He is unable to sleep well, feels hopeless and detached. What is the SINGLE most likely diagnosis?

A 26 year old political refugee has sought asylum in the UK. He complains of poor concentration. He keeps getting thoughts of his family whom he saw was killed in a political coup. He is unable to sleep well, feels hopeless and detached. What is the SINGLE most likely diagnosis?

A. Acute stress disorder
B. Post traumatic stress disorder
C. Social phobia
D. Obsessive compulsive disorder
E. Generalized anxiety disorder

Post-traumatic stress disorder (PTSD) • Develops following a traumatic event Features • Re-experiencing: o Flashbacks, nightmares • Avoidance: o Avoiding people, situations or circumstances resembling or associated with the event • Hyperarousal o Hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating • Emotional numbing o Lack of ability to experience feelings Management • Trauma-focused cognitive behavioural therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR): are first-line treatments It is very common to have questions with a patient with clear symptoms of PTSD and the question would ask which is first line. If CBT is present, that is usually the answer.

• SSRI’s would be second line. e.g. paroxetine, sertraline are licensed for PTSD. Other unlicensed possibilities include: fluoxetine, citalopram, escitalopram, and fluvoxamine.

If you find all these names of SSRI’s difficult to remember. Just remember these 3 → Paroxetine, sertraline, and fluoxetine