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Collège royal > DSM PTSD + Canadian Clinical Practice Guidelines for Treatment of PTSD > Flashcards

DSM PTSD + Canadian Clinical Practice Guidelines for Treatment of PTSD Flashcards

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1
Q

there are two sets of criteria for PTSD–what is the age cut off for these two sets of criteria?

A

age 6

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2
Q

criterion A for PTSD

A

exposure to ACTUAL or THREATENED death, serious injury or sexual violence in ONE (or more) of the following ways:

  1. directly WITNESSING a traumatic event
  2. witnessing the event, in person, as it occurred TO OTHERS
  3. LEARNING that the traumatic event(s) occurred to CLOSE family member or close friend–> in cases of actual or threatened death of a family member or friend, the events must have been VIOLENT or ACCIDENTAL
  4. experiencing REPEATED or EXTREME exposure to aversive details of the traumatic event(s) (i.e first responders collecting human remains, police officers repeatedly exposed to details of child abuse) –> does NOT apply to exposure through electronic media (i.e TV, movies, pictures) unless exposure is work related
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3
Q

criterion B for PTSD

A

presence of ONE (or more) of the following INTRUSION symptoms associated with the traumatic event(s), beginning after the event(s) occurred:

  1. recurrent, involuntary and intrusive distressing MEMORIES of the event(s) (in kids, may be repetitive play in which themes or aspects of the events are expressed)
  2. recurrent distressing DREAMS in which the content and/or affect of the dreams are related to the event(s) (in kids, may be frightening dreams without recognizable content)
  3. dissociative reactions (i.e FLASHBACKS) in which the individual feels or acts as if the traumatic events were recurring (may occur on a continuum with most extreme expression being complete loss of awareness of present surroundings)
  4. intense or prolonged PSYCHOLOGICAL DISTRESS at EXPOSURE to internal or external cues that symbolize or resemble an aspect of the traumatic event
  5. marked PHYSIOLOGICAL REACTIONS to internal or external cues that symbolize or resemble aspects of the traumatic event
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4
Q

criterion C for PTSD

A

persistent AVOIDANCE of stimuli associated with the traumatic events beginning after the traumatic events occurred as evidenced by ONE or both of:

  1. avoidance of or efforts to avoid distressing MEMORIES, thoughts or feelings about or closely associated with the traumatic events
  2. avoidance of or efforts to avoid EXTERNAL REMINDERS (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts or feelings about or closely associated with the traumatic events
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5
Q

criterion D for PTSD

A

negative alterations in COGNITIONS or MOOD associated with the traumatic event, beginning or worsening after the event as evidenced by TWO or more of the following:

  1. INABILITY TO REMEMBER an important aspect of the traumatic event (typically due to dissociative amnesia and not to other factors like head injury, alcohol, drugs)
  2. persistent and exagerrated NEGATIVE BELIEFS or EXPECTATIONS about oneself or others or the world (i.e “i am bad,” “no one can be trusted,” “the world is completely dangerous,” “my whole nervous system is permanently ruined.”)
  3. persistent DISTORTED COGNITIONS about the cause or consequences of the traumatic events that lead the individual to BLAME him/herself or others
  4. persistent NEGATIVE EMOTIONAL STATE (i.e fear, horror, anger, guilt or shame)
  5. markedly diminished INTEREST or participation in significant activities
  6. feelings of DETACHMENT or estrangement from others
  7. persistent INABILITY to experience positive emotions (i.e inability to experience happiness, satisfaction or loving feelings)
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6
Q

criterion E for PTSD

A

marked alterations in AROUSAL and REACTIVITY associated with the traumatic events, beginning or worsening after the event and evidence by TWO or more of the following ways:

  1. IRRITABLE behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression towards people or objects
  2. RECKLESS and self destructive behaviour
  3. HYPERVIGILANCE
  4. exaggerated STARTLE response
  5. problems with CONCENTRATION
  6. SLEEP disturbance
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7
Q

criterion F for PTSD

A

duration of disturbance is MORE THAN 1 MONTH

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8
Q

criterion G PTSD

A

clinically significant distress/impairment

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9
Q

criterion H PTSD

A

not attributable to substance, medical condition

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10
Q

what specifiers are available for diagnosing PTSD

A
  1. with dissociative symptoms (either depersonalization or derealization)
  2. with delayed expression
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11
Q

what is PTSD with “delayed expression”

A

if full diagnostic criteria are not met until at least 6 months after event (although some symptoms may be immediate)

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12
Q

what is PTSD “with dissociative symptoms”

A

meet criteria for PTSD and in addition, in response to the stressor, person experiences persistent or recurrent symptoms of depersonalization or derealization

*must not be attributable to physiological effects of substance or another medical condition (i.e complex partial seizures)

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13
Q

define depersonalization

A

persistent or recurrent experiences of feeling detached from, as it one were an outside observer of, one’s mental processes or body (i.e feeling as though one were in a dream, feeling a sense of unreality of self or body or of time moving slowly)

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14
Q

define derealization

A

persistent or recurrent experiences of unreality of surroundings (i.e world around the individual is experienced as unreal, dreamlike, distant or distorted)

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15
Q

what is a mnemonic for remembering PTSD criteria?

A

TIA-C2R2D

Trauma event

Intrusion symptoms (at least one)

Avoidance symptoms (at least one)

Cognition or mood symptoms (at least 2)

arousal or Reactivity symptoms (at least 2)

duration (1 month)

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16
Q

how many ways are there in the DSM that someone could have been exposed to trauma such that criterion A is satisfied for PTSD

A

4

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17
Q

how many possible intrusion symptoms are there for criterion B for PTSD

A

5

(memories, dreams, dissociative reactions, psychological distress at exposure to cues, physiological response in response to cues)

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18
Q

how many possible avoidance symptoms are there for criterion C for PTSD

A

2

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19
Q

how many cognition/mood symptoms are possible for criterion D for PTSD

A

7

(difficulty remembering, negative beliefs/expectations, distorted cognitions about cause/consequence, negative emotional state, diminished interest/participation, detachment/estrangement, little positive emotion)

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20
Q

how many symptoms are possible for “arousal and reactivity” in criterion E for PTSD

A

6

(irritable/angry outbursts, reckless, hypervigilance, startle response, concentration, sleep)

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21
Q

how do the criteria for PTSD differ if child affected is under age 6

A

combine persistent avoidance of stimuli and negative alterations in cognition into one criteria–> and only need ONE of these

also the negative alterations in cognition are different:
1. substantially increased frequency of negative emotional states
2. markedly diminished interest or participation in significant activities
3. socially withdrawn behaviour
4. persistent reduction in expression of positive emotions

also “alterations in arousal and reactivity” do not include “recklessness/self destructive behaviour” as an option

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22
Q

what medical incidents qualify as “traumatic events” in the DSM

A

a life threatening illness or debilitating medical condition is NOT necessarily considered a traumatic event

events that qualify include SUDDEN, CATASTROPHIC events (i.e waking in surgery, anaphylactic shock)

witnessing medical catastrophe (i.e hemorrhage) in one’s child or loved one would count however

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23
Q

does learning about death due to natural causes of a close family or friend count as a traumatic event per the DSM

A

no

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24
Q

what types of traumas may result in PTSD being especially severe and long lasting

A

when the stressor is interpersonal and intentional

i.e torture, sexual violence

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25
Q

how long might dissociative states last in PTSD (i.e flashbacks)

A

from a few seconds to several hours or even days

during which, components of the event are relived and individual behaves as if event were occurring at that moment

occur on a continuum–> from brief visual or sensory intrusions to loss of awareness of present surrounding

can be associated with prolonged distress or heightened arousal

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26
Q

how might PTSD affect children’s development

A

developmental REGRESSION may occur–> i.e loss of language in young children

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27
Q

what perceptual abnormalities may accompany PTSD symptoms

A

auditory pseudo-hallucinations–> sensory experience of hearing one’s thoughts spoken in one or more different voices

–> paranoid ideation may also be present

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28
Q

what is the projected lifetime risk for PTSD in the USA

A

8.7%

12 month prevalence in US adults = 3.5%

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29
Q

how do estimates of PTSD 12 month prevalence compare between USA and other parts of the world (europe, asia)

A

lower estimates of prevalence seen in Europe and most Asian, African and LA countries (around 0.5-1%)–compared to 3.5% in USA

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30
Q

amongst which populations are the highest rates of PTSD seen? what are the rates of PTSD amongst these populations?

A

survivors of rape

military combat and captivity

ethnically or politically motivated internment and genocide

*rates of PTSD of 1/3 to more than HALF of affected persons in these populations

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31
Q

how might presentation of PTSD differ in later life?

A

more likely to be sub-threshold rather than full PTSD symptoms but still assoc with substantial clinical impairment

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32
Q

which ethnic populations in the USA have comparatively lower rates of PTSD (when adjusted for traumatic exposure and demographic variables)? higher rates?

A

lower rates reported among Asian Americans

higher rates reported amongst US latinos, african americans, american indians

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33
Q

when can PTSD occur in the lifespan

A

anytime after the age of 1

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34
Q

when do symptoms of PTSD usually begin

A

usually within first 3 months of trauma

but can be a delay of months or even years before criteria are met

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35
Q

what is the natural course of PTSD (i.e, do people recover spontaneously, and if so, how quickly)

A

complete recovery within 3 months occurs in about HALF of adults

some people remain symptomatic for more than 12 months and sometimes for more than 50 years

initially, people often meet criteria for acute stress disorder immediately following trauma then progress to PTSD

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36
Q

list factors that may exacerbate PTSD in later life

A

worsening cognitive function

social isolation

declining health

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37
Q

in older adults, PTSD is associated with what three expressions?

A

negative health preceptions

primary care utilization

suicidal ideation

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38
Q

what is one way of understanding risk factors for PTSD

A

dividing them into pre-peri-and post-traumatic risk factors

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39
Q

list “pre-traumatic” risk factors for PTSD (10)

A
  1. childhood emotional problems by age 6 years (i.e prior traumatic exposure, or prior mental disorders)
  2. lower SES
  3. lower education
  4. exposure to prior trauma (esp. during childhood)
  5. childhood adversity (i.e family dysfunction, economic deprivation)
  6. cultural characteristics (i.e fatalistic or self blaming coping strategies)
  7. lower intelligence
  8. minority cultural/ethnic status
  9. family psych hx
  10. female gender
  11. younger age at time of trauma exposure (for adults)
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40
Q

what is a protective factor pre-trauma

A

social support prior to the traumatic event

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41
Q

list some “peri-traumatic” risk factors for PTSD (6)

A
  1. severity (dose) of the trauma (i.e greater magnitude of trauma the likelier is PTSD)
  2. perceived life threat
  3. personal injury
  4. interpersonal violence (esp. if violence by a caregiver or involving witnessed threat to caregiver in children)
  5. for military–> being a perpetrator, witness atrocities, killing the enemy
  6. dissociation that occurs during the trauma and persists afterward
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42
Q

list some “post-traumatic” risk factors for PTSD (6)

A
  1. negative appraisals
  2. inappropriate coping strategies
  3. development of acute stress disorder
  4. subsequent exposure to repeated upsetting reminders
  5. subsequent adverse life events
  6. financial or other trauma related losses

**social support is protective that moderates outcome after trauma

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43
Q

name a factor that moderates outcome after experiencing trauma

A

social support (including family stability in children)

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44
Q

how and why might the onset and severity of PTSD differ across cultural groups

A

onset and severity of PTSD may differ across cultural groups

may be due to:
1. variation in type of traumatic exposure (i.e genocide)
2. impact on disorder severity of meaning attributed to traumatic event (i.e inability to perform funeral rights after mass killing)
3. ongoing sociocultural context (i.e residing among unpunished perpetrrators in post conflict settings)
4. other cultural factors (i.e acculturative stress in immigrants)

*also the relative risk for various exposures i.e religious persecution may vary across cultural groups
*clinical expression of symptoms/symptom clusters may vary culturally, especially with regard to avoidance and numbing symptoms, distressing dreams, somatic symptoms

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45
Q

which gender appears to be more likely to develop PTSD

A

female (experiences more frequently and for longer duration than do males)

*at least some of this seems related to females having greater risk of traumatic events like rape and other interpersonal violence–> within populations exposed specifically to such stressors, gender difference inPTSD is attenuated or nonsignificant

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46
Q

how does PTSD/traumatic events impact suicide risk

A

traumatic events increase persons suicide risk

PTSD is associated with SI and SAs

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47
Q

ddx PTSD

A
  1. adjustment disorder
  2. other posttraumatic disorders and conditions
  3. acute stress disorder
  4. anxiety disorders
  5. OCD
  6. MDD
  7. personality disorders
  8. dissociative disorders
  9. conversion disorder
  10. psychotic disorders
  11. TBI
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48
Q

how do you differential acute stress disorder from PTSD

A

time–> acute stress disorder is sx for 3 days to one month after the traumatic event (PTSD is after one month)

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49
Q

how do you differentiate adjustment disorder from PTSD

A

either person has symptoms of PTSD but the stressor does not meet criterion A for PTSD (i.e not threatened bodily harm etc… maybe spouse left etc) OR has experienced stressor meeting criterion A for PTSD but does not meet full other symptoms for PTSD

50
Q

does having PTSD increase likelihood of having another cooccurring mental illness

A

yes–> those with PTSD 80% more likely to have comorbidity

51
Q

what comorbidities are most common amongst males (compared to females) with PTSD

A

SUDs and conduct disorder

52
Q

what % of those military personnel returning from Iraq/Afghanistan have both PTSD and mild TBI

A

almost half

53
Q

list some commonly comorbid conditions with PTSD

A

SUDs (more likely in males)

conduct disorder (more likely in males)

TBI

ODD, separation anxiety (in kids)

major neurocognitive disoder

54
Q

what is the estimate lifetime prevalence of PTSD in canada

A

9.2%

55
Q

what % of Canadians reported exposure to a significantly traumatic event

A

over 76%

56
Q

according to the canadian guidelines, list the 5 most common forms of trauma resulting in PTSD

A

unexpected death of someone close

sexual assault

serious illness or injury to someone close

having a child with a serious illness

being beaten by a partner or caregiver

57
Q

PTSD is associated with high rates of what other types of somatic problems?

A

chronic pain

sleep problems

sexual dysfunction

cognitive dysfunction

alexithymia

58
Q

by how much is the risk of suicide attempts increased due to the presence of PTSD

A

2-3x

59
Q

list 7 frequently comorbid conditions with PTSD

A

anxiety and related d/os

ADHD

ODD

MDD

SUD

alcohol dependence

borderline PD

60
Q

with regard to PTSD prevention, is it beneficial for individuals who have been exposed to a traumatic event to engage in single or multiple session psychological debriefing after the event (if they have no been identified as suffering from any specific psychological difficulties)?

A

no–> may actually have an adverse effect on some people

this is from a meta analysis–> for individual debriefings only, no data for group debriefings

61
Q

is there evidence for efficacy for multisession trauma-focused CBT (TF-CBT)?

A

YES for those with acute stress disorder or PTSD

*thus debriefing of all trauma victims is not recommended but rather, screening and treating appropriate people is preferred

*TF-CBT was more effective for prevention of chronic PTSD in thsoe with acute stress disorder or PTSD than wait list and supportive counselling options

62
Q

is there evidence for the effectiveness of structured writing vs minimal intervention in the treatment of PTSD

A

no

63
Q

is there evidence for the early use of benzos after trauma to PREVENT PTSD?

A

no–> may increase risk of developing PTSD

(also gabapentin/pregabalin also had no effect on this)

64
Q

is there a medication that may help prevent PTSD from developing after trauma?

A

?propanolol–> one small RCT showed sign. decrease in severity of PTSD sx and lower likelihood of developing PTSD (but some conflicting data)

SSRIs–> sig. better than placebo for preventing PTSD symptoms according to parent reports but not child reports in RCT in kids

morphine–> cohort studies suggest early use during trauma care may reduce risk of subsequent development of PTSD in kids and adults

65
Q

has psychotherapy demonstrated efficacy in treating PTSD? how does it compare to pharmacotherapy?

A

YES–> psychotherapy has demonstrated “significant” efficacy

meta analysis–> may be LESS effective than pharmacotherapy in improving PTSD symptoms and comorbid depression symptoms

66
Q

list psychological interventions that have evidence for efficacy in the treatment of PTSD

A

individual TF-CBT

EMDR

stress management

group TF-CBT

prolonged exposure therapy

(other nontrauma based interventions did not reduce PTSD symptoms as significantly, i.e psychodynamic therapy).

67
Q

which psychological interventions appear to be most effective in PTSD treatment

A

EMDR and TF-CBT–> EMDR seems to result in faster recovery while TF-CBT is more gradual

68
Q

cognitive therapy approaches have been used effectively to treat PTSD followin which 3 types of trauma

A

sexual or interpersonal violence

civilian trauma

military trauma

69
Q

what is cognitive processing therapy

A

treatment for PTSD

effective protocol

combines cognitive therapy and written accounts

–> data seems tos how no differences in outcomes with either component alone or with the combine protocol

70
Q

is prolonged exposure therapy efficacious in treating PTSD

A

yes, as efficacious as CBT/other interventions

30 min imaginal exposures were as effective as 60 min in vivo exposures

71
Q

is there benefit to adding cognitive restructuring to exposure therapy for PTSD?

A

some studies suggest exposure alone is better than the combo

large RCT showed combo significantly better than exposure alone

cognitive restructuring (when adjunct to exposure therapy) may help improve NON FEAR problems like ANGER AND GUILT (may be best for patients in whom these emotions predominate)

72
Q

why might you add social emotional rehabilitation to exposure therapy in treating PTSD

A

does not seem to improve PTSD sx but did improve social functioning in male combat veterans with chronic PTSD

73
Q

name the two currently identified limitations of CBT for PTSD

A
  1. about 1/3-1/2 patients experience substantial RESIDUAL SYMPTOMS and functional impairments post treatment, still report. meeting dx criteria at follow up, or relapse and require booster sessions
  2. external VALIDITY issues–> CBT for PTSD has been shown efficacious in RCTs but dearth of effectiveness studies that CBT can be generalized to many patients commonly found in clinical practice (i.e many studies exclude people with complex clinical profiles like childhood abuse histories, current SUDs, PDs, SI or NSSI, homelessness, refugees, intimate partner violence, significant dissociative symptoms) –> study found that the more exclusion criteria in a study, the larger effect size for CBT found in the study

(also numerous studies fail to reflect if people had any adverse effects from psychological treatment and whether dropout rates result from treatment demands)

74
Q

is DBT useful in treatment of PTSD

A

when used as PREtreatment, reduced self harm behaviours allowing over 1/2 of patients to become suitable canditates for PTSD treatment

so basically, treated self harm so that PTSD treatment could occur

75
Q

is there a psychological intervention that has been explicitly studied in comorbid PTSD and substance abuse

A

yes–> prolonged exposure

76
Q

CBT seems to be useful for what type of PTSD

A

fear-based

77
Q

what might need to be added to CBT for those with complex PTSD

A

a treatment module targeting affective regulation for patients presenting with c-PTSD

78
Q

is combination psychotherapy + pharmacotherapy better than either alone?

A

conflicting results

recent RCT showed combo therapy was superior to psychotherapy alone

earlier RCTs showed combo was not superior to psychotherapy alone but was superior to pharmacotherapy alone

79
Q

what medication should be considered as adjunctive treatment if engaging in trauma reactivation therapy? why?

A

propanolol

found to help PREVENT RECONSOLIDATION of the traumatic memory and thus decreased physiological responses and PTSD symptoms during subsequent follow up in randomized and open trials

80
Q

is d-cycloserine helpful as adjunctive treatment in PTSD psychotherapy

A

no–> may in fact decrease response to psychotherapy

81
Q

are the benefits of psychotherapy maintained long term

A

yes they appear to be (i.e PE follow up showed benefits at 5-10 years)

82
Q

list the 4 first line medications for treatment of PTSD

A

Fearful People Spurn Vacations

Fluoxetine

Paroxetine

Sertraline

Venlafaxine XR

83
Q

list the 3 second line meds for treatment of PTSD

A

Fluvoxamine

Mirtazapine

Phenelzine

84
Q

list third line medications for treatment of PTSD

A

amitriptyline

aripiprazole

buproprion SR

buspirone

carbamazepine

desipramine

duloxetine

escitalopram

imipramine

lamotrigine

memantine

moclobemide

quetiapine

reboxetine

risperidone

tianeptine

topiramate

trazodone

85
Q

name three medications that are second line as adjunctive therapy for treatment of PTSD

A

eszopiclone

olanzapine

risperidone

86
Q

list 8 medications that can be used third line as adjunctive treatments for treatment of PTSD

A

aripiprazole

clonidine

gabapentin

levetiracetam

pregabalin

quetiapine

reboxetine

tiagabine

87
Q

name 4 medications that are NOT recommended as adjunctive therapy for treatment of PTSD

A

buproprion SR

guanfacine

topiramate

zolpidem

88
Q

name 7 medications that are NOT recommended in the treatment of PTSD

A

alprazolam

citalopram

clonazepam

desipramine

divalproex

olanzapine (only as adjunctive second line)

tiagabine (only as adjunctive third line)

89
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

mirtazapine

A

second line

90
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

risperidone

A

third line mono or second line adjunctive

91
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

fluoxetine

A

first line

92
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

olanzapine

A

NOT as monotherapy

yes as second line adjunctive

93
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

fluvoxamine

A

second line

94
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

venlafaxine XR

A

first line

95
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

eszopiclone

A

second line adjunctive

96
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

alprazolam

A

NOT recommended

97
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

desipramine

A

conflicting in guidelines–> says both third line and NOT recommended

98
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

buspirone

A

third line

99
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

phenelzine

A

second line

100
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

paroxetine

A

first line

101
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

sertraline

A

first line

102
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

escitalopram

A

third line

103
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

buproprion SR

A

third line

NOT recommended as adjunctive

104
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

citalopram

A

NOT recommended

105
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

clonazepam

A

NOT recommended

106
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

risperidone

A

second line adjunctive

107
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

abilify

A

third line adjunctive

108
Q

state whether the following medication is first/second/third line, adjunctive, or not recommended for treatment of PTSD:

divalproex

A

NOT recommended

109
Q

of the four first line agents for the treatment of PTSD, which TWO have the BESTt evidence

A

venlafaxine XR

paroxetine

*fluoxetine has some conflicting reports as does sertraline though they are both still level 1 (conflicting) and first line treatments–> conflicting reports may be related to types of traumas, symptom clusters, comorbidities

110
Q

how does efficacy compare between mirtazapine to sertraline

A

one study showed mirtazapine had significantly higher response rates than sertraline in the treatment of PTSD however this was in a randomized open label trial so mirtazapine is second line

111
Q

what type of drug is phenelzine

A

MAOI

112
Q

atypical antipsychotics may be particularly helpful for which PTSD symptom cluster?

A

intrusion

113
Q

name a medication that demonstrated efficacy for reducing trauma nightmares and improving sleep quality in the treatment of PTSD

A

prazosin

114
Q

name a medication that may specifically help reduce flashbacks associated with PTSD

A

naltrexone

115
Q

name a medication that may specifically improve trauma re-experiencing symptoms in the treatment of PTSD

A

fluphenazine

116
Q

is cyproheptadine helpful in PTSD assoc. nightmares?

A

no–> was not effective and may actually exacerbate sleep disturbance

117
Q

does ongoing SSRI therapy reduce relapse rates in treatment of PTSD

A

yes–> significant reduction in relapse rates compared to placebo over 6 months

118
Q

what neurostimulation treatment may be effective in the treatment of PTSD

A

rTMS–> monotherapy or adjunct to SSRIs in those with PTSD

at least some improvements were maintained at 2-3 months post tx

(also adjunctive ECT may be helpful in patients with REFRACTORY PTSD)

119
Q

is acupuncture effective in the treatment of PTSD

A

RCT data–> acupuncture more effective than wait list + as effective as group CBT

120
Q

is CBT an effective first line option for treatment of PTSD

A

yes–> TF CBT, EMDR, PE, stress management therapy

121
Q

does the evidence support the widespread use of early intervention with psychological strategies for prevention of PTSD

A

no–> debriefing of all trauma victims is not recommended

122
Q

what is the approach to pharmacotherapy in the treatment of PTSD

A

start with one of the 4 first line agents

if response inadequate despite optimal dosing, switch to another first or second line agent, or add a second line agent

augmentation with second and third line agents may be important early in treatment to preserve even small gains achieved

Collège royal (18 decks)

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