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


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.


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.


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.


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.


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.


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.


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.


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.


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Related Content
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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