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Chapter 59: Post-Traumatic Stress Disorder

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LH is a 34-year-old woman who has experienced persistent flashbacks and nightmares after being robbed at gunpoint while leaving a restaurant several months ago. She finds it difficult to talk about the experience, and avoids situations that remind her of the event. She was recently diagnosed with PTSD.

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Which of the following agents should be used as a first-line treatment for PTSD in this patient?

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a. Phenelzine

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b. Paroxetine

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c. Amitriptyline

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d. Bupropion

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Answer b is correct. Paroxetine is a SSRI and is a first-line agent.

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Answer a is incorrect. Phenelzine is a MAOI and reserved for last-line treatment.

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Answer c is incorrect. Amitriptyline is TCA and is a third-line agent.

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Answer d is incorrect. Bupropion is not effective in PTSD.

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LH is a 34-year-old woman who has experienced persistent flashbacks and nightmares after being robbed at gunpoint while leaving a restaurant several months ago. She finds it difficult to talk about the experience, and avoids situations that remind her of the event. She was recently diagnosed with PTSD.

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In addition to medication therapy, LH would like to receive some type of nonpharmacologic treatment. Which of the following nonpharmacologic treatments for PTSD has the most evidence supporting its use and is often utilized in the management of PTSD?

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a. Group counseling

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b. Stress inoculation treatment

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c. Psychoeducation

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d. Cognitive behavioral therapy

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Answer d is correct. Cognitive behavioral therapy is the most studied nonpharmacologic treatment in PTSD and is widely utilized in PTSD management.

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Answers a, b, and c are incorrect. All others have data but they are still limited.

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TW is a 43-year-old man with PTSD. He has tried several medications in the past, including sertraline, escitalopram, and venlafaxine; however, he has not experienced significant improvement of symptoms with any of these agents. The physician wants to start alprazolam 1 mg twice daily and asks if this is appropriate. How do you correctly respond to the physician?

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a. Alprazolam is not effective in the treatment of PTSD.

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b. Alprazolam is effective; however, dose should be started at 0.5 mg twice daily.

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c. Alprazolam is effective and dosing is appropriate.

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d. Alprazolam is not the most ...

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