A 32yr woman in tears describing constant irritability with her 2 small children and inability to relax

A 32yo woman in tears describing constant irritability with her 2 small children and inability to
relax. She describes herself as easily startled with poor sleep and disturbed nightmares following
a house fire a year ago, while the family slept. What is the single best tx?
a. Rassurance
b. Relaxation therapy
c. Quetiapine
d. Lofepramine
e. Fluoxetine
Q. 1. What is the key
Q. 2. What is the diagnosis?
Q. 3. What are the points in favour of your diagnosis?
Ans. 1 The key is E. Fluoxetine. [NICE guidelines suggest that trauma-focussed psychological therapies
(CBT or EMDR) should be offered before medication, wherever possible. As these are not in option the
best answer here is Fluoxetine (SSRI). At present, there is evidence that EMDR, psychotherapy,
behaviour therapy and antidepressants are all effective. There is not enough information for us to say
that one of these treatments is better than another].
Ans. 2. The diagnosis is post traumatic stress disorder.
Ans. 3. Points in favour of PTSD: i) H/O stressor (house fire a year ago) ii) Nightmares of the stressor iii)
Hyper arousal (very anxious and inability to relax (leading to irritability) iv) associated depression (poor
sleep, tearful).
Note: Fluoxetin and peroxetin are the drugs of choice in PTSD. CBT is the non-pharmacological
treatment.