PTSD

Post traumatic stress disorder definition

mental health condition that can develop after experiencing or witnessing a traumatic event

PTSD symptoms/clinical presentation

patients often feel stressed or frightened even when they are not in danger; symptoms include intrusive thoughts, nightmares, flashbacks, avoidance behaviors, hypervigilance, sleep disturbances, etc

Examples of trauma that may lead to PTSD (6)

1. sexual violence

2. interpersonal violence

3. military exposure/combat experiences

4. life-threatening events

5. childhood trauma

6. exposure to violence

How many DSM-5 diagnostic criteria are there for diagnosing PTSD?

8

PTSD DSM-5 diagnostic criterion A

Experienced exposure to actual or threatened death, serious injury, or sexual violence.

PTSD DSM-5 diagnostic criterion B

The traumatic event is persistently re-experienced.

PTSD DSM-5 diagnostic criterion C

Persistence avoidance of stimuli associated with the trauma and numbing of general responsiveness.

PTSD DSM-5 diagnostic criterion D

Negative alterations in cognition and mood related to the event.

PTSD DSM-5 diagnostic criterion E

Persistent symptoms of increased arousal and reactivity not present before the trauma.

PTSD DSM-5 diagnostic criterion F

Duration > 1 month

PTSD DSM-5 diagnostic criterion G

Disturbances cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

PTSD DSM-5 diagnostic criterion H

No attributable substance use or other disorder.

Post-Traumatic Stress Disorder (PTSD) symptoms usually occur within the first _____ months after the trauma.

3

PTSD Treatment Goals (3)

1. Decrease symptoms

2. Restore quality of life

3. Return to as close to baseline as possible

First line treatment for PTSD

CBT + SSRI

Which types of CBT are considered "trauma focused?" (3)

1. Prolonged Exposure (PE)

2. Cognitive Processing Therapy

3. Eye movement desensitization and reprocessing (EMDR)

What are the first line SSRIs used for PTSD treatment? (3)

1. paroxetine

2. fluoxetine

3. sertraline

Starting doses for SSRIs are usually _________ (lower/higher) than starting doses for MDD.

lower

Paroxetine starting dose for PTSD is ______ and the target dose is _____.

10 mg; 20-60 mg

Fluoxetine starting dose for PTSD is ______ and the target dose is _____.

10 mg, 30-60 mg

Sertraline starting dose for PTSD is ______ and the target dose is _____.

25 mg; 50-200 mg

If patient fails first line treatment for PTSD, what is the next medication step?

Try another first line agent --> may introduce venlafaxine

When appropriate to try a second line agent in PTSD treatment?

If the failure of of all (or most/multiple) first line agents occurs

What are the second line medication choices for PTSD?

1. amitriptyline

2. imipramine

3. mirtazapine

4. fluvoxamine

Name the three drug classes used for adjunctive/add-on therapy in PTSD.

1. Second generation antipsychotics

2. Anticonvulsants

3. Anti-adrenergic agents

Second generation antipsychotics are helpful in patients with PTSD and ......

comorbid psychiatric disorders or psychotic symptoms

Name the second generation antipsychotic drugs used in PTSD (4)

1. quetiapine

2. olanzapine

3. risperidone

4. aripiprazole

Anticonvulsants are helpful in patients with PTSD and ......

agitation, aggression, mood liability, avoidance or re-experiencing

Name the anticonvulsant drugs used in PTSD (3)

1. lamotrigine

2. valproic acid

3. carbamazepine

Anticonvulsants may increase _________ risk.

suicidality

Antiadrenergic drugs are helpful in patients with PTSD and ......

nightmare or flashbacks

Name the antiadrenergic drugs used in patients with PTSD (2)

1. prazosin

2. clonidine

Patients taking prazosin should be educated on risk for _______ __________.

orthostatic hypotension

When should benzos be used in patients with PTSD

NEVER

Improvements in PTSD symptoms should be seen in how long?

4-6 weeks

What duration is considered an adequate medication trial for patients with PTSD?

12 weeks at an adequate dose

Patients with PTSD who respond to pharmacotherapy should be continued at the full therapeutic dosage for a minimum of __________.

12 months