Snapshot A 40-year-old man presents to his psychiatrist for a follow-up appointment. He had been in the army for 10 years and had post-traumatic stress disorder (PSTD). He started seeing his psychiatrist 1 month ago and had been treated with cognitive behavioral therapy and sertraline. He reports that while this has helped with his thoughts during the day, he continues to have nightmares almost every night. His psychiatrist adds prazosin. Introduction Overview PSTD is a condition resulting from exposure to real, threatened, or perceived serious injury or sexual assault with symptoms lasting > 1 month often long latency (e.g., childhood abuse may appear as PTSD as an adult) Epidemiology incidence lifetime prevalence of 8% demographics female > male risk factors trauma Pathogenesis mechanism may be due to alterations in amygdala, hippocampus, prefrontal cortex, and hypothalamic pituitary axis Associated conditions other mood disorders Prognosis prognostic variable resilience Presentation Symptoms diagnosis according to DSM-5 requires exposure to actual or threatened death, injury, or assault persistent re-experience of event intrusive thoughts, nightmares or related dreams, recurrent memories, dissociative experiences such as flashbacks, and negative feelings due to triggers avoidance of potential triggers or of talking/thinking about the event negative alterations in cognition and mood inappropriate blaming of oneself or others persistent negative emotions loss of interest detachment from others hyperarousal irritability insomnia difficulty concentrating self-harming acts recklessness symptoms last > 1 month symptoms cause significant distress or dysfunction symptoms are not attributable to anything else such as medications or medical condition Physical exam physiological signs of arousal tremor, sweating, or agitation decreased range of emotions Differential Acute stress disorder key distinguishing factor onset of similar symptoms after traumatic event that lasts 3 days to 1 month treatment is cognitive behavioral therapy (CBT) Treatment Lifestyle cognitive behavioral therapy (CBT) indications all patients Medical beta-blocker indications may prevent PTSD SSRI (selective serotonin reuptake inhibitor) indications first-line drugs sertraline and paroxetine are FDA-approved SNRI (serotonin-norepinephrine reuptake inhibitor) indications first-line along with SSRIs above drugs venlafaxine clonidine and guanfacine indications agitation prazosin indication reduce nightmares and insomnia Complications Mood disorders Panic and other anxiety disorders Substance abuse disorders Headaches
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.PY.17.4682) A 28-year-old male presents with a recent onset of upsetting dreams, anxiety, and disturbing flashbacks. The patient reports that he returned from active duty in Iraq 3 months ago and was adjusting to life back at home until about 7 weeks ago when he began having intense fear of loud noises and seeing sudden flashbacks to bombing attacks he endured during his time in Iraq. He had to take a leave from his army instructor duties as he was not able to handle the familiar settings of practice shooting ranges and sudden loud explosions during battalion training. After refusing to leave his house, he was finally persuaded by his wife to visit your clinic. What is the most likely diagnosis? Tested Concept QID: 107301 Type & Select Correct Answer 1 Acute stress disorder 0% (0/0) 2 Performance anxiety 0% (0/0) 3 Schizophrenia 0% (0/0) 4 Posttraumatic stress disorder 0% (0/0) 5 Panic attack 0% (0/0) M 6 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept
All Videos (1) Login to View Community Videos Login to View Community Videos Acute Stress Disorder Benjamin Jack Psychiatry - Post-Traumatic Stress Disorder (PTSD) D 12/6/2012 82 views 4.5 (2)