Mini Quiz: PTSD Assessment and Treatment in an Elderly Patient

Poll

A 79-year-old widow with a history of severe physical abuse during childhood and throughout her married life attributes her outbursts to old age. Take the quiz and learn more.

CASE VIGNETTE

A 79-year-old widow was referred by her primary care physician (PCP) for isolating herself from others and episodic outbursts. She has a history of severe physical abuse during childhood and throughout her married life. While generally avoiding discussion about her deceased husband, she says, “I don’t remember much, but maybe he wouldn’t have hit me so much if I wasn’t such a negative person!” She wakes up multiple times during the night although she denies any nightmares. She attributes her symptoms to changes that happen as “one normally ages. Taking into account the patient's long-term trauma and episodic nature of her outburses, as well as other variables including the fact that she has sequestered herself from others, the initial assessment suggests a diagnosis of PTSD. Scroll down for the quiz >>

The logical next step would be to:

A. Ask her PCP to refer her to a neurologist, as these are early signs of dementia
B. Request that the PCP lower patient’s dose of anti-hypertensive medications and start her on prazosin
C. Suggest initiating sertraline after explaining the risks and potential benefits
D. Point out how she is “beating up” on herself and encourage her to try meditation the next time she is upset
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