Review of PTSD and Current Treatment Strategies

Abstract

• Updated treatment strategies for PTSD by VA and DoD.
• Trauma-focused therapies (CPT, PE, EMDR) are the gold standard.
• Medication can aid but avoid benzodiazepines due to negative effects.

Introduction

• Freud’s early theories focused on trauma and psychological defense mechanisms.
• Trauma affects individuals indiscriminately and can impair life function significantly.

Modern Concept of PTSD

• PTSD diagnosis has evolved with understanding of stress response.
• Historical observations (Auenbrugger's nostalgia) noted symptoms in soldiers.
• PTSD affects both military and civilian populations, with significant prevalence among adolescents and adults.
• Primary care settings play a crucial role in mental health screening and treatment initiation.

Diagnosis

• DSM-V (2013) reclassified PTSD from anxiety to trauma-associated disorder.
• Diagnosis requires significant trauma exposure with occupational/social impairment for over a month.
• Symptoms: intrusive, avoidance, cognitive/mood alterations, arousal/reactivity changes.
• Specific criteria for children under 6 due to developmental differences.

Non-Pharmacologic Treatment

Shared Decision Making and Collaborative Care

• Early interventions improve patient-centered care and outcomes.
• Collaborative care in primary settings increases compliance.

Trauma-Focused Therapy

• Recommended as first-line treatment over pharmacotherapy.
• Evidence supports manualized trauma-focused therapies (e.g., PE, EMDR, CPT) for reducing PTSD symptoms.
• Emerging therapies like Written Exposure Therapy show promise.
• Video conferencing therapy is effective and cost-efficient.

Pharmacologic Treatment

Recommended Medications

• SSRIs and SNRIs (fluoxetine, venlafaxine, paroxetine) are beneficial as monotherapy.
• Medication augments therapy but therapy addresses broader symptomology.

Augmentation Strategies

• Insufficient evidence for augmentation strategies like prazosin and mirtazapine.
• Benzodiazepines are not advised due to harm with long-term PTSD use.

Non-Advised Treatments

• Atypical antipsychotics, anti-convulsants, benzodiazepines, cannabis not recommended.
• Insufficient evidence for procedures like ECT, rTMS, and others.

Summary

• Trauma-focused therapies with manuals are most beneficial.
• Access to trained therapists and insurance coverage may be limiting factors.
• SSRIs and SNRIs offer strong evidence for symptom reduction in absence of therapy access.