Problem
A psychiatric consultation was requested for Ron, a 24-year-old male who recently returned from a combat mission in which he lost several members of his unit during an explosion while he was driving. Ron was seen by a family practice provider who diagnosed him with depression and started him on bupropion. Ron reported no improvement and began having nightmares, flashbacks, and intrusive thoughts of combat and the explosion. He also reported a panic attack when he was driving and has begun to avoid driving. His PCP prescribed Ativan for the panic attacks and referred him to psychiatry for further management.
During the initial evaluation, the PMHNP learns that in the past year during deployment, Ron sustained two traumatic brain injuries. It is also discovered that Ron has been having progressively worsening symptoms for the past six weeks. Initially he felt depressed, but he is becoming more irritable and withdrawn.