555 ptsd

Define PTSD.

A psychiatric condition triggered by exposure to actual or threatened death, serious injury, or sexual violence.

Identify common types of trauma leading to PTSD.

Military combat, sexual assault, interpersonal violence, accidents, disaster, abuse, medical illness.

State the prevalence of PTSD in U.S. adults.

Approximately 6-9%.

State the prevalence of PTSD in veterans.

Approximately 30%.

List common co-occurring conditions with PTSD.

Depression, anxiety, substance use disorders, sleep disturbance, chronic pain, suicidality.

Identify major risk factors for PTSD.

Psych history, family history, substance use, female sex, younger age, low SES, previous trauma.

Identify peri-trauma risk factors.

Severity, perceived threat to life, dissociation, role in event.

Identify post-trauma risk factors.

Lack of support, isolation, new stressors, maladaptive coping, no access to mental health care.

Define re-experiencing symptoms.

Intrusive memories, nightmares, flashbacks, distress/reactivity to cues.

Define avoidance symptoms.

Avoiding trauma-related thoughts, feelings, people, places, reminders.

Define negative cognition/mood symptoms.

Negative beliefs, self-blame, inability to recall aspects of trauma, diminished interest, detachment, inability to feel positive emotions.

Define hyperarousal symptoms.

Hypervigilance, irritability, sleep disturbance, startle response, reckless behavior, difficulty concentrating.

State DSM-5 Criterion A for PTSD.

Exposure to a traumatic event via direct experience, witnessing, learning of trauma to close contact, or repeated exposure (first responders).

State DSM-5 Criterion B requirements.

≥1 intrusive symptom.

State DSM-5 Criterion C requirements.

≥1 avoidance symptom.

State DSM-5 Criterion D requirements.

≥2 negative mood/cognition symptoms.

State DSM-5 Criterion E requirements.

≥2 arousal/reactivity symptoms.

State duration required for PTSD diagnosis.

1 month of symptoms.

Identify screening tools for PTSD.

PC-PTSD-5 (primary care), PCL-5 (symptom severity).

Explain what a high PCL-5 score indicates.

Greater PTSD symptom severity and functional impairment.

List hallmark symptoms of PTSD.

Intrusive memories, nightmares, hyperarousal, avoidance, negative mood changes.

Describe typical emotional reactions to trauma.

Fear, anger, guilt, shame, numbness, detachment.

Describe physiological trauma reactions.

Autonomic arousal, increased startle, sleep disruption, vigilance.

Identify first-line non-pharmacologic therapy for PTSD.

Trauma-focused psychotherapy.

List core evidence-based psychotherapies.

Prolonged exposure (PE), cognitive processing therapy (CPT), EMDR.

Describe prolonged exposure therapy.

Repeated, detailed recounting of trauma to reduce fear response.

Describe cognitive processing therapy.

Addresses negative beliefs ("stuck points") and emotional processing.

Describe EMDR.

Uses bilateral stimulation while recalling trauma to reduce emotional intensity.

Identify expected treatment goals in PTSD.

Reduce symptoms, improve functioning, regain sense of safety and control.

Identify symptom domains most improved by medications.

Sleep, hyperarousal, re-experiencing, mood.

Identify symptom domains least improved by medications.

Avoidance, emotional numbing, behavioral withdrawal.

List first-line pharmacologic therapies for PTSD.

SSRIs (sertraline, paroxetine, fluoxetine), SNRIs (venlafaxine).

Explain SSRI benefits in PTSD.

Reduce re-experiencing, avoidance, mood symptoms, anxiety, hyperarousal.

Identify key SSRI side effects.

GI upset, insomnia or sedation, sexual dysfunction, withdrawal risk, activation.

Identify paroxetine cautions.

Avoid in elderly (anticholinergic effects), avoid in pregnancy (cardiac malformations).

Identify fluoxetine characteristics.

Activating, long half-life.

Identify sertraline characteristics.

More GI side effects.

Identify citalopram risks.

QTc prolongation at higher doses.

Identify SNRI used in PTSD.

Venlafaxine.

Identify benefits of venlafaxine.

Useful for depression, anxiety, neuropathic pain; effective for PTSD symptoms.

Identify concerns with venlafaxine.

Hypertension, short half-life, withdrawal symptoms.

Explain the role of prazosin in PTSD.

Reduces nightmares and hyperarousal.

List prazosin major side effects.

Orthostatic hypotension, dizziness, nasal congestion.

Identify initial prazosin dosing strategy.

Start low (1 mg nightly) and titrate based on nightmares.

Identify clonidine benefits in PTSD.

Helps with hyperarousal, sleep initiation, nightmares.

Identify trazodone's role.

Helps sleep initiation/maintenance; used when insomnia is prominent.

Identify hydroxyzine's role.

Helps with sleep initiation and anxiety.

Identify therapies NOT recommended for PTSD.

Benzodiazepines.

Explain why benzodiazepines are avoided.

Interfere with psychotherapy, risk of misuse, worsen avoidance, limited evidence of benefit.

Recognize PTSD features in a patient case.

Combat trauma, nightmares, hyperarousal, avoidance, negative mood, impaired concentration.

Identify treatment goals for patients with PTSD.

Reduce nightmares, improve mood and sleep, improve functioning.

Identify considerations for therapy selection.

Comorbid alcohol use, medication adherence, symptom cluster severity, patient preference.

Describe basic counseling points for PTSD medications.

Start low/titrate gradually, consistency is key, benefits may take weeks, watch for side effects.

Explain expected timeline for SSRI/SNRI improvement.

4-6 weeks for core symptoms; earlier benefit in sleep/anxiety.

Identify monitoring needs during PTSD treatment.

Symptom scales, mood changes, suicidality in younger patients, side effects.

Explain the role of psychotherapy combined with medication.

Combination therapy often yields greatest functional improvement.