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treatment in a setting that is least restrictive, yet most likely
to prove safe and effective. Consider
comorbid physical or psychiatric diagnoses;
suicidal and homicidal ideation, plans, or
level of functioning and available support
the patient's personal safety;
ability to adequately care for self;
ability to provide reliable feedback to the
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
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.
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
One team member (sometimes the psychiatrist)
must assume primary overall responsibility for the patient's
Establish clear role definitions, plans for
the management of crises, and regular communication among clinicians
involved in the treatment.
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.
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.
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
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.
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
Monitor presence, type(s), and severity of medical
Assess level of functioning on an ongoing basis.