Interactive Case
Intro: Patient Background
James, 35 years old, served two tours in a combat zone. He has been experiencing intense nightmares, flashbacks, and episodes of severe anxiety since returning home 8 months ago. Family reports he is easily startled by loud noises, avoids crowded places, and has difficulty sleeping.
He also mentions feeling "on edge," having frequent outbursts of anger, and unwillingness to discuss his experiences with anyone. He has refused multiple social gatherings and often sits alone in his room.
Key Assessment Findings
- History of combat exposure with possible traumatic experiences
- Symptoms of re-experiencing (flashbacks, nightmares)
- Avoidance of reminders (crowded places, social events)
- Hyperarousal (easily startled, hypervigilant, trouble sleeping)
- Emotional dysregulation (anger outbursts, irritability)
Vital signs show slight tachycardia (HR 96), BP 130/82, RR 20. James appears guarded, making minimal eye contact, stating "I don't want to talk about it."
Priority Interventions
- Establish rapport and trust via a calm, supportive environment.
- Encourage James to share (as tolerated) and validate his experiences.
- Educate about grounding techniques to manage flashbacks and anxiety.
- Collaborate with mental health provider for trauma-focused therapy (e.g., Cognitive Processing Therapy or EMDR).
- Evaluate for pharmacological interventions (SSRIs, prazosin for nightmares).
Interactive Quiz
Q1: Which symptom is most characteristic of James's condition?
Q2: Which initial intervention helps build rapport with James?
Q3: James often wakes up sweaty and terrified. Which medication may help his nightmares?
Q4: Which therapy is most effective in addressing trauma-related symptoms?