Post-traumatic stress disorder — KFP-style written assessment

KFP 1 (10 marks)

A 31-year-old teacher attends for repeat antidepressant scripts. Her dispensed history shows sertraline 100 mg continued for two years. On direct questioning she describes an armed robbery at her previous workplace four years ago. She still has monthly nightmares of the event, avoids shopping centres, feels estranged from her partner, and startles at sudden noise. She has never been asked about the robbery before and says she assumed "the tablets were for stress". ^[1][5]

1. List the features from this history that satisfy each DSM-5 symptom cluster of PTSD. (4 marks)
2. Give two reasons her current management is incomplete despite two years of sertraline. (2 marks)
3. Outline your first-line management plan, naming the specific therapy type and its expected benefit. (3 marks)
4. State one screening instrument appropriate to confirm symptom burden and one limitation of it. (1 mark)

Model answers

1. Intrusion: nightmares of the event, startle at reminders. Avoidance: avoiding shopping centres (trauma-associated public spaces). Negative alterations in cognition/mood: estrangement from partner. Hyperarousal: exaggerated startle, sleep disturbance.^[1]
2. First, PTSD was never diagnosed or treated with first-line therapy — SSRIs alone are second-line and her symptoms persist on adequate dose and duration. Second, no trauma-focused psychotherapy has ever been offered despite strong evidence (TF-CBT SMD -1.62 vs usual care; EMDR SMD -1.17; NNT below 4 for diagnosis loss).^[2][3]
3. Refer for trauma-focused CBT or EMDR with a trained therapist (8-12 sessions typical), continue sertraline meanwhile, assess suicidality and substance use, and review at completion. Network meta-analysis ranks EMDR and TF-CBT highest for symptom reduction and remission; head-to-head data show equivalence, so access decides.^[4][5]
4. PCL-5 quantifies symptom severity and tracks change, but validation studies show moderate diagnostic utility — screen and monitor, never diagnose from the score alone.