A Victim of Tsunami has difficulty in overcoming the experience. She still recollects the happenings in dreams and thoughts. The most likely diagnosis is

Ans. a (Post traumatic stress disorder) (Ref: Ahuja Psychiatry 6th/pg. 263)POST TRAUMATIC STRESS DISORDER# PTSD arises as a delayed or protracted response to an exceptionally stressful or catastrophic life event such as disasters, rape, war or torture or serious accident.# The reaction may occur shortly after the trauma (acute stress disorder) or be delayed and subject to recurrence (PTSD).- Acute Stress Disorder: Anxiety lasts < 1 month (but > 2 days).- Post Traumatic Stress Disorder (PTSD): Anxiety lasts > 1 month.# In both syndromes, individuals experience associated symptoms of detachment and loss of emotional responsivity.# Women more likely to be affected than men.# Symptoms of PTSD may develop after a period of latency, within 6 months after the stress or may be delayed beyond this period.# The patient may feel depersonalized and unable to recall specific aspects of the trauma, though typically it is reexpe- rienced through intrusions in thought, dreams, or flashbacks, particularly when clues of the original event are present.# Patients often actively avoid stimuli that precipitate recollections of the trauma and demonstrate a resulting increase in vigilance, arousal, and startle response.# Risk factors for the development of PTSD include a past psychiatric history and personality characteristics of high neuroticism and extroversion. Twin studies show a substantial influence of genetics on all symptoms associated with PTSD, with less evidence for environment effect.# Etiology and Pathophysiology:- In PTSD there are excessive release of norepinephrine from the locus coeruleus in response to stress and increased noradrenergic activity at projection sites in the hippocampus and amygdala.# Rx:- Acute stress reactions are usually self-limited, and treatment typically involves the short-term use of benzodiazepines and supportive/expressive psychotherapy.# TCAs such as imipramine and amitriptyline, the MAOI phenelzine, and the SSRIs (fluoxetine, sertraline, citalopram, paroxetine) can all reduce anxiety, symptoms of intrusion, and avoidance behaviors, as can prazosin.# Trazodone, a sedating antidepressant, is frequently used at night to help with insomnia (50 to 150 mg qhs).# Carbamazepine, valproic acid, or alprazolam have also independently produced improvement in uncontrolled trials.# Psychotherapeutic strategies that encourage the patient to dismantle avoidance behaviors through stepwise focusing on the experience of the traumatic event are the most effective.