Post Traumatic Stress Disorder

Question 1

Criterion A for trauma in PTSD

Answer 1

Exposure to actual or threatened death, serious injury or sexual violence in one or more of the following:

• direct experience
• witnessing the event in person
• learning the trauma occurred to a close family member or friend
• repeated exposure to aversive details of a trauma

Question 2

DSM-5 criteria for PTSD

Answer 2

1) criterion A trauma is met

• *Must have the following at least 1 symptom from the following 4 domains:**
  1) negative alterations in mood
• difficulty remembering details of event
• persistent distortions of cognition about the world related to event
• perisistent negative emotional state
• anhedonia
• detachment

2) intrusion symptoms must be present
- nightmares
- flashbacks
- intense psychological distress in response to triggers
- marked physiologic reaction in response triggers

3) hyperarousal
- irritable
- hyper vigilant (especially to associated stimuli)
- sleep disturbances

4) avoidance Of memories or external triggers similar to event
* Duration must be >1 month with significant distress or impaired function. (less an it is acute stress disorder)*

Question 3

DSM-5 acute stress disorder

Answer 3

Essentially PTSD but only lasts 3 days - 1 month

Treatment = no early intervention and monitor or basic therapy
- most cases will resolve spontaneously, if meet PTSD, then treat differently

Question 4

When to ask for PTSD

Answer 4

Any patient with anxiety or depression should be asked about past and current trauma

Also patients with substance use disorders (SUD)
- often trauma is the cause of their substance use

Question 5

How do you ask about trauma?

Answer 5

“Have you ever experience a traumatic event in which you feared for your life or saw a some die/almost die?”

Question 6

Risk factors of PTSD

Answer 6

Presence of childhood trauma

Borderline/paranoid/dependent or antisocial personalities

Being female

Being in the military or being in abusive relationships

Genetics (1st order relatives)

Recent stressful life changes

Recent excessive alcohol intake

Poor social support system

Question 7

PTSD prognosis

Answer 7

With proper treatment, 30% will remit spontaneously

Prognosis is better with good social support, less psychiatric/medical/substance comorbidity

Question 8

Therapies used in PTSD

Answer 8

Always exposure therapy

• cognitive processing therapy
• prolonged exposure therapy
• eye movements desensitization and reprocessing therapy

Question 9

Meds used for PTSD

Answer 9

Only use if symptoms are bad:

• SSRIs/SNRIs (first line)
• Prazosin (night terrors/nightmares only)
• quetiapine (only use with conjunction with SSRIs/SNRIs, never as mono-therapy)
• TCAs (only as last line)

avoid benzos unless you absolutely need to use it

Question 10

DSM-5 adjustment disorder

Answer 10

Development of emotional/behavior symptoms in response to an identifiable stressor.
- occurs within 3 months of the onset of the stressor

Symptoms include one or both of the following:
1) marked distress that is out of proportion to the severity or intensity of the stressor taking into account the external context and cultural factors

2) significant impairment in social or occupational
- there is usually NO anhedonia (helps differentiate from MDD)

does not meat the criteria for acute stress disorder, MDD or PTSD

Symptoms do not represent normal bereavement
- is associated with higher risks of suicide

• *when the stressor ends, the symptoms usually resolve within 3 months, but don’t last past 6 months**
• if it does last > 6 months = GAD

Treatment = CBT
- can consider anxiolytics and antidepressants as adjunct treatment.