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  #1  
Old 06-03-2012
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Psyche Treatment of Post-Traumatic Stress Disorder (PTSD)

A 34-year-old man is evaluated at the urging of his wife because of a 3-month history of nightmares, increased irritability, outbursts of anger, and social isolation. He recently returned from reserve duty in Iraq. The nightmares are especially frequent and troubling around the time of his monthly weekend reserve duty, and he has started to drink heavily at these times to try to block out the dreams. The patient has lost interest in his usual activities, does not play with his children, spends much time alone, wonít watch the news on television, and is very uncomfortable in crowded places, such as restaurants. He has avoided repeated efforts by his wife to talk about his experiences in Iraq. Findings on physical examination are unremarkable. Which of the following is the most effective treatment for this patient?

A Prescribe fluoxetine
B Prescribe zolpidem and alcohol counseling
C Provide brief counseling for the patient and his wife
D Refer for cognitive-behavioral therapy
E Refer for psychodynamic therapy
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Old 06-03-2012
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A...........???
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Old 06-04-2012
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D Refer for cognitive-behavioral therapy

Not sure though
Can also be A but i think CBT is superior to pharmacotherapy.
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Old 06-04-2012
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-option A=the best phrmacotherapy
-optionB=if theres alcohol or sbstance abuse with the ptsd rx first,but zolpidem is CI with alcohol and any other sleep aid drug.
-C=not approprait here
-D=best non pharmacotherby in adult
-E=good option for childern &adolecence
*theris say ;if the depretion present focus on ptsd,if alcohol or substance abuse are present then focus on them?!!!!!!!!!!!!!here the pt depresed &alcholic. idon'tknow but i wish if theres anathore option in QWITH COMPINATION OF A&D.
-ANY WAY MY ANS IS=A.
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Old 06-04-2012
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started to drink heavily at these times to try to block out the dreams. so drinking is a consequent of ptsd. >>> treat ptsd and pt will be fine .>>> will go with A
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This patientís presentation is consistent with a diagnosis of posttraumatic stress disorder (PTSD). The combination of cognitive-behavioral therapy (CBT) with exposure therapy is the evidence-based treatment of choice for PTSD and is associated with higher response rates and lower drop-out rates than those achieved with pharmacotherapy. An expert panel convened by the Institute of Medicine concluded that CBT with exposure therapy is the only treatment for which there is sufficient evidence to recommend it for PTSD.

Unlike other anxiety disorders, PTSD is preceded by a clear precipitating trauma, such as war, an accident, or experiencing or witnessing a violent assault. To meet criteria for PTSD, the trauma must be followed by at least 1 month of disabling symptoms in three different categories: re-experiencing the event, avoiding reminders of the trauma, and heightened arousal.

Although selective serotonin reuptake inhibitors such as fluoxetine are better than other pharmacologic agents for treating PTSD, they have a lower response rate and less durable effect than CBT with exposure therapy. Administration of zolpidem and a decrease in alcohol intake may possibly help with this patientís sleep difficulties. However, the sleep disturbance is primarily secondary to nightmares, which is only one of the manifestations of PTSD displayed by this patient, and this approach does not address the underlying problem. There is no compelling evidence to support brief counseling or psychodynamic therapy as being effective for treating PTSD.
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Old 06-05-2012
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i have done q from uworld regarding PTSD + KLN psychiatry videos--> both mention pharmacotherapy as ans when both CBT and SSRI is the option.
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Quote:
Originally Posted by tyagee View Post
i have done q from uworld regarding PTSD + KLN psychiatry videos--> both mention pharmacotherapy as ans when both CBT and SSRI is the option.
The guidelines unanimously recommend cognitive behavioral therapies as the most effective treatment for PTSD

Quote:
Posttraumatic Stress Disorder (PTSD) has biological, psychological, and social components. Medications can be used in treatment to address the biological basis for PTSD symptoms and co-morbid Axis I diagnoses. Medications may benefit psychological and social symptoms as well. While studies suggest that cognitive behavioral therapies such as prolonged exposure (PE) and cognitive processing therapy (CPT) have greater effects in improving PTSD symptoms than medications, some people may prefer medications or may benefit from receiving a medication in addition to psychotherapy.
Quote:
Behavioral and Cognitive Behavioral therapy (CBT) seeks to change the way a trauma victim feels and acts by changing the patterns of thinking or behavior, or both, responsible for negative emotions. CBT have been proven to be an effective treatment for PTSD and is currently considered the standard of care for PTSD by the United States Department of Defense

PTSD-American Psychiatric Association
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Thanks
But I stick to ssri. I have done smilar q. :-(
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Old 12-20-2012
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Default CBT

novobiocin is right..i just checked in DSM iv criteria


Cognitive behavioral therapy (CBT) seeks to change the way a trauma victim feels and acts by changing the patterns of thinking or behavior, or both, responsible for negative emotions. CBT has been proven to be an effective treatment for PTSD and is currently considered the standard of care for PTSD by the United States Department of Defense[113] In CBT, individuals learn to identify thoughts that make them feel afraid or upset and replace them with less distressing thoughts.
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