Psych Station 10

Setting:

You are a GP in a community health centre. Your next patient is a 20 year old male who presents today with complaints of poor sleep and difficulty concentrating.

Name (patient): Michael Thompson

Tasks:

1. Take a history from the patient.

2. Give the examiner your main diagnosis and 2 differentials.

3. Discuss the intial management plan with the patient.

You are not required to examine the patient during this station.

Briefing

Diagnosis: PTSD
You are Michael Thompson, age 20.
You have presented to the GP with difficulty sleeping and concentrating in college. 

Appearance and Behaviour

Nil specific.

Opening statement

“I have trouble falling asleep, and when I do, I often wake up in a panic, drenched in sweat.”

Information to give freely

“I feel anxious and on edge most of the time. My concentration has worsened, making it difficult to focus on my university work.”

Presenting Complaint

Diagnosis - PTSD
History - I was involved in a severe car accident three months ago, where I lost control of the car on a wet road and crashed into a tree. I sustained minor physical injuries but was discharged from the hospital after a couple of days.
Core symptoms of PTSD

Flashbacks - I try to avoid thinking about the accident, but the memories come back unexpectedly. I have nightmares about the crash.

Hypervigulance - I am often triggered by loud noises or seeing a car that looks like mine. I always feel on edge.

Avoidance - since the accident, I avoid driving.

Mood - I just feel down a lot, like there’s this constant weight on me. I don’t enjoy hanging out with my friends or doing anything I used to like. I’m not the same person anymore. I snap at people for no reason, and I don’t even know why. I’m just always tense, like something bad is about to happen.
Sleep - I have these nightmares almost every night. It’s like I’m reliving the accident over and over again. I wake up in a panic, sweating, and then I can’t get back to sleep.
Concentration - I used to do pretty well in school, but now I just can’t focus. My mind keeps drifting back to the accident.
Mania / Psychosis / Compulsion - no manic, compulsive, or psychotic symptoms.
Risk Assessment - Sometimes I feel like it’s too much to handle, but I haven’t thought about hurting myself. I just want it to stop.

Past Medical History

Previous similar episodes - nothing similar previously
Other medical conditions - none

Forensic History

Previous police encounters - none

Drug History

Prescribed - None
Over the counter - None
Allergies - None

Family History

None

Social History

Smoking / Alcohol / Drugs - None
Job - Uni student and bar tender
Home - live with parents, they are concerned you are not yourself.

Systems Review

General/red flags - night sweats, no fever or weight change.
Neuro - Nil
Resp - Nil, no hyperventilation
Cardio - Palpitations and chest pain when thinking of the accident
GI - nil

Ideas / Concerns / Expectation

Ideas - Will it be like this forever now?
Concerns - I’m worried that this is affecting my whole life.
Expectations - I really hope there is something I can do to get back to normal.

Discussion / Questions

The candidate will explain his management plan to you, you should be receptive to this.