Exam 3: Treatment Approaches

Question 1

Stepped care treatment for PTSD

Answer 1

1) SSRIs, SNRIs, prazosin (nightmares)
2) Switch SSRIs or SNRIs
3) Mirtazepine, Nefazodone, TCAs
4) Switch alternative options, or TC/Phenelzine (MAOI)

Question 2

Tapering plan when stopping benzodiazepines

Answer 2

10-25% reduction every 1-2 weeks

Slow down rate once 50% of original dose achieved

Question 3

Steps for Anxiety maintenance therapy

Answer 3

1) SSRI/SNRI or pregabalin for GAD
2) switch SSRI/SNRI, buspirone, pregabalin, or combination therapy or CBT if partial response
3) switch to second-line agent or augment

Question 4

Stratified care for migraine treatment

Answer 4

Grade I (0-5): NSAIDs, analgesics, triptans (if infrequent but severe)

Grade II (6-10): combination NSAIDS and analgesics, antiemetics, triptans, prophylactic

Grade III/IV (11+): triptans, ergots, opioids, prophylactic, consultation