Posttraumaticstressdisorder

JeanineBlais,CarrieBurd
&T.J.Erhart

Symptoms

Intrusivethoughtsormemoriesabouttraumaticevents
Avoidancebehaviors
Negativethinkingormood
Hyperarousalsymptoms
(Mayoclinic.org,2014)

DSM5Criteria
CriterionA:stressor(trauma)1required
1.Directexposure
2.Witnessing
3.Indirect(trauma,accidentalorviolentdeathofclosefriendorrelative)
4.Repeatedorextremeindirectexposuretoaversivedetailsofevent,suchas:
Professionalsexposedtochildabusedetails,firstresponders,retrievingbody
parts.
CriterionB:intrusionsymptoms(reexperiencingtheevent)1required
1.Recurrent,involuntary,intrusivememories
2.Traumaticnightmares
3.Dissociativereactions(e.g.,flashbacks)frombriefepisodetocompleteloss
ofconsciousness)
4.Intense/prolongeddistressafterexposuretoreminder/trigger
5.Physiologicreactionafterexposuretotrigger.
(AmericanPsychiatricAssociation,2013)

DSM5Criteria
CriterionC:avoidance1required
1.Thoughtsorfeelingsrelatedtotraumaticevent
2.Externalreminders(people,places,activities,objects,etc.)
CriterionD:negativealterationsincognition/mood2required
1.Inabilitytorecallkeyfeaturesoftraumaticevent(dissociativeamnesia)
2.Persistentnegativebeliefs/expectationsaboutselforworld.
3.Persistentblameofselforothersforcausingtraumaticevent
4.Persistentnegativetraumarelatedemotions(fear,anger,guilt,shame)
5.Markeddecreasedinterestinpretraumaticactivities
6.Feelingalienatedfromothers
7.Constrictedaffect:persistentinabilitytoexperiencepositiveemotions
(AmericanPsychiatricAssociation,2013)

DSM5Criteria
CriterionE:alterationsinarousalandreactivity2required
1.Irritableandaggressivebehavior
2.Selfdestructive,recklessbehavior
3.Hypervigilance
4.Exaggeratedstartleresponse
5.Problemsconcentrating
6.Sleepdisturbances
CriterionF:duration
Musthavepersistentsymptomsformorethatonemonth
CriterionG:functionalsignificance
Significantsymptomrelateddistressfunctionalimpairmentinwork,school,
relationships,etc.
(AmericanPsychiatricAssociation,2013)

DSM5Criteria
CriterionH:exclusion
DisturbanceisnotD/Tmeds,substanceabuseorotherillness.
PTmaybediagnosedwithdissociativesymptoms:
1.Depersonalization:experienceofbeinganoutsideobserverorbeingina
dream.
2.Derealization:unreality,distanceordistortionasthoughthingsarenotreal.
PTmayhaveadelayedexpression.
Fulldiagnosisisnotmetuntilatleastsixmonthsaftertrauma.
Onsetofsymptomsmayoccurimmediatelyoryearsaftertheevent.
(AmericanPsychiatricAssociation,2013)

Haveyoueverserved?

HaveYouEverServedisapartofa
nationalcampaigncalledtheJoining
ForcesCampaign.
BackedbytheAmericanNursing
Association,FirstLadyMichelleObama,
andDr.JillBiden.
Assessmentofsymptomsisthefirststep
inanintegratedtreatmentapproach.
AlwaysaskthepatientsHaveyou
served?
Anyonecanbeaveteran,andPTSDas
wellasmanyothermedicalconcernsare
seenmorecommonlyinmilitary
members.
Identifyingapatientasaveteranis
criticaltoprovidingqualitycare.

(Americanacademyofnurses,n.d.)

TherapeuticCommunication
Goaltostrengthenthepersonsmotivationforseekinghelp.
Anychangemustbetheclientswishes,nottheNurses.
Whentalkingtoclientsthatdisplays/sofPTSD,keepthefocusof
theconversationonexploringandresolvingambivalenceabout
seekinghelp.
Keeptheconversationgroundedwitharespectfulstance,focusing
onbuildingarapport.
Createconversationthatevokeschange.
Keepconversationfocusedontheclientasanindividual

(Americannursesfoundation,2014)

TherapeuticCommunication
Openendedquestions
Questionsthatencourageelaborationandthought.
Requiremorethanayesornoanswer.
Tellmemore
Howexactlydidthefightbetweenthetwoofyoustart?
Thesehelptheclientimprovecognition.
(Americannursesfoundation,2014)

TherapeuticCommunication

Encourageandreaffirmtheclientsselfexamination
Donthesitatetooffertactfulcompliments.
Highlightstrengthswhenpossible
Keepfocusonclientsthoughts,feelingsandcircumstances.
Seektounderstandandofferthatunderstandingbackandconfirm
thattheclientisunderstood.
Repeatwhatclientsaidbacktothem
Rephrasewhattheclientalreadysaidtoyou.
Actasareflectionoftheclientsfeelings.
Summarizeorcreatemetaphorstohelpclientunderstandthoughts.
(Americannursesfoundation,2014)

Psychotherapy
TherearefourevidencebasedtreatmentsusedforPTSD.
Cognitivebehavioraltherapy(CBT)(mosteffective)
Twotypes:
Prolongedexposure(PE):Survivorsrepeatedlyreexperiencetraumatic
eventbytalkingthroughitandsaferealworldexposuretothestimuli.
Cognitiveprocessingtherapy(CPT):Changesmaladaptivebeliefs
relatedtothetraumaticevent,includeswrittenexposurecomponent.
Eyemovementdesensitizationandreprocessing(EMDR)
PTrepeatedlyreexperiencestraumaticeventbytalkingthroughitwhile
performingeyemovementbytrackinganobject.
Anxietymanagement
Involvesbehaviortherapy,managementtechniquesandgrouptherapy.
(Hamblen,Schnurr,Rosenburg&Eftekhari,2015)

Pharmacotherapy
Firstlineoftreatment
SSRIs:Paroxetine(Paxil),sertraline(Zoloft),fluoxetine(Prozac)
SNRI:Venlafaxine(Effexor)
Secondlineoftreatment
TCAs:Amitriptyline(Elavil,Endep),imiprimine(Tofranil)
Others:Mirtazapine(Remeron)
Prazosin(minipress)helpfulwithnightmaresonly
Nefazodone,Phenelzyne
IfPTisstillexperiencingsymptomswhileonmedicationassesstoseeif
medicationisbeingtakenasprescribed,oftennonadherenceistheproblem.
(Freedman,2015)

PatientTeaching

Takemedicationasprescribed
Donotstoptakingmedication
Nefazodone:hepatotoxic,periodicliverfunctionlabsarenecessary
Phenelzyne(MAOI):Donottakewithotherantidepressants,donoteat
foodscontainingtyramine;avocados,bananas,raisins,papayaproducts,
meattenderizers,figs,cheese,sourcream,yogurt,beer,wines,many
processedmeats,chocolate,yeastproductsandothers.
Avoidalcoholanddrugs(selfmedication)
Avoidopioidsandbenzodiazepines
Themosteffectivetreatmentispsychotherapywithmedication.
CBThasahighrateofremission,withPTremaininginremissionfor5+
years.
(Adams,Holland,&Urban,2014;Freedman,2015)

Treatmentfacilities
SUNY Upstate
Syracuse VA Medical Center
Psychology today website lists local
individual providers
Oswego Health does not offer
services specifically for PTSD.

References
Adams,M.,Holland,N.,&Urban,C.(2014).Pharmacologyfornurses:A
pathophysiologicalapproach(4thed.).UpperSaddleRiver,NJ:Pearson
Education,Inc.
Americanacademyofnursing.(n.d.).InHaveyoueverservedinthe
military?. Retrievedfromhttp://www.haveyoueverserved.com
Americannursesfoundation.(2014).Workingwithpatients.InThePTSD
toolkitfornurses.Retrievedfromhttp://www.nurseptsdtoolkit.org/ index.php
AmericanPsychiatricAssociation.(2013)Diagnosticandstatisticalmanual
of mentaldisorders,(5thed.).Washington,DC:Author.
Hamblen,PhD.,Schnurr,PhD.,Rosenburg,MA.,&Eftekhari,PhD.(2015,
August).OverviewforpsychotherapyforPTSD.InUSdepartmentof
veteran'saffairs.RetrievedSeptember3rd,2015.
Freedman,M.(2015,August).PharmacologicaltreatmentofPTSDand
comorbiddisorders[Videolecture].InUSdepartmentofveteransaffairs.
RetrievedSeptember29th,2015.
MayoClinic.(2014,April).Posttraumaticstressdisorder(PTSD).In
Mayoclinc.org.RetrievedSeptember3rd,2015.