PTSD

Question 1

What is considered a traumatic event according to DSM?

Answer 1

• Objective life-threatening/injuring event
• Direct victim, witness or learning of someone close
• Repeated and extreme exposure to aversive details of trauma (first responders)

**No media unless work related

Question 2

Who will develop PTSD after a traumatic event?

Answer 2

Those who have peri traumatic reactions:

• Fear, helplessness or horror
• Alterations in the experience of time, place and persons

Question 3

When does a traumatic reaction become pathological?

Answer 3

3 days - 1 month: Acute stress disorder

1 month or more: PTSD

Question 4

What are the 4 general components of PTSD diagnosis?

Answer 4

1) Persistent reexperiencing and intrusive symptoms
2) Avoidance
3) Alterations in cognition and mood
4) Anxiety or Hyoerarousal

And… 1 month or more duration

Question 5

What is first line pharmacotherapy for PTSD? Which are FDA approved?

Answer 5

Paroxetine (FDA)
Fluoxetine (2 RCT’s)
Sertraline (FDA)
Venlafaxine (2 RCT’s)

Question 6

Are Benzo’s okay in PTSD?

Answer 6

No, they can be detrimental in PTSD due to risk of substance abuse and interference with extinction learning

Question 7

What adjunctive treatments can be used in PTSD?

Answer 7

• Antipsychotics: Risperidone
• Mirtazapine if insomnia and comorbid depression
• Eszopiclone for sleep
• Prazosin if nightmares
• Possibly Propranolol pre-reactivation

Question 8

What types of psychotherapy are strongly recommended?

Answer 8

Cognitive processing therapy, Cognitive therapy, trauma-focused CBT, EMDR, prolonged exposure

Question 9

What are some Novel approaches to PTSD that are being studied?

Answer 9

Ketamine, FAAH, oxytocin, MDMA assisted therapy