STRESS

Question 1

What is the DSM-V criterial for Adjustment Disorder

Answer 1

Patients must have
• Emotional or behavioral symptoms within 3 months of having been exposed to a stressor

Symptoms must be clinically significant as shown by ≥ 1 of the following:
• Marked distress that is out of proportion to the stressor (taking cultural and other factors into consideration)
• The symptoms significantly impair social or occupational functioning

Does not meet criteria for another mental disorder
Does not represent bereavement
Once stressor or it’s consequences are terminated, symptoms do NOT persist more than 6 months

Specify:

• w/ depressed mood, anxiety, disturbance of conduct

Question 2

What is the treatment for Adjustment Disorder?

Answer 2

• Counselling
• Usually goes away within 3 months of stressor getting dealt with
• Can do on for years if stressor continue

Question 3

Give 2 screening questions for PTSD

Answer 3

Have you experienced or seen a life-threatening or traumatic event such as a rape, accident, someone badly hurt or killed, assault, natural or man-made disaster, war, or torture?

Do you re-experience the event in disturbing (upsetting) ways such as dreams, intrusive memories, flashbacks, or physical reactions to situations that remind you of the event?

Question 4

Name 2 screening questionnaires specific to PTSD

Answer 4

• Primary Care PTSD DSM-5 (PC-PTSD-5)

* PTSD Checklist of the DSM-5 (PCL-5)

Question 5

DSM-V DIAGNOSIS OF PTSD: TRAUMA

Answer 5

Traumatic event
Re-experience (Intrusion Symptoms)
Avoidance / Numbing 
Unable to function or Significant Distress
Mood / Dissociation / 1 Month durations
Arousal (Hyperarousal)

Applies to > 6 yrs of age

Not due to substance use or any other medical condition

Question 6

What is the difference between acute or chronic PTSD

Answer 6

< 3 months = acute

> 3 months = chronic

Question 7

Define delayed onset PTSD

Answer 7

if onset of symptoms is at least 6 months after the stressor

Question 8

List 5 co-morbidities to screen for with PTSD

Answer 8

• Anxiety Disorder
• Depression
• Substance use disorder, Alcohol dependence
• Borderline personality disorder
• May frequently present with somatic symptoms or pain

Question 9

List 4 non-pharmacologic therapies for PTSD

Answer 9

• Early Debriefing in individuals suffering from psychological symptoms
• CBT
• Eye Movement Desensitizing and Processing (EMDR)
• Stress Management
• Cognitive Processing Therapy (CPT)
• Prolonged Exposure (PE), both imaginal and in vivo
• ICBT and VRE

Question 10

What class of medication is first line pharmacologic therapy for PTSD

Answer 10

SSRI / SNRI

Question 11

Name 4 medications from the first line pharmacologic therapy for PTSD

Answer 11

Paroxetine
Fluoxetine
Sertraline
Venlafaxine

Question 12

List 5 general side effects of SSRIs

Answer 12

Jitteriness
H/A
GI upset
Insomnia
Sexual s/e

Question 13

List 2 specific s/e of SNRI (not included as side effects of SSRIs)

Answer 13

Sweating + Dizziness at higher doses

Question 14

List 5 symptoms of SSRI discontinuation

Answer 14

Flu like symptoms
Insomnia
Nausea
Imbalance
Sensory disturbance
Hyperarousal

Question 15

Name 1 second line anti depressant medication for PTSD and 3 of it’s side effects

Answer 15

Mirtazapine
Somnolence
Dry Mouth
Constipation

Question 16

Name 2 medications that can be used for nightmares in PTSD

Answer 16

Trazodone

Prazosin

Question 17

Name 5 side effects of prazosin

Answer 17

Dizziness
Drowsiness
headache
fatigue
Palpitations
nausea
Weakness

Question 18

List 3 lifestyle interventions for PTSD

Answer 18

Caffeine
Alcohol
Stress