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  • Image not available. The short-term goal in posttraumatic stress disorder (PTSD) is reduction in core symptoms, while the long-term goal is remission.
  • Image not available. Cognitive behavioral therapy and eye movement desensitization and reprocessing are the most effective nonpharmacologic methods to reduce symptoms of PTSD.
  • Image not available. The selective serotonin reuptake inhibitors (SSRIs) and venlafaxine are considered first-line treatments for PTSD.
  • Image not available. An adequate trial of SSRIs in PTSD requires appropriate dosing and duration of treatment.
  • Image not available. Patients with PTSD who respond to pharmacotherapy should continue treatment for at least 12 months.
  • Image not available. SSRIs are the drugs of choice for the treatment of obsessive-compulsive disorder (OCD).
  • Image not available. Augmentation of SSRI treatment with low doses of antipsychotics may be helpful.
  • Image not available. If an inadequate response to an SSRI for OCD occurs after 4 to 6 weeks at the maximum dose, switch to another SSRI.
  • Image not available. Medication taper can be considered after 1 to 2 years of treatment in patients with OCD.

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On completion of the chapter, the reader will be able to:

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  1. Explain the pathophysiology of posttraumatic stress disorder.

  2. Describe the clinical presentation of posttraumatic stress disorder.

  3. Contrast the duration of symptoms required for the diagnosis of posttraumatic stress disorder and acute stress disorder.

  4. Recommend a first-line agent for the pharmacotherapy of posttraumatic stress disorder.

  5. Formulate a plan for the use of alternate drug therapy in patients with posttraumatic stress disorder.

  6. Discuss initial doses and dosing ranges for drugs used for the management of posttraumatic stress disorder.

  7. Recommend nonpharmacologic therapy for treatment of posttraumatic stress disorder.

  8. Discuss the goals of pharmacotherapy for posttraumatic stress disorder.

  9. Discuss the duration of pharmacotherapy of posttraumatic stress disorder.

  10. Develop a monitoring plan for the pharmacotherapy of patients with posttraumatic stress disorder.

  11. Explain the neurotransmitter theories of the pathophysiology of obsessive-compulsive disorder.

  12. Describe the signs and symptoms of obsessive-compulsive disorder.

  13. Recommend nonpharmacologic therapies for treatment of obsessive-compulsive disorder.

  14. Discuss the goals of pharmacotherapy for obsessive-compulsive disorder.

  15. Recommend a first-line agent for the pharmacotherapy of obsessive-compulsive disorder.

  16. Discuss initial doses and dosing ranges of the antidepressant options for treatment of obsessive-compulsive disorder.

  17. Formulate a plan for the use of augmenting drug therapy in patients with obsessive-compulsive disorder and persistent symptoms following first-line pharmacotherapy.

  18. Define an appropriate duration of pharmacotherapy for obsessive-compulsive disorder.

  19. Recommend a pharmacotherapy plan for a child with obsessive-compulsive disorder.

  20. Develop a monitoring plan for the pharmacotherapy of patients with obsessive-compulsive disorder.

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Traumatic world or local events (e.g., wars, terrorist attacks, natural disasters, kidnappings, interpersonal violence) can lead to development of posttraumatic stress disorder (PTSD). Initially diagnosed in veterans of war, PTSD is now acknowledged as a significant psychiatric illness in the civilian population and more recently among deployed service personnel of the Afghanistan and Iraq campaigns in whom the suicide rate has escalated.13 PTSD continues to be poorly recognized and diagnosed in clinical practice.4 Because of its co-occurrence with other anxiety disorders, depression, substance abuse, and traumatic brain injury, the overlapping symptoms can lead to diagnostic uncertainty. Advances in the science and ...

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