treatment

How to Treat ACUTE Stress DISORDER AND POST TRAUMATIC Stress DISORDER?


Things to note:
  • Patient and family Reassurance and support.
  • Suitable medical attention.
  • Psychotherapy, as shown in clinical presentations and usually supportive / cognitive- behavioral.The debriefing of traumas was questioned as a routine approach.

Medical Treatment:
Acute management
For anxiety and insomnia:
Benzodiazepines repeated as necessary to control symptoms, e.g:
* Diazepam, oral, 2-5 mg per dose.
OR
In more serious cases:
  • Diazepam, IV, 5- 10 mg as single dose.
OR
  • A single dose of clonazepam, IM / oral, 0.5-1 mg.
Maintenance Antidepressant therapy
Indicated for characteristics of post- traumatic stress disorder and the possibility of a major depressive disorder emerging comorbidity.
Antidepressant therapy
  • It takes 4- 6 weeks for all Antidepressants to maximize their effect. In the first 1- 2 weeks, some patients may experience initial response. There is little evidence to support treatment with combination drugs.
  • Tricyclic Antidepressants( TCA) and selective inhibitors for serotonin reuptake(SSRI) are equally effective.
    Comorbid conditions, e.g., guide the choice of therapy. Prevent TCAs in patients with heart disease and use TCAs and SSRIs with caution in the elderly.
  • After remission, the pharmacotherapy continues for at least another 6 months.
  • Afterwards, review the need for pharmacotherapy. Taper slowly to avoid discontinuation symptoms when the medication is discontinued. If recurrence occurs, restore the drug at the same dose.
  • Patients with three or more episodes may need to check the maintenance pharmacotherapy every two years.
Major depressive disorder
First line
Tricyclic Antidepressants at bedtime, e.g:
* Amitriptyline, oral.
  • Range of dosages: 75-150 mg.
  • Start with: 25 mg, increase by 25 mg per day at intervals between 3 and 4 days.
  • Doses exceeding 150 mg: see the psychiatrist.
OR
* Reuptake inhibitors for selective serotonin, e.g:
* oral fluoxetine.
  • Initial dose: 20 mg
  • If 4-8 weeks later there is no or partial response, increase to 40 mg if well tolerated.
OR
  • Oral, Citalopram 20-40 mg per day.
If Antidepressant sedation is necessary and TCAs can not be used:
* Mianserin, oral, 10 mg at night. Initiated specialist.
  • Increase by 10 mg every seven days to a maximum of 60 mg incrementally.
Second line
  • Change to the other SSRI or TCA on an SSRI.
  • Change to a SSRI on a TCA.
  • If you first use fluoxetine, wait 7 days after you stop fluoxetine before you start citalopram.

When to refer:
  • Continuous symptoms.
  • Inadequate treatment response.
  • Conditions of Comorbidity.

treatment