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7453 Neurology > S56 - Post Traumatic Stress Disorder > Flashcards

S56 - Post Traumatic Stress Disorder Flashcards

1
Q

FDA approved for acute treatment of PTSD?

A

sertraline (Zoloft)

paroxetine (Paxil)

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2
Q

_______ is FDA approved for long-term treatment.

Other antidepressants can be used.

A

sertraline (Zoloft)

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3
Q

____________ are ineffective in PTSD

A

Benzodiazepines

  • clobazam (Onfi®)
  • clonazepam (Klonopin®)
  • clorazepate (Tranxene®)
  • diazepam (Valium®)
  • lorazepam (Ativan®)
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4
Q

Pentathol used to be used to treat PTSD which was known as

A

Combat fatigue

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5
Q

PTSD expanded to include women when?

A

Vietnam

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6
Q

Wounded warrior is approximately __% effetive at helping decrease symptoms

A

95%

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7
Q

SSRI’s approved for the treatment of PTSD

A

sertraline (Zoloft)
paroxetine (Paxil)
fluoxetine (Prozac)

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8
Q

_________ ________ useful in some patients, ↓ nightmares and sleep disturbance and other core PTSD symptoms.

A

Prazosin (alpha1-adrenergic antagonist)

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9
Q

Slow response. Start SSRI’s after 3-4 weeks at low doses with 8-12 weeks needed to assess response.

A

Increase sertraline 50 mg/wk. or paroxetine 10 mg/wk.

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10
Q

Aytpical Antipsychotics in the treatment of PTSD for the following symptoms indications: hallucinations, delusions, and violent thoughts, feelings or behaviors.

Symptoms that may be helpful: explosiveness, intrusive thoughts, aggression, flashbacks.

A

Quetiapine (Seroquel): low doses 50-150 mg/d.; up to 300 mg/d.
Olanzapine (Zyprexxa): 5 – 20 mg/d.
Risperidone (Risperidol): 0.5 – 8.0 mg/d; controversial use…
Aripiprazole (Abilify): 5 – 20 mg/d

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11
Q

First line treatment for PTSD

A 
SSRI's
- sertraline (Zoloft)
- paroxetine (Paxil)
- fluoxetine (Prozac)
SNRI's
- Venlafexine
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12
Q

OCD: ↓ obsessive thoughts and in the time to perform compulsive acts.
FDA approved five drugs:

A
  • clomipramine (Anafranil)
  • fluvoxamine
  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • fluoxetine (Prozac)

Adolescents and adults: CBT for mild; drugs + CBT for moderate-severe OCD

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13
Q

SSRI’s are the first-line agents for OCD.

SSRI’s > clomipramine (CMI) due to anticholinergic, weight gain, cardiovascular, and sedative are major AE’s.

A

If one SSRI’s is ineffective, then another SSRI should be attempted.

Treatment resistance is defined as failure to ↓ 25% from baseline YBOCS scores.

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14
Q

Pregnancy – CBT alone first.

A

Symptoms can increase exp. first trimester (drug dc’d),

↓ 2nd trimester and increase again in 3rd trimester.

If drugs are used, fluoxetine appears to be the safest.

Avoid clomipramine.

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15
Q

First line treatment for OCD

A

CBT alone
SSRI’s alone
CBT + SSRI

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16
Q

Clomipramine – effects 5-HT. Second-Line Tx

Metabolized to desmethylclomipramine (more NE).

A

Pts. > 40 yrs, get baseline ECG.

Fever or sore throat, get WBC with diff. immediately, possible agranulocytosis.

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17
Q

PTSD agents

A
  • sertraline (Zoloft)

- paroxetine (Paxil)

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18
Q

OCD Agents

A
  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • fluoxetine (Prozac)
  • fluvoxemine
  • escitalopram (Lexapro)
  • Clomipramine (Anafranil)
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19
Q

Trichotillomania (TCM)

A

Irresistible urge to pull out hair – obsession.
Ritual compulsion to pull the hair out.
Females > males; overall incidence 0.6%.
Comorbidity with OCD – 13%.

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20
Q

What two SSRI agents are FDA approved to treat PTSD?

A

Sertraline and Paroxetine

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21
Q

What dose-dependent adverse side effect is associated with clomipramine?

22
Q

Which agent would you recommend for a child age 10 yrs for OCD treatment – fluvoxamine or clomipramine?

A

Fluvoxamine – safety > efficacy

23
Q

Benzodiazepines are ineffective in PTSD.

24
Q

Pentathol was used to treat combat fatigue (PTSD) during World war II

25
Q

Vietnam War was when PTSD was first identified in women.

26
Q

APA / VA – 2017 Guidelines Available (combonation medication with psychotherapies). NO controversy any more! Previowusly this was a major contraversy.

27
Q

SSRI’s ↓ numbing PTSD symptoms whereas other agents do not.

28
Q

Venlafaxine effective for avoidance/numbness and hyperarousal.

29
Q

Paroxetine (Paxil), Fluoxetine (Prozac) and Sertraline (Zoloft) are approved SSRI’s for the treatment of PTSD

30
Q 
Atypical antipsychotics - 
 quetiapine (Seroquel)
olanzapine (Zyprexa)
risperidone (Resperidal)
aripiprazole (Abilify)
augmentation to SSRI’s.
31
Q

Prazosin (alpha1-adrenergic antagonist) useful in some patients, ↓ nightmares and sleep disturbance and other core PTSD symptoms.

32
Q

Slow response. Start SSRI’s after 3-4 weeks at low doses with 8-12 weeks needed to assess response.

33
Q

For PTSD

Remission is defined as > 70% reduction of symptoms.
Adequate response > 50% .
Partial responders 25-50%.

34
Q 
Diagnosis of PTSD:
First Line SSRI's
- sertraline (Zoloft)
- paroxetine (Paxil)
- fluoxetine (Prozac)
4-6 weeks at max dose
35
Q 
Diagnosis of PTSD:
First Line SSRI's
- sertraline (Zoloft)
- paroxetine (Paxil)
- fluoxetine (Prozac)
4-6 weeks at max dose

NO RESPONSE

A

Switch to new SSRI or Venlafexine

36
Q 
Diagnosis of PTSD:
First Line SSRI's
- sertraline (Zoloft)
- paroxetine (Paxil)
- fluoxetine (Prozac)
4-6 weeks at max dose

Partial RESPONSE

A

Augment based on symptoms

37
Q 
Diagnosis of PTSD:
First Line SSRI's
- sertraline (Zoloft)
- paroxetine (Paxil)
- fluoxetine (Prozac)
4-6 weeks at max dose

Partial RESPONSE
Residual Symptoms - Sleep disturbance, nightmares

38
Q 
Diagnosis of PTSD:
First Line SSRI's
- sertraline (Zoloft)
- paroxetine (Paxil)
- fluoxetine (Prozac)
4-6 weeks at max dose

Partial RESPONSE
Residual Symptoms - Anger

A

Lamotrigine

39
Q 
Diagnosis of PTSD:
First Line SSRI's
- sertraline (Zoloft)
- paroxetine (Paxil)
- fluoxetine (Prozac)
4-6 weeks at max dose

Partial RESPONSE
Residual Symptoms - Intrusive Thoughts

A

Resperidone

Quetiapine

40
Q 
Diagnosis of PTSD:
First Line SSRI's
- sertraline (Zoloft)
- paroxetine (Paxil)
- fluoxetine (Prozac)
4-6 weeks at max dose

Partial RESPONSE
Residual Symptoms - Intrusive Thoughts

A

Resperidone

Quetiapine

41
Q

Is remains unknown how long a patient with PTSD should be treated with a SSRI or venlafaxine to achieve maximal response. It can up 12 weeks before response can be observed.

42
Q

General Approach for OCD:

A

YBOCS rating scale used by clinicians.

43
Q

OCD FDA approved five drugs: clomipramine, fluvoxamine, fluoxetine, paroxetine, and sertraline.

44
Q

For OCD in adolescents and adults: CBT for mild; drugs + CBT for moderate-severe.

45
Q

SSRI’s are the first-line agents for OCD.

  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • fluoxetine (Prozac)
A
  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • fluoxetine (Prozac)
46
Q

Pregnancy – CBT alone first.
Symptoms can increase exp. first trimester (drug dc’d), ↓ 2nd trimester and increase again in 3rd trimester.
If drugs are used, FLUOXETINE appears to be the safest.
Avoid clomipramine.

47
Q

OCD- CBT when used alone as first line treatment use for 13 - 20 sessions

48
Q

OCD- SSRI when used alone as first line treatment use for 8-12 weeks, but at least 4-6 weeks at max dose

49
Q

Trichotillomania (TCM) more common in women than men

A

True
Female 93%
> 18 yrs and female 80%

50
Q

Most common age for Trichotillomania (TCM) onset is between 6-12 years old.

A

True

< 6 yrs 6%
6-12 yrs 52%
13-17 yrs 24%
> 18 yrs 17%

7453 Neurology (18 decks)

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