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1. Evaluate the safety of the patient and others, including risk for suicide.

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2. Determine a treatment setting.

  • Deliver treatment in a setting that is least restrictive, yet most likely to prove safe and effective. Consider

    • symptom severity;

    • comorbid physical or psychiatric diagnoses;

    • suicidal and homicidal ideation, plans, or intention;

    • level of functioning and available support system;

    • the patient's personal safety;

    • ability to adequately care for self;

    • ability to provide reliable feedback to the psychiatrist; and

    • willingness to participate in treatment and ability to trust clinicians and the treatment process.

  • Outpatient treatment is appropriate for the majority of individuals, but consider inpatient treatment for patients who

    • have comorbid psychiatric and other medical diagnoses;

    • have suicidal or homicidal ideation, plans, or intention; or

    • are severely ill and lack adequate social support outside of a hospital setting.

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3. Establish and maintain a therapeutic alliance.

  • Conduct evaluation and treatment with sensitivity in a safe environment that facilitates the development of trust.

  • Acknowledge the patient's worst fears about reexposure to intolerable traumatic memories.

  • Recognize that treatment itself may be perceived as threatening or overly intrusive.

  • Address the patient's concerns and treatment preferences.

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4. Coordinate the treatment effort.

  • One team member (sometimes the psychiatrist) must assume primary overall responsibility for the patient's treatment.

  • Establish clear role definitions, plans for the management of crises, and regular communication among clinicians involved in the treatment.

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5. Monitor treatment response.

  • Monitor for the emergence of changes in destructive impulses toward self or others.

  • If risk of harmful behaviors increases, consider hospitalization or more intensive treatment.

  • Reevaluate diagnostically if new symptoms emerge, there is significant deterioration in functional status, or significant periods elapse without response to treatment.

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6. Provide education.

  • Provide education about the natural course of and interventions for ASD and PTSD as well as the broad range of normal stress-related reactions.

  • Clarify that symptoms may be exacerbated by reexposure to traumatic stimuli, perceptions of being in unsafe situations, or remaining in abusive relationships.

  • Consider providing ongoing educational efforts for individuals or groups whose occupation entails likely exposure to traumatic events (e.g., military personnel, police, firefighters, emergency medical personnel, journalists).

  • Refer to APA's Disaster Psychiatry web site (http://www.psych.org/disasterpsych/) for additional information and educational materials.

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7. Enhance adherence to treatment.

  • Improve medication adherence by emphasizing to the patient

    • when and how often to take the medicine;

    • the expected time interval before beneficial effects of treatment may be noticed;

    • the necessity to take medication even after feeling better;

    • the need to consult with the physician before tapering or discontinuing medication, to avoid the possibility of symptom rebound or relapse; and

    • steps to take if problems or questions arise.

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8. Increase understanding of and adaptation to the psychosocial effects of the disorder.

  • Assist the patient in addressing issues that may arise in various life domains, including family and social relationships, living conditions, general health, and academic and occupational performance.

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9. Evaluate and manage physical health and functional impairments.

  • Monitor presence, type(s), and severity of medical symptoms continuously.

  • Assess level of functioning on an ongoing basis.

References

NOTE:
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Related Content
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The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 43.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 35.  >
APA Practice Guidelines > Chapter 6.  >
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