A patient comes with a complaint of flashback after a traumatic event and having nightmares. The patient may suffer from which psychiatric illness?

1. A

   Generalized anxiety disorder

2. B

   Post-traumatic stress disorder

3. C

   Panic anxiety disorder

4. D

   Obsessive compulsive disorder

Appeared in: NORCET-7 Mains-2024

Explanation

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• The patient's primary complaints are flashbacks and nightmares, which are hallmark intrusion symptoms of PTSD.
• These symptoms are directly linked to a preceding traumatic event, which is a core diagnostic criterion for PTSD.
• Flashbacks are dissociative reactions where the individual feels or acts as if the traumatic event is recurring, a key feature that distinguishes PTSD from other anxiety disorders.
• The combination of a known trauma followed by re-experiencing symptoms makes PTSD the most fitting diagnosis.

Why Other Options Were Wrong

• Option A: Generalized Anxiety Disorder (GAD) involves chronic, excessive worry about multiple future events or activities, not re-experiencing a specific past trauma through flashbacks.
• Option C: Panic Disorder is characterized by sudden, unexpected panic attacks with intense physical symptoms (like palpitations and shortness of breath), not by flashbacks related to a past trauma.
• Option D: Obsessive-Compulsive Disorder (OCD) involves obsessions (unwanted, intrusive thoughts) and compulsions (repetitive behaviors to reduce anxiety), which are distinct from trauma-related flashbacks.

Related Visual

• Visual 1: Diagram - Illustrating the four core symptom clusters of PTSD (Intrusion, Avoidance, Negative Alterations in Cognition/Mood, and Alterations in Arousal/Reactivity) to help differentiate it from other anxiety disorders.

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Identification of Post-Traumatic Stress Disorder (PTSD) based on hallmark symptoms in acute care settings.
• Recognizing the classic signs of PTSD is critical for nurses to initiate safety protocols, provide appropriate psychological first aid, and facilitate referral for specialized trauma-focused therapy.
• Patients with PTSD are at a higher risk for suicide, substance abuse, and depression. Early identification and intervention can significantly improve long-term outcomes.
• What if? If the patient's symptoms (e.g., nightmares, irritability, avoidance) appeared immediately after the trauma but resolved within three weeks, the diagnosis would be Acute Stress Disorder, not PTSD, which requires symptoms to persist for more than one month.

How to Approach the Question

• First, identify the key symptoms presented in the clinical scenario: 'flashback' and 'nightmares'.
• Next, note the critical context provided: these symptoms occurred 'after a traumatic event'.
• Analyze the options provided. Evaluate which disorder is defined by the re-experiencing of a past trauma.
• Post-traumatic stress disorder is specifically characterized by intrusion symptoms like flashbacks and nightmares related to a past trauma.
• Eliminate the other options: GAD is about general worry, Panic Disorder is about panic attacks, and OCD is about obsessions and compulsions. None of these are defined by re-living a past trauma.

Concept Tested & Keywords

• Concept Tested: Identification of Post-Traumatic Stress Disorder (PTSD) based on hallmark symptoms.
• Stem keywords: flashback, traumatic event, nightmares, psychiatric illness
• Lead-in keywords: suffer from which
• Clinical cues: Complaint of flashback and nightmares after a traumatic event: These are classic intrusion symptoms pointing directly to PTSD.

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