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Essentials of Diagnosis
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Exposure to a traumatic or life-threatening event
Flashbacks, intrusive images, and nightmares, often represent reexperiencing the event
Avoidance symptoms, including numbing, social withdrawal, and avoidance of stimuli associated with the event
Increased vigilance, such as startle reactions and difficulty falling asleep
Symptoms impair functioning
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General Considerations
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Posttraumatic stress disorder (PTSD) moved from among the Anxiety Disorders in DSM-IV to new the category Trauma and Stressor-Related Disorder in DSM-5
Characterized by "reexperiencing" a traumatic event (eg, sexual assault, severe burns, military combat) and decreased responsiveness and avoidance of current events associated with the trauma
Symptoms frequently arise after a long latency period—eg, child abuse can result in later-onset PTSD
DSM-5 includes the requirement that the symptoms persist for at least 1 month
In some individuals, the symptoms fade over months or years but in others may persist for a lifetime
Persons with comorbid chronic pain tend to have heightened PTSD symptoms compared to persons without chronic pain
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The estimated lifetime prevalence of PTSD among adult Americans is 6.8% with a point prevalence of 3.6%, with women having rates twice as high as men
Data indicate that 13% of veterans who served in Iraq and 6% of those who served in Afghanistan have experienced PTSD
Studies using cross-sectional surveys have indicated a higher risk for PTSD among frontline workers during the COVID-19 pandemic
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Physiologic hyperarousal
Startle reactions
Intrusive thoughts
Illusions
Overgeneralized associations
Sleep problems
Nightmares
Dreams about the precipitating event
Impulsivity
Difficulties in concentration
Hyperalertness
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Differential Diagnosis
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Selective serotonin reuptake inhibitors (SSRIs)—in full dosage
Helpful in ameliorating depression, panic attacks, sleep disruption, and startle responses in chronic PTSD
Sertraline and paroxetine are FDA approved for this purpose
Early treatment of anxious arousal with β-blockers (eg, propranolol, 80–160 mg daily orally)
May lessen the peripheral symptoms of anxiety (eg, tremors, palpitations)
Has not been shown to help prevent the development of the disorder
Noradrenergic agents, such as clonidine (titrated from 0.1 mg orally at bedtime to 0.2 mg three times a day), have been shown to help with the hyperarousal symptoms of PTSD
Antiseizure medications such as carbamazepine (400–800 mg daily orally) often mitigate impulsivity and difficulty with anger management
Benzodiazepines