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Behavioral Med III > PTSD > Flashcards

PTSD Flashcards

1
Q

How is a dx of PTSD differentiated from Acute Stress D/o?

A

PTSD sx must have been present for >1 month

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2
Q

What is the breakdown of how many sx and types of sx a pt with PTSD must have for dx?

A

1+ Intrusion Sx

1 or both Avoidance Sx

2+ negative alterations in cognition or mood

2+ alterations in arousal and reactivity

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3
Q

In pts with PTSD, insomnia is either ____ or ____.

A

primary or middle insomnia

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4
Q

In a pt with PTSD, sx cause a disturbance in _____, not attributable to ____/____

A 
function
substance use/medical conditions
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5
Q

What is the only sx of depression that does not overlap w/ PTSD?

A

↓ appetite

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6
Q

A pt can be dx’d with PTSD w/ dissociative sx if what is present?

A

depersonalization/derealization persistent/recurrent

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7
Q

A pt can be dx’d with PTSD w/ delayed expression if full criteria not met until after ____(time frame)____ from traumatic event

A

6 months

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8
Q

In PTSD in children 6 y/o or younger:

  1. May stem from traumatic events via ______ experiences.
  2. Intrusive memories may be expressed as _______.
  3. Content of dreams and nightmares often (cannot/can) be recalled
  4. Negative alterations in cognitions or mood may manifest as _______ and/or ______.
  5. ______ behavior and new_______ fears are common.
  6. New unexplained ______ sx may occur (i.e. _______)
  7. “________ trauma” may have long-lasting impacts.
A
  1. Caregiver
  2. play re-enactment
  3. cannot
  4. social withdrawal; constriction of play
  5. Regressive; separation
  6. somatic; tummy ache
  7. Developmental
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9
Q

Upon PE of a pt with PTSD, a pt may present w/_____ resulting from trauma, general appearance or hygiene may be affected

A

injuries

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10
Q

Pts with PTSD may have ______ complaints/medical conditions indicative of dysregulated stress responses, such as what 5 complaints?

A

somatic

HTN, CVD, HA, PUD, IBS

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11
Q

T/F There are no validated dx lab tests or neuroimaging for PTSD

A

T

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12
Q

_______ atrophy may correlate w/ intensity of sx, and the _____ axis is likely abnormal in patients with PTSD

A

Hippocampal

H-P-A

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13
Q

As part of the Mental Status Exam for a pt with PTSD, you should observe the patient’s ____, ____, and _____.

A

hygiene, resting activity level, startle response

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14
Q

What additional things should you assess a pt with PTSD for on the mental status exam? (FYI)

A

Orientation, short term memory may be affected
Poor concentration, forgetfulness may be evident
Potential alterations in speech rate/volume/flow
Mood and affective changes are common
Assess for perceptual disturbances (flashbacks, hallucinations)

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15
Q

What should you always ask a pt with PTSD about?

A

Always ask about suicidal/homicidal ideation/behavior

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16
Q

Pts with PTSD are at risk for many complications of their dx, including ↑ risks of _____ behavior, anxiety/depression, somatization, and suicide/homicide, in addition to ↑ risks of CVD, such as ____, ____, ____, and ____.

A

impulsive

HTN, CHF, PVD, and MI

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17
Q

One study of pts with PTSD found ↑ rates of _____ in older male veterans

A

dementia

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18
Q

In regards to substance abuse in pts with PTSD, pts will use alcohol (more/less), with ____, ____, and ____.

A

↑ use

craving, dependence, legal problems

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19
Q

In regards to substance abuse in pts with PTSD, pts will use opioids with an ↑ misuse/abuse potential due to _________. Subjectively, pts with PTSD claim that opioids are _______ in improving sx.

A

co-occurring pain syndromes

Opioids are highly effective in improving sx

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20
Q

When treating a pt with PTSD, the provider should consider impacts of the dx on the pt’s family and support system. The pt’s caregivers/family may also experience ____, ____, ____, and ____. If the pt’s condition is chronic, feelings of ____/____ may develop towards the victim.

A

shock, fear, anger, depression
alienation/anger

*Emphasize importance of individual and family therapy
Anger management, couples therapy, Family therapy
Encourage family to maintain other relationships and activities

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21
Q

Prognosis of PTSD is highly (variable/predictable), individual cases are (straightforward/difficult) to determine

A

variable, difficult

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22
Q

Some individuals w/ PTSD gradually recover (with/without) tx

A

without

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23
Q

T/F: Many pts receiving tx for PTSD can recover near completely

A

T

24
Q

What are some factors that are indicative of a good prognosis in a pt with PTSD? (x7+)

A 
Rapid engagement in tx
Early/ongoing social support
Avoid re-traumatization
Strong pre-trauma fxn
No comorbidities
Strategies for Resilience and Thriving
Face fears/problem-solve, exercise, spiritual meaning, social support, find the good, embrace optimism/humor
25
Q 
In the tx of a pt with PTSD, typically both \_\_\_\_ and \_\_\_\_ required, in addition to cessation of \_\_\_\_ \_\_\_\_\_.
\_\_\_\_\_ \_\_\_\_\_\_ (if  present) must be the initial focus of tx.
A

therapy and medication
ongoing trauma
Substance abuse

26
Q

“Psychological First Aid” protocols are in place for _____ and ___ ____ to prevent PTSD.

A

military

1st responders

27
Q

What are some examples of Evidenced-based individual therapies used for pts with PTSD? (x2 main, x6 others)

A

Trauma-Focused CBT
Eye Mvmt Desensitization/Reprocessing
Others: CBT, Group, Family, Psychodynamic, Art, Hypnosis

28
Q

As an approach to treating PTSD, the initial focus should be on what three things?
The pt should also be assessed for _____/_____ risk, and ____.

A

safety, sleep, potential substance abuse
suicide/homicide risk
ADLs

29
Q

In the tx of a pt with PTSD, one should target sleep w/ ____ ____ and/or ____.

A

sleep hygiene and/or meds

30
Q

A provider should screen a pt with PTSD for substance abuse with a _____ and _____.

A

hx and urine toxicology

31
Q

T/F: May not start tx for PTSD prior to a comprehensive dx eval

A

F, you can!

32
Q

What are 3 examples of social interventions to be taken in the tx of a pt with PTSD?
3 Psych interventions?

A

Social interventions: stop trauma, safe housing, legal protections

Psych interventions: stress management, coping skills, social supports

33
Q

Medications are useful for treating ____, ____, and ____ in pts with pTSD.

A

insomnia, panic, severe anger

34
Q

What referrals are recommended for pts with PTSD? (x2)

A

Referrals for psychotherapy and psychiatric eval

35
Q

Pts with PTSD are (less/more) likely to use health care system, but (less/more) likely to seek mental health care

A

more
less

PCPs more likely than MH providers to encounter untx PTSD

36
Q

Pts w/ untreated PTSD are (unlikely/likely) to be aware of their condition

A

unlikely

37
Q

PTSD is often obscured in pts by other physical health conditions, such as ___, ____, and ____. They may present with somatic complaints such as unexplained ____, ___, ____, ____, and ____. Additionally, they may presents with other mental health issues, such as ____, ____, ____, ____, and ____.
When suspected, refer to a ______ provider for eval/tx

A

CV, GI, MSK

unexplained fatigue, dizziness, HA, N, pain

depression, anger, anxiety, insomnia, substance abuse

mental health

38
Q

Pts with PTSD typically require (short term/long term) medication management

A

long term

39
Q

What are some examples of classes of medications that can be used in the tx of PTSD?

A

Antidepressants, Alpha Receptor Modulators, Alpha 2 Recptor Agonists, Beta Blockers, BZDs, Buspirone, Anticonvulsants, Antipsychotics

40
Q

What are some examples of Antidepressants that can be used to tx PTSD? What is the MOA?

A

SSRIs: enhance limbic system fxn, ↓ stress rxns
Sertraline (Zoloft) +Paroxetine (Paxil), Fluoxetine (Prozac)

Shown to ↓ disability and ↑ functioning in adults w/ PTSD

41
Q

Which Antidepressants are the only ones approved for tx of PTSD by the FDA?

A

Sertraline (Zoloft) +Paroxetine (Paxil) only FDA approved agents for PTSD

42
Q

Which antidepressant has efficacy for PTSD in children AND adults?

A

Fluoxetine (Prozac), only one!

43
Q

According to the VA, Clinical Guidelines: _____ may ↓PTSD sx

A

SNRI Venlafaxine (Effexor) may ↓PTSD sx

44
Q

_____ and _____ are potent adjunctive sleep aides in pts with PTSD

A

Mirtazapine (Remeron) and Trazodone (Desyrel): potent adjunctive sleep aides

45
Q

What is an example of an Alpha receptor modulator that can be used in the tx of PTSD?

A

Alpha-1 Receptor Antagonist: Prazosin (Minipress)

46
Q

What is Prazosin (Minipress) most efficacious for regarding the tx of pts with PTSD?

A

Efficacy for hyperarousal and sleep-associated PTSD sx
May ↓ nightmares/restore normal sleep architecture
Efficacy for daytime hyperarousal w/ AM dosing

47
Q

What are some examples of Alpha 2 receptor agonists that can be used in the tx of PTSD? How do they work? Which one is safest? Which one is the least sedating?

A

Stimulate brainstem receptors activates inhibitory neurons peripheral relaxation

Clonidine (safest) commonly used for HTN, drug w/drawal, ADHD
Beneficial for hyperarousal, insomnia, nightmares

Guanfacine: similar effects to Clonidine, tends to be less sedating

48
Q

What medications are going to counter the effect of adrenaline in a pt with PTSD?

A

Beta Blockers, i.e. Propranolol

49
Q

Propranolol may ↓ physiologic hyperarousal when given w/in ___ hrs of a traumatic event, possibly impeding PTSD development

A

6 hours

50
Q

BZDs have (delayed/immediate) potent effects→ and are (not addictive/very addictive), which may worsen long term outcomes. Thus, they (should not/should) be used greater than one month

A

immediate
very addictive
should not

51
Q

BZDs provide short term relief of ____, ____, and _____.

They enhance _____ activity at _____ receptors, which ↓ anxiety.

A

irritability, sleep disturbances, and hyperarousal
GABA
GABA-A

52
Q

T/F: Buspirone is non-addictive, generally effective for anxiety

A

T

53
Q

_____ are otherwise known as mood stabilizers in the tx of PTSD

A

Anticonvulsants

54
Q

Anticonvulsants are used to target ______ and ______ in pts with PTSD

A

emotional lability

impulsivity

55
Q

What are some examples of Anticonvulsants that can be used in the tx of PTSD? What do they do? Which one is ineffective in PTSD and should not be used?

A

Lamotrigine (Lamictal) inhibits glutamate release, some evidence of benefit
Topiramate (Topamax): 2 studies found improvement in PTSD sx
May help ↓ EtOH consumption, consider w/ comorbid EtOH use d/o
Carbamazepine may suppress over-activity in thalamus
Divalproex (Depakote): no benefits for PTSD sx, don’t use

56
Q

There is scant evidence for the use of _____ in the tx of PTSD, but ______ ↓ re-experiencing sx in x1 study

A

Antipsychotics

Olanzapine

Behavioral Med III (11 decks)

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