Interrater Reliability
Case Study #25-96
Behavioral Health Condition
Clinical History – Presenting Status
A 50-year-old female presented to the emergency department (ED) with a 4-week
history of flashbacks, nightmares, and severe anxiety about her past experiences
during the World Trade Center (WTC) terrorist attacks.
Past Medical History
Diagnosed with posttraumatic stress disorder (PTSD) after the WTC terrorist
attacks. At time of attacks, she worked as a consultant in the south tower on the
42nd floor. She was attending a meeting on the 20th floor when the north tower
was hit by the first plane. Stated she could feel the building shake. Stated the
towers were made to move in the wind, so at times you could feel them sway a
little, but this felt like a jolt. She became very afraid and knew almost intuitively
she should leave immediately. Made her way out of the building and could see
dark smoke emerging from the WTC. People were crying, yelling, and asking
questions. She witnessed people jumping out of the buildings. Described it as
total hysteria. Made it to the ferry and was being transported across the Hudson
when the north tower fell. Stated several of her friends/coworkers died that day.
She underwent several years of therapy after attacks; things had improved, but
over the last year, her life has become quite stressful. She worked from home for
the last year and a half and has had little social interaction with people because
of the COVID-19 pandemic. Her mother, with whom she was close and spoke with
several times a day, died from COVID-19 6 weeks ago. Patient stated she cannot
sleep, and if she falls asleep, she has reoccurring nightmares about the day’s
events during the WTC attack. She sees people she cares about jumping out of
towers’ windows. She has guilt that she should have done something to save
people in her life who died including friends, coworkers, and mother. Indicated
she has no energy to help comfort father and siblings during their grieving
process. Stated she only showers and dresses once a week. No appetite, but she
does eat once a day. Has only left her condo twice since mother died. Feels
anxious and frightened to do anything and is missing work deadlines because she
cannot focus on projects. Has had suicidal ideation but no definite plan, as she
“couldn’t do that” to her family since her mother had just passed.
PTSD had been well controlled until now; she had not taken any medications for it
until mother died. Two weeks after she died, patient saw primary care provider
(PCP), who started her on a selective serotonin reuptake inhibitor (SSRI) when she
began to have nightmares, and severe guilt over people dying in WTC attacks
and her mother’s death. She was now thinking she might be better off dead.
“What was the purpose of life?” Brother then insisted she come to ED as her
downward spiral became very apparent.
Current Medications / Allergies
SSRI. NKDA.
© 2021 MCG. All Rights Reserved. Confidential, Do not Informed care strategies that move our patients
Distribute. toward health
Case studies are solely for learning/training purposes. Actual answers and guideline application may be influenced by
organizational workflow processes or medical management policies.
, Interrater Reliability
Case Study #25-96
Behavioral Health Condition
© 2021 MCG. All Rights Reserved. Confidential, Do not Informed care strategies that move our patients
Distribute. toward health
Case studies are solely for learning/training purposes. Actual answers and guideline application may be influenced by
organizational workflow processes or medical management policies.
Case Study #25-96
Behavioral Health Condition
Clinical History – Presenting Status
A 50-year-old female presented to the emergency department (ED) with a 4-week
history of flashbacks, nightmares, and severe anxiety about her past experiences
during the World Trade Center (WTC) terrorist attacks.
Past Medical History
Diagnosed with posttraumatic stress disorder (PTSD) after the WTC terrorist
attacks. At time of attacks, she worked as a consultant in the south tower on the
42nd floor. She was attending a meeting on the 20th floor when the north tower
was hit by the first plane. Stated she could feel the building shake. Stated the
towers were made to move in the wind, so at times you could feel them sway a
little, but this felt like a jolt. She became very afraid and knew almost intuitively
she should leave immediately. Made her way out of the building and could see
dark smoke emerging from the WTC. People were crying, yelling, and asking
questions. She witnessed people jumping out of the buildings. Described it as
total hysteria. Made it to the ferry and was being transported across the Hudson
when the north tower fell. Stated several of her friends/coworkers died that day.
She underwent several years of therapy after attacks; things had improved, but
over the last year, her life has become quite stressful. She worked from home for
the last year and a half and has had little social interaction with people because
of the COVID-19 pandemic. Her mother, with whom she was close and spoke with
several times a day, died from COVID-19 6 weeks ago. Patient stated she cannot
sleep, and if she falls asleep, she has reoccurring nightmares about the day’s
events during the WTC attack. She sees people she cares about jumping out of
towers’ windows. She has guilt that she should have done something to save
people in her life who died including friends, coworkers, and mother. Indicated
she has no energy to help comfort father and siblings during their grieving
process. Stated she only showers and dresses once a week. No appetite, but she
does eat once a day. Has only left her condo twice since mother died. Feels
anxious and frightened to do anything and is missing work deadlines because she
cannot focus on projects. Has had suicidal ideation but no definite plan, as she
“couldn’t do that” to her family since her mother had just passed.
PTSD had been well controlled until now; she had not taken any medications for it
until mother died. Two weeks after she died, patient saw primary care provider
(PCP), who started her on a selective serotonin reuptake inhibitor (SSRI) when she
began to have nightmares, and severe guilt over people dying in WTC attacks
and her mother’s death. She was now thinking she might be better off dead.
“What was the purpose of life?” Brother then insisted she come to ED as her
downward spiral became very apparent.
Current Medications / Allergies
SSRI. NKDA.
© 2021 MCG. All Rights Reserved. Confidential, Do not Informed care strategies that move our patients
Distribute. toward health
Case studies are solely for learning/training purposes. Actual answers and guideline application may be influenced by
organizational workflow processes or medical management policies.
, Interrater Reliability
Case Study #25-96
Behavioral Health Condition
© 2021 MCG. All Rights Reserved. Confidential, Do not Informed care strategies that move our patients
Distribute. toward health
Case studies are solely for learning/training purposes. Actual answers and guideline application may be influenced by
organizational workflow processes or medical management policies.
