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Reduce the severity of
ASD or PTSD symptoms.
Assist the patient
to better tolerate and manage the immediate distress of the memories
of the traumatic experience(s) and to decrease distress over time.
Help reduce intrusive reexperiencing and
psychological and physiological reactivity to reminders.
Reduce trauma-related avoidant behaviors,
nightmares, and sleep disturbance.
Diminish anxieties related to fears of recurrence.
Reduce behaviors that unduly restrict daily
life, impair functioning, interfere with decision making, and contribute
to engagement in high-risk behavior.
Prevent or treat trauma-related comorbid
conditions that may be present or that may emerge.
Improve adaptive functioning and restore
a psychological sense of safety and trust.
and assist the patient in adaptively coping with trauma-related
stresses and adversities.
Help identify and develop strategies to restore
and promote normal developmental progression.
Limit the generalization of the danger experienced
as a result of the traumatic situation(s).
Protect against relapse.
Help the patient
anticipate symptomatic exacerbation resulting from exposure to reminders
of trauma or loss, additional life stresses or adversities, subsequent
encounters with situations of danger or trauma, or discontinuation
of psychotropic medication.
Assist the patient in developing skills such
as problem solving, emotional regulation, and the appropriate use
of interpersonal support and professional help.
Integrate the danger experienced as a
result of the traumatic situation(s) into a constructive schema
of risk, safety, prevention, and protection.
Assist the patient
in addressing the meaning of the trauma in terms of his or her life
for the symptoms of ASD or PTSD involves three approaches either
alone or in combination: psychopharmacology, psychotherapy, and
education and supportive measures.
Consider pharmacological intervention
to relieve overwhelming physical or psychological pain, impairing
insomnia, or extremes of agitation, rage, or dissociation, especially
for patients whose degree of distress precludes new verbal learning
or nonpharmacologic treatment strategies.
Once the patient's safety and
medical stabilization have been addressed, supportive psychotherapy,
psychoeducation, and assistance in obtaining resources such as food
and shelter and in locating family and friends are useful.
age and gender;
presence of comorbid medical and psychiatric
propensity for aggression or self-injurious
recency of the precipitating traumatic event;
severity and pattern of symptoms;
presence of particularly distressing target
symptoms or symptom clusters;
development of interpersonal or family issues
or occupational or work-related problems;
preexisting developmental or psychological
vulnerabilities, including prior traumatic exposure; and
the patient's preferences.
Attempt to minimize the risk for additional
trauma and development or prolongation of PTSD through direct and
vigorous treatment of underlying depression with psychotherapy,
antidepressant pharmacotherapy, or both.
review factors that may contribute to treatment nonresponse, including
of the initial treatment plan, including its goals and rationale;
the patient's perceptions of the
effects of treatment;
the patient's understanding of and
adherence to the treatment plan;
the patient's reasons for nonadherence
if nonadherence is a factor; and
the potential for other psychological disorders
or underlying personality traits to interfere with treatment.
One strategy for nonresponse is to augment
the initial treatment with another, for example, by adding pharmacotherapy
to psychotherapy, psychotherapy to pharmacologic intervention, or
couples therapy to individual psychotherapy.
Exhaust first the treatments for which
there is the best evidence of efficacy before trying more novel
In some cases, the original treatment
may need to be discontinued and a different modality selected, as
in the case of a patient who is too overwhelmed by anxiety to tolerate
Understand the importance of social and cultural
dynamics, to avoid alienating the patient from his or her family
Consider the cultural meaning of symptoms or
illness and the cultural values of the patient and the patient's
Recognize that cultural context and societal
views may affect development of symptoms and treatment response.
Consider cultural values in the patient's
decision making about taking medication and adhering to medication
regimens and other treatment.
When determining a pharmacologic treatment plan,
understand that genetic polymorphisms in hepatic cytochrome P450
enzymes occur at varying frequencies across ethnic groups.