A patient experiences a sudden episode of severe anxiety. Of these medications in the patients medical record, which is most appropriate to give as a prn anxiolytic?

Correct Answer: B

Rationale: In the context of psychobiological disorders, the most appropriate prn anxiolytic medication for a sudden episode of severe anxiety is lorazepam (Ativan). Lorazepam is a benzodiazepine that acts quickly to alleviate acute anxiety symptoms by enhancing the effects of GABA in the brain, resulting in sedation, muscle relaxation, and anxiolytic effects. Option A, buspirone (BuSpar), is not ideal for acute anxiety relief as it typically requires regular dosing to build up therapeutic effects and is more suitable for generalized anxiety disorder rather than sudden severe anxiety episodes. Options C and D, amitriptyline (Elavil) and desipramine (Norpramin), are tricyclic antidepressants that are not typically used as first-line treatments for acute anxiety due to their slower onset of action compared to benzodiazepines. They are more commonly used for chronic pain conditions or depression. Educationally, understanding the pharmacological properties of different anxiolytic medications is crucial in selecting the most appropriate treatment for patients experiencing acute anxiety episodes. It is important for healthcare providers to be knowledgeable about the onset of action, side effect profiles, and contraindications of various medications to ensure safe and effective patient care.

Correct Answer: D

Rationale: Resilience refers to positive adaptation or the ability to maintain or regain mental health despite adversity. Loss of a child is among the highest-risk situations for an adjustment disorder and maladaptive grieving. The parents who throw flowers on the lake on each anniversary date of the accident are openly expressing their feelings. The other behaviors are maladaptive because of isolating themselves and/or denying their feelings. After 2 years, the frequency of visiting the grave should have decreased.

Correct Answer: C

Rationale: Depersonalization disorder involves a persistent or recurrent experience of feeling detached from and outside oneself. Although reality testing is intact, the experience causes significant impairment in social or occupational functioning and distress to the individual. Dissociative amnesia involves memory loss. Children with disinhibited social engagement disorder demonstrate no normal fear of strangers and are unusually willing to go off with strangers. Individuals with ASD experience three or more dissociative symptoms associated with a traumatic event, such as a subjective sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings; derealization; depersonalization or dissociative amnesia. In the scenario, the patient experiences only one symptom.

Correct Answer: B

Rationale: Cortisol is a hormone released in response to stress. Severe dissociation or mindflight occurs for those who have suffered significant trauma. The episodic failure of dissociation causes intrusive symptoms such as flashbacks, thus dysregulating cortisol. The cortisol level may go up or down, so diuresis and/or weight gain may or may not occur. Answering this question correctly requires that the student apply prior learning regarding the effects of cortisol.

Correct Answer: D

Rationale: The correct answer is D) Fireworks display on July 4th. This event can trigger distress in a soldier with PTSD due to the loud, sudden noises resembling gunfire or explosions, which are common triggers for PTSD symptoms. Fireworks can evoke intense feelings of anxiety, fear, and flashback experiences in individuals with PTSD, as they can remind them of traumatic experiences in combat zones. Option A) Halloween festival with neighborhood children may not be as distressing for the soldier with PTSD as it is a more predictable and controlled environment without sudden loud noises or triggers related to combat experiences. Option B) Singing carols around a Christmas tree is a peaceful and joyous activity that is less likely to trigger PTSD symptoms compared to the sudden and loud nature of fireworks. Option C) A family outing to the seashore is a relaxing and calming experience that is unlikely to evoke the same level of distress and triggers as a fireworks display. Educationally, understanding PTSD triggers and their impact on individuals is crucial for healthcare professionals, educators, and caregivers to provide appropriate support and create safe environments for individuals with PTSD. It is essential to be aware of potential triggers to prevent re-traumatization and promote the well-being of individuals living with psychobiological disorders like PTSD.