PANCE Blueprint Psychiatry (6%)

Trauma and stressor-related disorders (PEARLS)

Trauma and stressor-related disorders
Adjustment disorders Prolonged negative emotional reaction following a major life stressor (e.g., divorce, moving, new job)
Post-traumatic stress disorder An anxiety disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, and/or insomnia that lingers for four weeks or more after a traumatic experience
Adjustment disorders
Patient will present as → a 35-year-old woman who comes to your office with a 3-month history of feeling “depressed.” She feels “extremely distressed at work” and tells you that she is “burned out.” You discover that she moved into a managerial position at work 3 months ago and is having a great deal of difficulty (interpersonal conflict) with two of her employees. The patient has no history of psychiatric illness.  She has no other symptoms. She is not taking any medications.

The disproportionate response to a stressor that would normally be expected (ex. job loss, physical illness) which begin within 3 months of the stressor and end within 6 months after stressor resolved

  • Reaction out of proportion to the stressor or impairs daily functioning

Stressors:

  • Marital conflict
  • Financial conflict
  • Family conflict/parental separation
  • School problems/changing schools
  • Sexuality issues
  • Death/illness in the family

Treatment is psychotherapy

Post-traumatic stress disorder (PTSD)
Patient will present as → 33-year-old male presents with difficulty sleeping. The patient states that these symptoms began approximately 3 months ago when he lost his close friend while they were both in combat. He re-experiences this loss during the day and in his dreams. The patient reports anxiety and depression. 

The patient has experienced a traumatic event which causes an acute stress reaction. Once the symptoms persist past 1 month it is now considered post-traumatic stress disorder (PTSD)

Treatment:

SSRIs are considered first-line along with cognitive behavioral therapy (CBT)

  • Prazosin for nightmares
  • Benzodiazepines, if used, should not be continued more than 2 weeks after a traumatic event
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