Lecture 16 | pharmacotherapy of PTSD & OCD | Bartos

t/f

it is no uncommon for PTSD to be reactivated years after it has apparently resolved

true, this is a CHRONIC condition

what is the gold standard treatment for PTSD?

trauma-focused psychotherapy (exposure based)

what are the 3 phases of PTSD treatment?

phase I: stablize the patient and address acute symptoms

phase II: work through the trauma w/ exposure therapy

phase III: re-establish social relationships and occupational function

what is the first line therapy in PTSD?

SSRIs

what are the approved SSRIs for PTSD?

sertraline and paroxetine

according to Bartos what is an adequate trail for SSRIs in PTSD

6-8 weeks

how long should PTSD treatment continue?

a minimum of 12 months at a full dosage

what are the adjunct therapy for PTSD?

Prazosin (minipress)

MDMA (emerging)

MOA of prazosin

alpha-1 adrenergic antagonist

in nightmares: blunts NE activity in CNS, may increase REM and overall sleep time

what is the dosing for prazosin

start 1 mg QHS, titrate 1 mg every 2-3 days, then 2-5 mg per week, with a max at 16 mg QHS

what are ADRs of prazosin?

dizziness, drowsiness, headache, orthostatic hypotension, syncope

what are the drug interactions with prazosin?

additive hypotensive effects when combined w/ other antihypertensive medications

what are the most common comorbidities in PTSD?

depression - 80%

alcohol or substance use disorder - 50%

attempted suicide - 20%

How is MDMA helpful in PTSD?

a serotonergic drug that increases the release of monoamines and also promotes oxytocin

Neurobiology of OCD

abnormalities of serotonin transmission

CSTC loop dysfunction - cortico-striato-thalamo-cortical

• hyperactivity in orbitofrontal cortex

• dysfunction in caudate nucleus

• thalamic hyperactivity

t/f

CBT monotherapy is as effective as pharmacotherapy monotherapy

true

benefits of CBT last longer than pharmacotherapy

what is the best type of therapy for OCD?

exposure and response prevention

what is the duration of ERP therapy in OCD?

13-20 weekly session

3 weeks of daily sessions

What is first-line treatment for OCD?

SSRIs

what are the approved SSRIs in OCD?

paroxetine, sertraline, fluvoxamine, fluoxetine, clomipramine (not first line)

MOA of clomipramine

TCA with potent serotonin reuptake inhibition

t/f

meta-analyses found clomipramine was equally as effective as SSRIs, and maybe somewhat more effective, but is significantly less tolerated

true

what are the OCD treatment goals?

1. decrease symptom frequency and severity

2. improve functioning

3. improve quality of life