Case Study: Phillip McCarthy

You are seeing Phillip McCarthy, a 60-year-old British man. He speaks in a clipped British accent and goes through his story rather rapidly, as though he just wants to get through the story quickly.

“Three months ago, I was taking my daughter and grandson to the park, when we were hit by a car. Apparently, another driver fell asleep and drove into our car from the side. I thought Daisy and Skip were flying about in the car like everything else and that they had died. Maybe she did not put on their seatbelts and Skip’s car seat broke? I do not know what I was really thinking at the time. After rolling twice, the car eventually landed on its four wheels. I tried to look around to see if they were safe, but I was trapped and could not see them. I had excruciating pain in my back. I couldn’t really move. I thought I had broken my back, although it turned out I had not.

“After the car stopped, it was dead silent. And I thought that meant they were dead. I couldn’t hear anything at all. And I started screaming for them. However, they had survived because Skip started screaming back at me. Daisy did have a broken arm but that was all.

“That was all. Skip had a few bruises. So did I. Old man. Car accident. Had a limp for a month. That was all.”

Phillip pauses and takes a large breath. He starts talking a bit more slowly as the words are difficult to say. “So, what’s wrong? Daily, I’m having intrusive memories of the accident in which I see the car spinning and flipping. I also picture what could have… have happened to Daisy and to Skip and I picture them dead in the backseat. It’s difficult to admit this, British stiff upper lip and all. But it’s driving me crazy. Sometimes when I’m driving, I even have flashbacks several times a week. I get all hot and sweaty. I grip the steering wheel hard as I can and power through, but I am terrified of the cars around me. I don’t drive on the highway, especially where the accident happened. I have started to avoid going anywhere if I can help it. I have been waking up almost nightly from nightmares. I have been trying to push the memories away. I try to think about something else, anything else especially at bedtime.

“But I think I need more help.”

During the rest of the interview, you determine that while Phillip can remember the trauma, he hadn’t remembered all the details clearly, such as that the car had rolled twice until he had been told by his daughter. Phillip has many hyperarousal symptoms, including difficulty sleeping, feeling irritable, trouble concentrating, and being overly alert.

Questions
From your perspective as Phillip’s psychiatric nurse practitioner, answer the following questions in a page double-spaced paper (not including the reference page) and in APA format. Include at least three peer-reviewed, evidence-based references.

1-What screening or diagnostic tools would you use for Phillip and why? Identify additional questions you need to ask to determine the best treatment options.
2-Based on the information that you have, what diagnosis would you give Phillip? Please include differential diagnoses. Match his symptoms with the corresponding DSM-5 criteria.
3-What pharmacological treatment would you prescribe to Phillip? Please include rationale, starting dose, tapering schedule (if any), how the medication works, major drug/drug interactions, and patient education.
4-What community and support resources would you provide to Phillip?
5-Would you refer Phillip to therapy? If so, what type? Please provide evidence for your decision.