Training Title 85
Name: Mrs. Isla Flanagan
Gender: female
Age: 47 years old
T- 98.0 P- 82 R 18 136/62 Ht 5’0 Wt 123lbs
Background: Born and raised in Northern Ireland, parents brought her and her one sister to U.S.
when she was 15 to go to U.S. university where she met her husband. They live in Charleston,
SC. She obtained her master’s degree in education; no history of mental health or substance use
treatment, no family history. Her husband reported a recent school shooting nearby 3 weeks ago
“flipped a switch” in her. She is watching the news 24/7, barely sleeping, and even when she
does, it is only a few hours, Appetite is decreased. Hx of hysterectomy, NKDA, no legal hx.
Symptom Media. (Producer). (2017). Training title 85 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-85

1. Introduction
Patient: Mrs. Isla Flanagan, 47‑year‑old female.

Context: Case study from Symptom Media video (2017).

Clinical Focus: Anxiety disorders and PTSD in middle‑aged adults following exposure to community trauma.

Importance: Demonstrates how indirect trauma exposure (school shooting nearby) can precipitate acute anxiety and PTSD‑like symptoms even in individuals with no prior psychiatric history.

2. Demographics and Background
Age: 47 years old.

Gender: Female.

Vitals: T 98.0, P 82, R 18, BP 136/62 (normal).

Height/Weight: 5’0”, 123 lbs (BMI ~24 → normal).

Family: Lives with husband in Charleston, SC; one sister in U.S.

Childhood: Born and raised in Northern Ireland, immigrated at age 15.

Education/Occupation: Master’s degree in education.

Medical History: Hysterectomy.

Psychiatric History: No prior mental health or substance use treatment.

Family Psychiatric History: None reported.

Allergies: NKDA.

Legal History: None.

3. Psychosocial Stressors
Community Trauma: Nearby school shooting 3 weeks ago triggered acute anxiety.

Media Exposure: Watching news 24/7, reinforcing anxiety and hypervigilance.

Sleep Disturbance: Barely sleeping, only a few hours per night.

Appetite: Decreased, possible weight loss.

Family Role: Married, possible stress in relationship due to behavioral changes.

Occupational Identity: Educator, may feel heightened vulnerability due to school shooting context.

4. Clinical Presentation (Anxiety/PTSD Features)
Reported Symptoms:

Hypervigilance, preoccupation with news.

Insomnia, reduced sleep.

Decreased appetite.

Irritability, restlessness.

Possible intrusive thoughts about safety.

Behavioral Indicators:

Compulsive news watching.

Avoidance of normal routines.

Heightened fear response.

Risk Factors:

Indirect trauma exposure.

Occupational connection to schools.

Lack of prior psychiatric treatment (no coping strategies).

5. Mental Status Examination (MSE)
Appearance: Appropriate grooming, normal weight.

Behavior: Anxious, restless.

Speech: Normal rate/volume, may be pressured when discussing trauma.

Mood: Reports anxiety, fear.

Affect: Constricted, tense.

Thought Process: Logical, coherent.

Thought Content: Preoccupation with safety, news events.

Cognition: Alert, oriented ×3.

Insight/Judgment: Fair, recognizes stress but unable to disengage from triggers.

6. Differential Diagnosis
Acute Stress Disorder (ASD): Symptoms within 1 month of trauma exposure.

Post‑Traumatic Stress Disorder (PTSD): Trauma exposure with intrusive symptoms, avoidance, hyperarousal lasting >1 month.

Generalized Anxiety Disorder (GAD): Excessive worry ≥6 months, multiple domains.

Obsessive‑Compulsive Disorder (OCD): Compulsive news watching could mimic compulsive behavior, but lacks obsessions/rituals.

Depression: Decreased appetite, insomnia, irritability.

7. Diagnostic Considerations (DSM‑5)
ASD Criteria: Exposure to trauma, symptoms lasting 3 days–1 month.

PTSD Criteria:

Exposure to trauma (direct or indirect).

Intrusive symptoms (memories, nightmares).

Avoidance of reminders.

Negative alterations in mood/cognition.

Hyperarousal (sleep disturbance, irritability, hypervigilance).

GAD Criteria: Persistent worry ≥6 months, difficult to control.

Isla’s Case:

Symptoms began 3 weeks ago after school shooting.

Fits Acute Stress Disorder currently; risk of progression to PTSD if persistent.

8. Assessment Tools
PCL‑5: PTSD Checklist for DSM‑5.

CAPS‑5: Clinician‑Administered PTSD Scale.

GAD‑7: Screens for generalized anxiety.

HAM‑A: Hamilton Anxiety Rating Scale.

PHQ‑9: Screens for depression.

C‑SSRS: Suicide risk assessment.

9. Treatment Plan
Pharmacological:

SSRIs (sertraline, paroxetine) → first‑line for PTSD/anxiety.

SNRIs (venlafaxine) for anxiety.

Short‑term hypnotics for sleep disturbance (caution).

Avoid benzodiazepines long‑term.

Psychotherapy:

Trauma‑focused CBT.

Prolonged Exposure Therapy.

EMDR (Eye Movement Desensitization and Reprocessing).

Stress management techniques.

Lifestyle Interventions:

Limit media exposure.

Sleep hygiene.

Nutrition counseling.

Relaxation techniques (deep breathing, mindfulness).

Supportive Measures:

Family involvement.

Community support groups.

Coordination with primary care for medical issues.

10. Monitoring and Follow‑Up
Weekly therapy sessions initially.

Medication monitoring every 2–4 weeks.

Suicide risk reassessment.

Collaboration with family and healthcare team.

11. Challenges
Media Exposure: Compulsive news watching reinforces anxiety.

Sleep Disturbance: Chronic insomnia worsens symptoms.

Appetite Loss: Risk of malnutrition.

Stigma: Mental health stigma in middle‑aged women.

Transition Risk: Acute stress may progress to PTSD.

12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy.

Consent: Informed consent for treatment.

Safety: Suicide risk management.

Cultural Sensitivity: Address trauma in context of community violence.

13. Case Summary
Mrs. Isla Flanagan: 47‑year‑old female presenting with acute anxiety symptoms after nearby school shooting.

Likely Diagnosis: Acute Stress Disorder, risk of progression to PTSD.

Treatment: Combination of psychotherapy, possible SSRI, lifestyle interventions, family support.

Outcome Goal: Symptom reduction, improved functioning, resilience building, prevention of PTSD.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Isla’s age? a) 45 b) 47 c) 49 d) 51

Where does Isla live? a) Charleston, SC b) Buffalo, NY c) Memphis, TN d) Orlando, FL

What event triggered Isla’s symptoms? a) Divorce b) School shooting nearby c) Job loss d) Illness

How long ago did the event occur? a) 1 week b) 3 weeks c) 2 months d) 6 months

Which diagnosis involves symptoms within 1 month of trauma? a) Acute Stress Disorder b) PTSD c) GAD d) OCD

Which diagnosis requires symptoms lasting >1 month after trauma? a) PTSD b) ASD c) GAD d) Depression

Which tool screens for PTSD symptoms? a) PCL‑5 b) GAD‑7 c) PHQ‑9 d) HAM‑A

Which medication is FDA‑approved for PTSD? a) Sertraline b) Lithium c) Haloperidol d) Buspirone

Which therapy is trauma‑focused? a) CBT b) EMDR c) Prolonged Exposure d) All of the above

Which lifestyle intervention is appropriate? a) Sleep hygiene b) Smoking cessation c) Alcohol detox d) Dialysis

Which symptom indicates hyperarousal? a) Insomnia b) Decreased appetite c) Compulsive news watching d) Sadness

Which family history is reported? a) None b) Mother with anxiety