Post-traumatic Stress Disorder (PTSD)

Overview

Main Concepts:

Notable Features:

High Yield:

Other:

Definition

Clinical features:

  • Exposure to life-threatening trauma

  • Nightmares, flashblacks, intrusive memories

  • Avoidance of reminders, dissociation

  • Emotional detachment, negative mood, decreased interest in activities

  • Sleep disturbance, hypervigilance, exaggerated startle response, irritability

  • Duration >= 1 month

Diagnostics


Assessment


Management

First-line treatment options:

  • Trauma-focused CBT

  • Antidepressants (SSRIs and SNRIs)

    • SSRIs like paroxetine

    • SNRIs

Although anxiety and severe insomnia are common PTSD symptoms, benzodiazepines like lorazepam are not effective in PTSD (especially in patients with comorbid substance use disorder).

If the patient is using stimulants to counter insomnia (such as caffeine), advise the patient to taper use in conjunction with PTSD treatment.

Early treatment of PTSD may prevent the development of chronic functional impairment.

Benzodiazepines can be used to provide rapid relief of panic attacks and can also be used in the short-term while waiting for a SSRI to take effect. Benzos, however, should be prescribed cautiously in patients with a history of substance use disorder.