PTSD Flashcards
How is a dx of PTSD differentiated from Acute Stress D/o?
PTSD sx must have been present for >1 month
What is the breakdown of how many sx and types of sx a pt with PTSD must have for dx?
1+ Intrusion Sx
1 or both Avoidance Sx
2+ negative alterations in cognition or mood
2+ alterations in arousal and reactivity
In pts with PTSD, insomnia is either ____ or ____.
primary or middle insomnia
In a pt with PTSD, sx cause a disturbance in _____, not attributable to ____/____
function substance use/medical conditions
What is the only sx of depression that does not overlap w/ PTSD?
↓ appetite
A pt can be dx’d with PTSD w/ dissociative sx if what is present?
depersonalization/derealization persistent/recurrent
A pt can be dx’d with PTSD w/ delayed expression if full criteria not met until after ____(time frame)____ from traumatic event
6 months
In PTSD in children 6 y/o or younger:
- May stem from traumatic events via ______ experiences.
- Intrusive memories may be expressed as _______.
- Content of dreams and nightmares often (cannot/can) be recalled
- Negative alterations in cognitions or mood may manifest as _______ and/or ______.
- ______ behavior and new_______ fears are common.
- New unexplained ______ sx may occur (i.e. _______)
- “________ trauma” may have long-lasting impacts.
- Caregiver
- play re-enactment
- cannot
- social withdrawal; constriction of play
- Regressive; separation
- somatic; tummy ache
- Developmental
Upon PE of a pt with PTSD, a pt may present w/_____ resulting from trauma, general appearance or hygiene may be affected
injuries
Pts with PTSD may have ______ complaints/medical conditions indicative of dysregulated stress responses, such as what 5 complaints?
somatic
HTN, CVD, HA, PUD, IBS
T/F There are no validated dx lab tests or neuroimaging for PTSD
T
_______ atrophy may correlate w/ intensity of sx, and the _____ axis is likely abnormal in patients with PTSD
Hippocampal
H-P-A
As part of the Mental Status Exam for a pt with PTSD, you should observe the patient’s ____, ____, and _____.
hygiene, resting activity level, startle response
What additional things should you assess a pt with PTSD for on the mental status exam? (FYI)
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)
What should you always ask a pt with PTSD about?
Always ask about suicidal/homicidal ideation/behavior
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 ____.
impulsive
HTN, CHF, PVD, and MI
One study of pts with PTSD found ↑ rates of _____ in older male veterans
dementia
In regards to substance abuse in pts with PTSD, pts will use alcohol (more/less), with ____, ____, and ____.
↑ use
craving, dependence, legal problems
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.
co-occurring pain syndromes
Opioids are highly effective in improving sx
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.
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
Prognosis of PTSD is highly (variable/predictable), individual cases are (straightforward/difficult) to determine
variable, difficult
Some individuals w/ PTSD gradually recover (with/without) tx
without
T/F: Many pts receiving tx for PTSD can recover near completely
T
What are some factors that are indicative of a good prognosis in a pt with PTSD? (x7+)
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
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.
therapy and medication
ongoing trauma
Substance abuse
“Psychological First Aid” protocols are in place for _____ and ___ ____ to prevent PTSD.
military
1st responders
What are some examples of Evidenced-based individual therapies used for pts with PTSD? (x2 main, x6 others)
Trauma-Focused CBT
Eye Mvmt Desensitization/Reprocessing
Others: CBT, Group, Family, Psychodynamic, Art, Hypnosis
As an approach to treating PTSD, the initial focus should be on what three things?
The pt should also be assessed for _____/_____ risk, and ____.
safety, sleep, potential substance abuse
suicide/homicide risk
ADLs
In the tx of a pt with PTSD, one should target sleep w/ ____ ____ and/or ____.
sleep hygiene and/or meds
A provider should screen a pt with PTSD for substance abuse with a _____ and _____.
hx and urine toxicology
T/F: May not start tx for PTSD prior to a comprehensive dx eval
F, you can!
What are 3 examples of social interventions to be taken in the tx of a pt with PTSD?
3 Psych interventions?
Social interventions: stop trauma, safe housing, legal protections
Psych interventions: stress management, coping skills, social supports
Medications are useful for treating ____, ____, and ____ in pts with pTSD.
insomnia, panic, severe anger
What referrals are recommended for pts with PTSD? (x2)
Referrals for psychotherapy and psychiatric eval
Pts with PTSD are (less/more) likely to use health care system, but (less/more) likely to seek mental health care
more
less
PCPs more likely than MH providers to encounter untx PTSD
Pts w/ untreated PTSD are (unlikely/likely) to be aware of their condition
unlikely
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
CV, GI, MSK
unexplained fatigue, dizziness, HA, N, pain
depression, anger, anxiety, insomnia, substance abuse
mental health
Pts with PTSD typically require (short term/long term) medication management
long term
What are some examples of classes of medications that can be used in the tx of PTSD?
Antidepressants, Alpha Receptor Modulators, Alpha 2 Recptor Agonists, Beta Blockers, BZDs, Buspirone, Anticonvulsants, Antipsychotics
What are some examples of Antidepressants that can be used to tx PTSD? What is the MOA?
SSRIs: enhance limbic system fxn, ↓ stress rxns
Sertraline (Zoloft) +Paroxetine (Paxil), Fluoxetine (Prozac)
Shown to ↓ disability and ↑ functioning in adults w/ PTSD
Which Antidepressants are the only ones approved for tx of PTSD by the FDA?
Sertraline (Zoloft) +Paroxetine (Paxil) only FDA approved agents for PTSD
Which antidepressant has efficacy for PTSD in children AND adults?
Fluoxetine (Prozac), only one!
According to the VA, Clinical Guidelines: _____ may ↓PTSD sx
SNRI Venlafaxine (Effexor) may ↓PTSD sx
_____ and _____ are potent adjunctive sleep aides in pts with PTSD
Mirtazapine (Remeron) and Trazodone (Desyrel): potent adjunctive sleep aides
What is an example of an Alpha receptor modulator that can be used in the tx of PTSD?
Alpha-1 Receptor Antagonist: Prazosin (Minipress)
What is Prazosin (Minipress) most efficacious for regarding the tx of pts with PTSD?
Efficacy for hyperarousal and sleep-associated PTSD sx
May ↓ nightmares/restore normal sleep architecture
Efficacy for daytime hyperarousal w/ AM dosing
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?
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
What medications are going to counter the effect of adrenaline in a pt with PTSD?
Beta Blockers, i.e. Propranolol
Propranolol may ↓ physiologic hyperarousal when given w/in ___ hrs of a traumatic event, possibly impeding PTSD development
6 hours
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
immediate
very addictive
should not
BZDs provide short term relief of ____, ____, and _____.
They enhance _____ activity at _____ receptors, which ↓ anxiety.
irritability, sleep disturbances, and hyperarousal
GABA
GABA-A
T/F: Buspirone is non-addictive, generally effective for anxiety
T
_____ are otherwise known as mood stabilizers in the tx of PTSD
Anticonvulsants
Anticonvulsants are used to target ______ and ______ in pts with PTSD
emotional lability
impulsivity
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?
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
There is scant evidence for the use of _____ in the tx of PTSD, but ______ ↓ re-experiencing sx in x1 study
Antipsychotics
Olanzapine
