fongch
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A 37-year-old woman is abducted, beaten, and repeatedly raped. For 5 months after the attack she is nervous, tearful, easily fatigues, and has difficulty sleeping and lack of appetite, and is hyperreactive to unexpected or loud stimuli. By 6 months she has returned to her characteristic pre-attack behavioral pattern. Which of the following is the most likely diagnosis?
A. Acute stress disorder
B. Adjustment disorder w/ mixed anxiety and depressed mood
C. Major depressive disorder
D. Panic disorder w/o agoraphobia
E. Post-traumatic stress disorder
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| dericanthony
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e
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| sridevibandaru24
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E
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| fongch
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Personally I choose E. However the answer provided by Kaplan is B.
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| khorshid
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I would go with B too, because 2 very important criteria of PTSD are:1.reexperiencing as dreams or recollections and avoidance of stimuli...the rest is somehow common between ptsd and adjustment disorder, here we don't have those 2 criteria but everything including time frame is right for an adjustment disorder. and one more important point, adjustment disorders resolve by themselves, as this case I am not sure if PTSDs resolve spontaneously that easily.(and yet another one usually ptsds have long periods of latency)....but it is confusing:nod
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| DrS
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Yep E would be the asnwer as there is no recollection or reliving of the experience
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| young_doc
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B
"...In addition to evidence of trauma, there must be a repetitive, intrusive recollection or re-enactment of the event in memories, daytime imagery, or dreams..."
(PTSD. Criteria for Diagnosis)
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| DrS
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sorry I meant B!!!
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| klimt
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Makes sense now. Although my first choice was E also...
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| drfax
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definitely B.
as in BRS, life-threatening event like rape might cause PTSD if lasts for almost more than 6 mo. or even more with symptoms like nightmare,hyperarousal,re-experiencing.. so E is a distractor
adjusment disorder is return to normal life after less than 6 mo without any goup psychotherapy
good Q
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| mohelgamal
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but adjustment disorder is exagerated responce to trivial stimuli, I really don't think this is adjustment. although I can't oppose kaplan
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| hope99
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B is better answer i think...
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| fongch
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I agree w/ mohelgamal in that rape is considered to be life-threatening or potentially fatal events and thus the resulted disorder should be either PTSD or acute stress disorder. Adjustment disorder occurs after a seriour but usually not life-threatening evens and clearly this is not the case here. I still do not understand why Kaplan pick B.
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| equinoxe
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great Q, it's B.
acute stress disorder < 1 mo
PTSD > cannot be diag before 1 mo, by 3 mo can be disabling, average duration = 36 mo with ttt; 64 without ttt (ferri clinical advisor); can last for years, coworker raped can intensify PTSD (BRS)
adjustment disorder < 6 mo
> it would have been PTSD if > 6 mo still response; resolved by 6 Mo = adjustment disorder
PTSD = catastrophic stressor; adjustment = serios stressor;
major depressive = at least 2 weeks
Generalized anxiety disorder - unknown stressor
===
Adjustment Disorder
2. Criteria:
a. Presence of identifiable stressor within 3 months of onset
b. Symptoms last less than 6 months after end of stressor
c. Symptoms are clinically significant, with significant social, occupational, and/or academic impairment
d. Not a grief response
===
Post-Traumatic Stress Disorder
1. Manifestations:
a. Re-experiencc of the event as recurrent dreams or recollections (flashbacks)
b. Avoidance of associated stimuli
c. Diminished responsiveness to external world
d. Sleep disruption or excess
e. Irritability, loss of control, impulsivity
f. Headaches, inability to concentrate
g. Repetition compulsion
2. Symptoms must be exhibited for more than 1 month; if less, diagnose as acute stress disorder
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| docarchana
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does adjustment disorder return to normal behaviour pattern without therapy???
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