Class 4 +5 Flashcards
Assessment PTSD
Have you ever experienced or witnessed a serious trauma such as being attacked or assaulted that is still disturbing you in the past month?
About x% of the population experienced a trauma which
could trigger PTSD, but only x% had a lifetime Dx
80%, 8%
DDx PTSD
- Major depressive disorder: More common than PTSD following trauma, Many overlapping symptoms
- Borderline PD
- Dissociative disorders
- Malignerging
Tools PTSD
PTSD checklist, international trauma questionnaire
Psychotherapy for PTSD
- Trauma focused therapies
- CBT
- Prolonged exposure
- Cognitive processing therapy
- TF-CBT
• EMDR
Pharmacotherapy for PTSD
- Usually less beneficial than psychotherapy
- SSRIs 1st line
- Quetiapine XR 300 mg 2nd-line
- Nightmares: Prazosin - Alpha-1 antagonist, reduces autonomic hyperactivity associated with nightmares. Nabilone – CB1 receptor partial agonist
- Benzos not helpful
“Experiemental” treatments for PTSD supported by RCTs
- Pre-Reactivation Propranolol Therapy
- Take propranolol and then read a script of the trauma. Prevents memory reconsolidation
- MDMA assisted psychotherapy
- Supposed to assist processing of trauma by placing patient in optimal state of arousal
Remission
reduction or disappearance of the signs andsymptomsof a disease.
Response to treatment
supposes that the therapeutic targets that have been defined a priori - either symptoms or a syndrome - have been significantly modified bytreatment.
Goals for patients with anxiety and related disorders?
don’t feel anxious all of the time, no impaired functioning or significant distress. Increase quality of life. Stabilize symptoms. Feel more confident attacking in situations where she was previously anxious.
What is the general recommended monitoring frequency for patients with anxiety related disorders, eg how frequent would you plan for follow-up appointments?
Medication should be initiated at low doses and titrated to the recommended dosage range at one- to two-week intervals over four to six weeks. Once the therapeutic range has been achieved, improvement is usually seen over the next four to eight weeks. Follow-up should occur at two-week intervals for the first six weeks and monthly thereafter. For a patient undergoing psychotherapy, the treatment schedule is structured around weekly contact with a therapist for about 12-20 weeks, although shorter protocols and minimal intervention programs have also proven effective. A follow-up appointment four weeks later and then every two to three months is usually sufficient.
Describe situations for which closer monitoring is warranted.
Suicidal/ homicidal
What are typical baseline laboratory and medical investigations for patients who present with anxiety symptoms?
CBC, HDL, GLU, TSH, LIVER FN, NAKCL
What psychological testing is used for patients with anxiety and related disorder?
Clinical global impression, Hamilton anxiety rating scale, GAD-7
What clinical evaluation strategies can be used for monitoring progress of treatment?
Improvement on scales, clinical judgment, level of functioning
Describe common scales and screening tools available for anxiety disorders and OCD.
YBOCS (short or long), SPIN screen (SAD), Panic disorder severity scale, hoarding rating scale, PTSD checklist (PCL), international trauma questionnaire, HAM-D (clinician),
What tool[s] can be used to monitor for psychiatric medication side-effects?
CHEHIL KUTCHER SIDE EFFECTS SCALE (CKS)
What tool[s] can be used to monitor for suicide risk?
Columbia-SuicideSeverity Rating Scale (C-SSRS), Beck Scale for Suicide Ideation, Geriatric Suicide Ideation Scale, interRAI Severity of Self-harm Scale (interRAI SOS), Modified Scale for Suicide Ideation, Reasons for Living Inventory, SAD PERSONS and SAD PERSONAS Scales, Suicidal Behaviors Questionnaire, Suicide Intent Scale, Suicide Probability Scale, grille de suicide action montreal
Phenelzine what labs and why
Don’t give to people with renal problems. Do BUN Creat.
Avoid high protein
Tyramine moins de 6 mg par jour
Hypertensive crisis.
Hypertensice crisis sx
- Severe headache
- Nausea and vomiting
- Sweating and severe anxiety
- Nosebleeds
- Fast heartbeat
- Chest pain
- Changes in vision
- Shortness of breath
- Confusion
PTSD always assess for
suicide + homicide risk
Side effects of SSRIs
long term: sexual dysfunction and weight gain, QT prolongation. Short term: headache, nausea, anxiety, insomnia
Side effects SNRI
same as SSRI, but slightly better side effect profile, less weight gain or sexual dysfunction
side effect Mirtazapine
increased appetite and sedation
side effect Pregabalin
rash, toxic epidermal necrosis, tremors
Response remission rate therapy
within 3 months half of adults respond to therapy
Components of crisis intervention
psychosocial lethality assessment, rapidly establish rapport, identify major problems / crisis precipitants, deal with feelings and emptions, generate and explore alternatives, implement an action plan, follow-up
Prazosin, SSRIs, PTSD need to do labs?
No
Prazosin start at
start at 1 mg and go up to 15 mg
