1. Summarize the relevant details, such as existing medical and psychiatric conditions, plus the likely precipitating factors of PTSD of the selected case;
2. Describe the symptoms and other behavioral manifestations from the case;
3. Describe any co-occurring disorders or complicating factors that could exacerbate the symptoms of PTSD of this selected case ;
4. Discuss any obvious or potential barriers that may impede the person’s improvement;
5. Identify personal and environmental assets/strengths the individual might use to improve;
6. Propose areas/questions for further exploration about this person, in order to fully understand this individual’s needs;
7. Describe your recommended treatment interventions, with justifications. For example, types of therapy recommended, frequency of sessions, what medications might be considered, any alternative therapy that might be useful, are there family members that need support- if so how?, etc. be sure to explain your reasoning.
Walter is a 25 year-old single African-American man is in the Army National Guard and had 4 years of reserve service until was activated to full-time military duty 2 years ago. Before being activated, he was a full-time college student and competitive athlete. He was raised by a single mother in public housing in a large city. As a teenager he has a history of fighting while in school and within his neighborhood, and often was exposed to observing street violence while growing up.
Initially trained in supply transportation, he was called to active duty and retrained as a military policeman to serve with his unit in Afghanistan. He described enjoying the high intensity of his deployment and had become recognized by others as an informal leader because of his aggressiveness and self-confidence. He described seeing numerous after effects from car and building explosions while performing convoy escort and security detail. He also reports coming under small arms gunfire on several occasions, witnessing dead and injured civilians and Afghan soldiers and on occasion feeling powerless when forced to detour a planned route or take evasive action. He began to develop increasing mistrust of the operational environment, as “the situation on the street” seemed to deteriorate. He often felt that he and his fellow soldiers were placed in harm’s way needlessly by senior officers.
On one specific routine convoy mission, while serving as driver for the lead Humvee, his vehicle was struck by an improvised explosive device (IED). He was showered with shrapnel that struck him in the neck, arms, and legs. Another member of his vehicle was even more seriously injured. He described “kicking into autopilot,” driving his vehicle to a safe location, and jumping out to do a battle damage assessment. He denied feeling any pain at that time. He was then evacuated to the Combat Support Hospital (CSH) where he was treated and returned to duty (RTD) after two weeks, despite requiring crutches and suffering chronic pain from retained shrapnel in his neck.
He began to become angry at his commanding officer and military doctors for keeping him “in a combat theater” while he was unable to perform his duties fully and effectively. He developed symptoms of insomnia, hyper-vigilance, and a startle response. His initial dreams of the event became more intense and frequent and he suffered intrusive thoughts and flashbacks of the attack. He was never a tobacco user, but since the event, he started to smoke cigarettes believing this would keep his mind occupied and now he smokes tobacco constantly. When asked about using medications for pain control (such as opiates), he avoids being specific and tends to change the subject. He is very reluctant to seek mental health services or even talk with the military chaplain about his emotions or thoughts. He has since begun to withdraw from friends and suffered anhedonia, feels detached from others and fears his military future will be cut short.