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Understanding and Managing Post-Traumatic Stress Disorder (PTSD)

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nikkos
29 diapositives · 455 Views · Jul 31, 2014

This training session focuses on the application and interpretation of PTSD screening tools, enabling healthcare professionals to effectively diagnose and develop therapeutic care plans. Key takeaways include the importance of using the right tools, recognizing potential anxiety disorders, and the utility of SSRIs in treatment. Participants will engage in case discussions, emphasizing principles of therapy, risk assessment, and evidence-based interventions like cognitive behavioral therapy (CBT). Understanding the complexities of PTSD management is critical for improving patient outcomes.

#understanding and managing post-traumatic stress disorder (ptsd) #understanding and managing post-traumatic stress disorder (ptsd) ppt #powerpoint #presentation
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Understanding and Managing Post-Traumatic Stress Disorder (PTSD)
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  1. Post-Traumatic Stress Disorder Scott Grogan, DO, MBA, FAAFPMAJ, MC30 Aug 2013

  2. Objectives • Applied & interpreted screening • Utilized PTSD diagnostic tool • Developed comfort with initiation of therapy and care plan

  3. Take Home Points • “Right tool makes the job easy” • When in doubt, Anxiety d/o NOS • SSRIs are your friends

  4. Your Responses • Limited experience with PTSD • Diagnosis challenging • Frustrating because suspect malingering for VA rating • Overall with PTSD: 100% uncomfy

  5. Results • Principles of PTSD management • Screening &Dx • Prevention after trauma exposure • Pharmacotherapy • CBT

  6. Case #1 • In small groups… • Read case • Discuss and answer questions • Be prepared to share 5Minutes

  7. Screening • Who? • OTSG: All soldiers (RESPECT-Mil) • “Ask and you shall receive!” • What? • PC-PTSD (VA/DOD) • 4 questions; 2+ is positive

  8. Diagnosis • Multiple inventories • Primary Care: PTSD checklist (PCL) • 19 questions if screen +

  9. PTSD Checklist (PCL) ≥ 1 Re-experiencing (intrusion) ≥ 3 Avoiding ≥ 2 Hyperarousal • Score “Moderately” or above is + • Cut points vary; affect sens/spec

  10. Timing Matters

  11. BEWARE of AD!!!

  12. BEWARE of AD!!! • $$ & stigma at stake; need to be sure • 50% VA disability rating • Anxiety d/o NOS • Assess risk, safety net, start treatment • Then REFER to BH!

  13. BH Diagnosis • Mississippi Scale for Combat-Related PTSD - 35 questions • Personality Assessment Inventory • Self-report exam (1 hr) – 344 questions • Psych interview

  14. Case #1 Revisited • In small groups… • Read case AGAIN • Discuss and answer questions AGAIN • Be prepared to share AGAIN 5Minutes

  15. Principles of Therapy • Support • Risk assessment • Support • CBT • Support • Pharmacotherapy • Support

  16. Establishing Rapport • Empathetic approach • Elicit preferences, listen reflectively • Emphasize autonomy in decisions • Pros, cons, & barriers to treatment • Support self-efficacy

  17. Risk Assessment • TBI? • Substance abuse? • Weapons? • Suicidality/Homocidality? • Enlist help of family/friends

  18. Evidence-based CBT • Prolonged exposure therapy (PE) • Cognitive processing therapy (CPT) • Eye movement desensitization and reprocessing (EMDR) • Stress inoculation training (SIT)

  19. Pharmacotherapy • SSRIs most studied • Sertraline&paroxitine: FDA indications • Helps all three symptom clusters • DO NOT WAIT FOR PSYCH DX!!!

  20. Adjunctive Therapies • Trazodone • Prazosin • Clonidine • Imagery Rehearsal Therapy • Reprogramming dreams

  21. Expectation Management • Many get better with support • Frequent follow up • 12 weeks for full med effect • Follow PCL scores • Drop of ≥ 5 is adequate • <11 considered remission

  22. Case #2 • In small groups… • Read case • Discuss & answer questions, role play • Be prepared to share 10 Minutes

  23. My Challenge • Ask screening questions for BH disorders in clinic • “Ask and you shall receive!” • When precepting, ask about screening

  24. Objectives • Applied & interpreted screening • Utilized PTSD diagnostic tool • Developed comfort with initiation of therapy and care plan

  25. Take Home Points • “Right tool makes the job easy” • When in doubt, Anxiety d/o NOS • SSRIs are your friends