PTSD

PTSD

- anxiety associated w/ trauma

- exposure to trauma & intensity of the response incr risk of PTSD

- course of illness fluctuates, worsening w/ life stressors

PTSD Symptoms

- persistent re-experiencing of the traumatic event

- avoidance of stimuli associated w/ the trauma

- numbing of general responsiveness

- persistent symptoms of hyperarousal

PTSD: DSM-5 Criteria

- at least 1 intrusion sx

- at least 1 sx of avoidance of stimuli associated w/ trauma

- at least 2 sx of negative alterations in cognition & mood

- at least 2 sx of incr arousal

>> sx of each must be present for > 1 month & cause significant distress

PTSD Goals of Tx

- short-term: reduction in sx, improvements in disability, concurrent psychiatric conditions, resilience & QoL

- long-term: remission

PTSD Non-pharm Tx

- trauma-focused CBT

- exposure therapy

- stress management

- group therapy

- eye movement desensitization & reprocessing

PTSD 1st Line Tx

- SSRIs: fluoxetine, paroxetine, sertraline; effective at tx all PTSD sx clusters

- SNRIs: venlafaxine XR; effective in reducing avoidance/numbing & hyperarousal

PTSD 2nd Line Tx

- TCAs: amitriptyline, imipramine; effective for sx but high incidence for SEs

- mirtazapine; sx improvement

- augmentation: prazosin, risperidone, quetiapine, lamotrigine

PTSD Tx Algorithm

- diagnosis --> SSRI for 8-12 wks

- no response = switch SSRI or cenlafaxine

- response = continue for at least 1 year

- partial response = augment

PTSD Phases of Tx

- acute phase

- continuation phase

- maintenance / discontinuation

PTSD Key Points

- triad of sx due to traumatic event: hyperarousal & avoidance of neg alterations in thinking & mood

- SSRIs are 1st line

- prazosin = for nightmares