PTSD At a Glance

Armin Moradi

2020-07-17

Epidemiology
Comorbidity
Diagnosis
Prevention
Treatment

Epidemiology

20s
9.2%
76%
2-3x

Comorbidity

75%
Anxiety, MDD, ODD, ADHD, EtOH, Borderline
Panic, Mood

Diagnosis

Hello DSM-V
Vs DSM-IV-TR
Treatment data: DSM-IV

Prevention

Psycho

No individual debriefing, ? group
Yes TF-CBT

Pharmaco

Benzos :(
Propranolol :)
SSRI :|

Treatment

Psycho

Education
Exposure
CBT

Psychotherapy in quite effective, and it generally includes both education and exposure to cues relating to the traumatic event
Although it has been shown to be less effective than pharmacotherapy with dealing with comorbid depressive symptoms
Multiple types of CBTs have shown efficacy for treatment of PTSD such as TF-CBT, EMDR, stress management, and group TF-CBT
However, non-trauma focused therapies like supportive therapy, nondirective counseling, psychodynamic and hypnotherapy didn't reduce PTSD symptoms significantly
Eye movement desensitization and reprocessing (EMDR) was equal in effectiveness to TF-PTSD, although EMDR showed faster recovery
Cognitive therapy is also effective when dealing with sexual or interpersonal violence, civilian and military trauma
There is also Cognitive Processing Therapy (CPT), but the written portion didn't help
Prolonged exposure CBT is as effective as other forms of active treatment like CBT, CPT, EMDR
We can also use Cognitive Restructuring as an adjunc to exposure therapy
DBT has also been helpful proior to starting CBT to reduce self-harm behaiour
Internet-based CBT is more effective that placebo and wait-list
Long term, the benefits of psychotherapy are maintained at 6-18 months
longer term EMDR -> 3 years maintenance
very long term -> CPT and PE were maintained over an extended 5 to 10 years

Limitations

Pharmaco - first line

Fluoxetine
Paroxetine*
Sertraline
Venlafaxine*

Pharmaco - second line

mirtazapine

Pharmaco - third line

Antidepressants: imipramie, amitriptyline
Anticonvulsants: topiramate, lamotrigine, carbamazepine
Atypical antipsychotics

Pharmaco - adjunct

failed treatment with adequate antidepressant therapy: treatment-resistant PTSD
2: eszopiclone for sleep, no risperidone
3: quetiapine or aripiprazore

Combined

No dice :(
Small RCTs, combination therapy > pharmaco alone
Propranolol + trauma reactivation therapy

Symptom-specific

Prazocin: nightmare and sleep quality
Naltrexone: flashbacks
Fluphenazine: re-experiencing symptoms

Maintenance

fluoxetine and sertraline: low relapse rate over 6 months
paroxetine and sertraline: continued improvement over 6 to 12 months of continued SSRI therapy

PTSD At a Glance

Armin Moradi

2020-07-17

Table of Contents

Epidemiology

Comorbidity

Diagnosis

Prevention

Psycho

Pharmaco

Treatment

Psycho

Limitations

Pharmaco - first line

Pharmaco - second line

Pharmaco - third line

Pharmaco - adjunct

Combined

Symptom-specific

Maintenance