ChesterCountyMedicineWinter2018 - 28

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Dealing with Post Traumatic Stress
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* do a psychological evaluation, including a discussion of
the patient's signs and symptoms and the event which led
up to them
* use the criteria in the Diagnostic & Statistical Manual
of Mental Disorders (DSM-5) published by the American
Psychiatric Association.
Diagnosis of PTSD requires exposure to an event which involved actual or
possible threat of death, violence or serious injury, which the patient (a) directly
experienced, (b) personally witnessed, (c) learned that someone close to him
was seriously injured or threatened by the event, or (d) that the patient was
repeatedly exposed to graphic details of traumatic events (multiple exposures, or
as a first responder at the scenes of traumatic events).

Medication Treatments for PTSD: These may include: (a)

antidepressants [SSRIs such as sertraline (Zoloft) and paroxetine (Paxil) are
approved by the FDA for PTSD treatment. Fluoxetine (Prozac) and venlafaxine
(Effexor) have also been used] (b) anti-anxiety medications, although some, with
the potential for abuse, are generally used only for short periods of time; (c)
Prazosin (or Minipress) is not FDA approved for PTSD but some feel it may
reduce or suppress nightmares in PTSD patients.
Psychotherapy treatments for PTSD: These trauma-focused approaches
include:
* Cognitive therapy helps recognize cognitive patterns and
negative beliefs holding one back (talk therapy, often used
in combination with exposure therapy)
* Exposure therapy (a behavioral therapy approach, said to
be especially helpful for flashbacks and nightmares,
requiring patients to face up to situations and memories
they find frightening or troubling)
* Eye movement desensitization and reprocessing (EMDR)
combines exposure therapy with guided eye movements
which help process traumatic memories and change how
one deals with them.
* Other types of trauma-focused psychotherapy (for details,
consult https://www.ptsd.va.gov)
- Brief Eclectic Psychotherapy (BEP)
- Narrative exposure therapy (NEP)
- Written narrative exposure
- Specific cognitive behavioral therapies (CBTs) for PTSD
- Other treatment modes as published or re[ported
For non-trauma-focused approaches, the National Center for PTSD provides
mobile applications (apps) for iOS and Android devices, to provide self-help,
education and support following trauma. They also have "treatment companion
apps" for use with a health care provider, to make treatment easier. The DCOE
also lists several complementary integrative medicine methods of care which
can be used as adjunctive or alternative supplements to evidence-based care
treatments.

28 CHESTER COUNT Y Medicine | WINTER 2018
http://www.chestercms.org/index.html https://www.ptsd.va.gov
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