Professional Documents
Culture Documents
Disclosures
Neither presenter has a vested interest in or affiliation with any
corporate organization offering financial support or grant monies
for this continuing education activity, or any affiliation with an
organization whose philosophy could potentially bias their
presentation.
Michael Arnatt, MS
University of Alaska Anchorage
Question 1
Question 2
Stressors
Avoidance
Negative Cognitions and Mood
Arousal and Recovery
a. True
b. False
Question 3
Objectives
SSRIs
Benzodiazepines
Tricyclic Antidepressants
MAO Inhibitors
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DSM-5: Stressor(s)
Hypervigilance
Exaggerated startle response
Problems with concentration
Sleep disturbance (e.g., difficulty falling or
staying asleep or restless sleep)
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11
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Sources of Trauma
Epidemiology
Combat
Sexual Abuse
Accidents
Persistent, direct exposure to tragedy or
gruesome events (i.e. first responders,
psychologists with sexual abuse victimsnot
indirect exposure through media)
The case of pre-combat exposure
Complex trauma
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Psychotherapy
First line EB treatment (e.g., Bryant et al., 2008)
Patients who do not respond to pharmacotherapy
(Otto,Bruce, & Deckersbach, 2005)
Hyperarousal
Baseline
Activating Event
Hypoarousal
(disassociation)
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16
Pharmacotherapy Goals
17
* Symptoms drug therapy most effective at decreasing, less effective for other symptoms
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Pharmacotherapy
Pharmacotherapy
Antidepressants: SSRIs, SNRIs
Alpha-1 antagonists: prazosin
Beta adrenergic antagonists: propranolol
Anticonvulsants/Mood stabilizers
Atypical antipsychotics: risperidone, olanzapine
Overall not supported, some clinical trials with mixed results
Atypical antipsychotics can be used as augmentation
therapy in cases of partial response to SSRI therapy
Benzodiazepines
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20
Pharmacotherapy Algorithm
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22
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Monitoring
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Question 1
Acute Phase
Continuation Phase
Many patients undergoing concurrent psychotherapy during
this phase
6 month relapse prevention
Stressors
Avoidance
Negative Cognitions and Mood
Arousal and Recovery
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28
Question 2
Question 3
a. True
b. False
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SSRIs
Benzodiazepines
Tricyclic Antidepressants
MAO Inhibitors
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1/27/2015
References
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of psychotherapy for Congolese survivors of sexual violence. New England Journal of Medicine, 368, 2182-219.
Bruce, T. J., Spiegel, D. A., & Hegel, M. T. (1999). Cognitivebehavioral therapy helps prevent relapse and recurrence of panic disorder following
alprazolam discontinuation: A long-term follow-up of the Peoria and Dartmouth studies. Journal of Consulting and Clinical Psychology, 67(1),
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Bryant, R.A., Mastrodomenico, J., Felmingham, K.L., Hopwood, S., Kenny, L., Kandris, E., Cahill, C. & Creamer, M. (2008). Treatment of acute
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Norris, F. H., & Slone, L. B. (2013). Understanding Research on the Epidemiology of Trauma and PTSD Special Double Issue of the PTSD Research
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U.S. Department of Veterans Affairs. (2014). A VA Clinicians Guide to Managing Posttraumatic Stress Disorder: Improving quality of life through
the use of evidence-based medicine.
Van der Kolk, B. A. (2006). Clinical implications of neuroscience research in PTSD. Annals of the New York Academy of Sciences, 1071(1), 277293.
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