ĭiagnostic and Statistical Manual of Mental Disorders. Does this patient have posttraumatic stress disorder?: Rational clinical examination systematic review. Spoont MR, Williams JW, Kehle-Forbes S, et al. Psychiatric comorbidities, particularly mood disorders and substance use, are common in PTSD and are best treated concurrently. Clinicians should consider testing patients with PTSD for obstructive sleep apnea because many patients with PTSD-related sleep disturbance have this condition. Prazosin is effective for the treatment of PTSD-related sleep disturbance. Patients with PTSD often have sleep disturbance related to hyperarousal or nightmares. The addition of other pharmacotherapy, such as atypical antipsychotics or topiramate, may be helpful for residual symptoms. Selective serotonin reuptake inhibitors (i.e., fluoxetine, paroxetine, and sertraline) and the serotonin-norepinephrine reuptake inhibitor venlafaxine effectively treat primary PTSD symptoms. Pharmacotherapy is useful for patients who have residual symptoms after psychotherapy or are unable or unwilling to access psychotherapy. First-line treatment of PTSD involves psychotherapy, such as trauma-focused cognitive behavior therapy. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision provides diagnostic criteria, and the PTSD Checklist for DSM-5 uses these diagnostic criteria to help physicians diagnose PTSD and determine severity. Assessing for past trauma in patients with anxiety or other psychiatric illnesses may aid in diagnosing and treating PTSD. Symptoms typically involve trauma-related intrusive thoughts, avoidant behaviors, negative alterations of cognition or mood, and changes in arousal and reactivity. PTSD may develop at least one month after a traumatic event involving the threat of death or harm to physical integrity, although earlier symptoms may represent an acute stress disorder. Specify if: Chronic: if duration of symptoms is 3 months or more.Posttraumatic stress disorder (PTSD) is common, with a lifetime prevalence of approximately 6%. Specify if: Acute: if duration of symptoms is less than 3 months. The disturbance causes clinically significant distress or impairment in relationships with parents, sibling, peers, or other caregivers or with school behavior. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.į. Duration of the disturbance is more than 1 month.į. Duration of the disturbance (symptoms in criteria B, C, and D) is more than 1 month.Į. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects (including extreme temper tantrums). Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep). Alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidence by two (or more) of the following: 5. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two or more of the following:ĭ. Persistent reduction in expression of positive emotions.ĭ. Markedly diminished interest or participation in significant activities, including constriction play 5. Substantially increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion). 2.Īvoidance of or efforts to avoid people, conversations, or interpersonal situations that arouse recollections of the traumatic event(s).Negative alterations in cognitions 3. One or more of the following symptoms, representing either persistent avoidance of stimuli associated with the traumatic event(s), or negative alterations in cognitions and mood associated with the traumatic event, must be present, beginning after the traumatic event(s) or worsening after the event.Īvoidance of or efforts to avoid places or physical reminders that arouse recollections of the traumatic event(s). Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).Ĭ.
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