PTSD

What is post-traumatic stress disorder (PTSD)?

A trauma-related disorder characterized by intrusive symptoms, avoidance, negative mood/cognition changes, and hyperarousal following exposure to a traumatic event.

What qualifies as a traumatic event for PTSD?

Exposure to actual or threatened death, serious injury, or sexual violence.

What types of trauma exposures qualify for PTSD?

• Direct experience

• Witnessing trauma

• Learning of trauma to close contact

• Repeated exposure to traumatic details

What is the diagnostic duration requirement for PTSD?

Symptoms lasting >1 month*

What is acute stress disorder?

Similar symptoms to PTSD but lasting <1 month

What are intrusive symptoms in PTSD?

• Flashbacks

• Nightmares

• Distressing memories

• Psychological distress at reminders

What are avoidance symptoms in PTSD?

• Avoiding memories

• Avoiding thoughts

• Avoiding people/places associated with trauma

What negative mood/cognition changes occur in PTSD?

• Guilt

• Shame

• Detachment

• Negative beliefs

• Memory impairment

What hyperarousal symptoms occur in PTSD?

• Hypervigilance

• Exaggerated startle

• Irritability

• Sleep disturbance

• Concentration problems

What physical symptoms may occur in PTSD?

• Insomnia

• Somatic pain

• Autonomic hyperactivity

What risk factors are associated with PTSD?

• Prior trauma

• Childhood adversity

• Lack of support

• Female sex

• Pre-existing anxiety or depression

What medical conditions can mimic PTSD?

• Panic disorder

• GAD

• Depression

• Psychotic disorders

• Substance use

What differentiates PTSD from acute stress disorder?

PTSD lasts >1 month

What differentiates PTSD from adjustment disorder?

Adjustment disorder lacks trauma exposure and has milder symptoms.

What differentiates PTSD from borderline personality disorder?

PTSD has trauma-related triggers

What differentiates PTSD from psychotic disorders?

PTSD flashbacks are trauma-linked

What screening tools are used for PTSD?

• PCL-5

• CAPS-5

What medical workup may be needed for PTSD symptoms?

• Thyroid studies

• CBC

• CMP

• Toxicology screen

• Sleep evaluation

What is the first-line treatment for PTSD?

Trauma-focused psychotherapy

What psychotherapies treat PTSD?

• CBT

• Prolonged exposure therapy

• EMDR

• Cognitive processing therapy

What medications treat PTSD?

• SSRIs

• SNRIs

What SSRIs are used for PTSD?

• Sertraline

• Paroxetine

• Fluoxetine

What SNRIs are used for PTSD?

Venlafaxine

What medication treats PTSD-related nightmares?

Prazosin

What medications treat hyperarousal in PTSD?

• SSRIs

• SNRIs

• Clonidine

• Propranolol

What medications treat insomnia in PTSD?

• Trazodone

• Mirtazapine

What lifestyle modifications help PTSD?

• Sleep hygiene

• Exercise

• Avoiding substances

• Relaxation techniques

What complications can occur from untreated PTSD?

• Substance use

• Depression

• Suicide risk

• Social isolation

• Chronic pain

What is the prognosis of treated PTSD?

Good with psychotherapy and medication.

What is the prognosis of untreated PTSD?

Chronic symptoms, impaired functioning, increased comorbidity.

What is the classic symptom triad of PTSD?

• Intrusion

• Avoidance

• Hyperarousal

What symptom cluster strongly suggests PTSD?

• Flashbacks

• Nightmares

• Avoidance of reminders

What behavior cluster strongly suggests severe PTSD?

• Hypervigilance

• Exaggerated startle

• Sleep disturbance