of trauma- and stressor-related disorders based on timeline and symptoms in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Nurses must be able to recognize the signs of PTSD not only in patients but also in colleagues, especially those working in high-stress environments or with military backgrounds. Early recognition is key to facilitating support and treatment.
• A core nursing role is to create a therapeutic, non-judgmental environment where individuals feel safe to discuss traumatic experiences. This includes using active listening and providing psychoeducation about trauma responses.
• What if the nurse's symptoms had only started 2 weeks ago and occurred 2 weeks after returning from the war? In that case, the diagnosis would be Acute Stress Reaction, as the total duration is within the 1-month timeframe.

How to Approach the Question

• First, analyze the clinical scenario presented in the question stem. Identify the key elements: the patient (a nurse), the precipitating event (returning from a war), the symptoms (stressful events, insomnia, depression, loss of appetite), and the timeline (3 months).
• Recognize that the timeline is a critical factor in distinguishing between different trauma- and stressor-related disorders.
• Review the options provided and recall the specific diagnostic criteria for each, paying close attention to the duration of symptoms.
• Compare the patient's presentation to the criteria: Acute Stress Reaction requires symptoms to last less than 1 month. Adjustment Disorder is for less severe stressors. PTSD requires symptoms to last more than 1 month.
• Conclude that the patient's symptom duration of 3 months exceeds the limit for Acute Stress Reaction and the nature of the trauma (war) and symptom cluster align perfectly with the diagnosis of PTSD.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of trauma- and stressor-related disorders based on timeline and symptoms.
• Stem keywords: nurse, war, 3 months, stressful events, insomnia, depression, loss of appetite
• Lead-in keywords: suffer from
• Clinical cues: Timeline: 3 months after trauma (war) is a key diagnostic clue that points away from Acute Stress Reaction and towards PTSD.
• Negative lead-in flag: false

Question ID

QgDQ2zAJx3NEnY5Q72uv-C

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