Mary Ann, age 16 was recently released from the hospital after a serious motor vehicle accident.Shewastheonlysurvivor;3ofherfriendsdiedinthecrash.Theaccidenthappened 2 weeks ago.She had several broken bones and surgeries to repair her injuries.

Her parents brought her in because every time she closes hereyes she relives the accident all overagainandseesherfriends'bodies.Hermothertellsyou,"sheisalmostemotionless,she will sit and just stare for hours on end or cry,"

Mary Ann tells you, "I feel lucky to be alive, but I should be dead.I don't understand why they diedandIlived."Shetellsyoushecannotfallasleep,"EverytimeIclosemyeyesIseeushitting that bridge all over again."

She doesn't want to see her other friends. The only family members she wants to see are her parents.Sheisveryirritablearoundheryoungersiblings.Sheiseatingverylittle,"Imakesmy stomach hurt."

Priortotheaccident,MaryAnnwasactiveinsportsandherchurch.Shelosthersummerjob as a life guard because of the accident.She doesn't want to see any friends or teachers from school or go back to church.

Medical History

Rupturedspleenandaleftshoulderfracturewithsurgicalrepairduetotheaccident. No current medications

Physical Exam

Vitals:T97.9,P88,R16,BP94/64,weight115#,height5'5"BMI19.1

General:Alert&orientedx3 spheres.

HEENT:Normocephalic,atraumatic,TM'sintact,PERRLA,EOMI,nopapilledema,AVnickingor copper wire changes. Oropharynx clear, Neck supple no masses, no lymphadenopathy

Cardiac:RRRS1S2,nomurmurs,nocarotidbruits,no edema

Respiratory:EasyEvenandquiet,chestcleartoallfields,chestwallnon-tender

Abdomen:Soft,non-tender,non-distended,nomasses,andbowelsoundsactivex4quadrants.

Neuro:CN2-12intact,Reflexes+2-+3

Psych:Recent and Remote memory intact. Speech non pressured, non-tangential, Mood and affectcongruent,directeyecontactatalltimes.Answersquestionswithshortyes-noanswers, when asked questions about her feelings " I can't talk about it."

QUESTIONS

Any additional information you think you need to assist you in this case?

Additional Assessments you need, why or why not

i. Screening Tools

ii. Diagnostic Testing

Your Diagnosis

i. The ICD-10

ii. Document the DSM 5TR criteria that support your diagnosis

Differential Diagnosis

Pathophysiology of the condition

Your Treatment Plan

Psychotherapeutic Modalities

Psychosocial Interventions

Medications

Must include dose, directions, possible major side effects, any drug interactions, if applicable

Education

Follow-up