A 29-year-old, previously successful woman was climbing stairs in her new home about a month ago

A 29-year-old, previously successful woman was climbing stairs in her new home about a month ago, when the whole house fell apart. She ended up in a hospital with a fractured left femur. The psychiatry team was consulted because the patient complained of nightmares and flashbacks and was afraid to go to sleep as a result. During the interview, she is tearful, and afraid that her fear of falling is preventing her from participating enough in her rehabilitation, and that the team will discharge her from hospital. Which of the following is the most appropriate treatment for this patient?

A. Insight-oriented psychotherapy
B. No therapy because the patient needs to take responsibility for her treatment
C. Put a sitter to stay in the patient’s room 24 hours a day to calm her anxiety
D. Start an antidepressant
E. Start benzodiazepines

Explanation: The correct answer is D. The patient is having symptoms of posttraumatic stress disorder (PTSD), as well as depressive symptoms. Sertraline is an antidepressant approved for treatment of this disorder. Other antidepressants and anticonvulsants have also been shown to be effective in the treatment of PTS D. Insight-oriented psychotherapy (choice A) is focused on getting insight into the underlying unconscious conflicts on the basis of exploration of transference feelings evoked during the process. It is not suitable for the treatment of acute PTS D. No therapy (choice B) in a patient with obvious symptoms that are interfering with his or her treatment and social functioning would be unacceptable and considered neglect. A 24-hour watch by a sitter (choice C) would be indicated if the patient is actively suicidal and has poor impulse control. Having a family member for support is encouraged, but enforcing a regressed and dependent position by a 24-hour watch would not be appropriate. Benzodiazepines (choice E) can be used in for symptom relief in cases of acute stress reaction, but they are not indicated as long-term treatment of PTSD because of their addictive potential.