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Clinical Guidelines for the Management of PTSD and Acute Stress Disorder

Background

1. According to the DSM-5’s definition of traumatic events, all of the following are criteria for how one can meet the trauma definition, except for:

A. Direct exposure to traumatic events such as actual or threatened death, serious injury, or sexual violence or assault.

B. Indirect exposure such as learning that a loved one was exposed to a traumatic event and then died, even if the death was not violent or accidental.

C. Witnessing traumatic events, including people who directly observed such events but were not harmed themselves.

D. Exposure to extreme details of trauma, such as seeing dead body parts or severely injured people as part of one’s professional duties.


2. Dissociative Subtype of PTSD is diagnosed when an individual meets all diagnostic criteria for PTSD and also exhibits:

A. Depersonalization

B. Derealization

C. Either depersonalization or derealization

D. Neither depersonalization nor derealization


3. Which of the following symptoms has been added to the DSM-5 for PTSD diagnosis?

A. A persistent and distorted sense of blame for the trauma or its consequences.

B. Persistent negative emotions.

C. Reckless or self-destructive behavior.

D. Persistent and distorted sense of blame for the trauma or its consequences, persistent negative emotions, and reckless or self-destructive behavior have all been added to the DSM-5 for PTSD diagnosis.


4. In the case of a patient who has been diagnosed with PTSD based on DSM-IV criteria, retains symptoms of PTSD, but who does not meet DSM-5 criteria, the present guidelines may be used with confidence to make treatment decisions.

A. True

B. False


5. The overall lifetime prevalence of PTSD in the NCS-R was 6.8%, with men higher than women in lifetime prevalence and in current prevalence.

A. True

B. False


6. Which of the following is the strongest predictor of mental health problems among those deployed to Iraq and Afghanistan?

A. Combat exposure

B. Sexual or physical assault

C. Prior trauma exposure

D. Longer deployment time


7. There is a _____ -fold increase in PTSD risk with deployment, regardless of war era.

A. 1.5 - 2.5

B. 1.5 - 3.5

C. 1.5 - 4.5

D. 1.5 - 5.5


8. Data indicate that some Veterans continue to experience PTSD into old age.

A. True

B. False


9. There is a specific increased risk of PTSD co-occurring with:

A. Depression

B. SUD

C. Both depression and SUD

D. There is no increased risk of PTSD co-occurring with depression or SUD


About this Clinical Practice Guideline

10. The recommendations provided in the clinical practice guidelines are for the management of PTSD in:

A. Adults

B. Adolescents

C. Children

D. All age groups (adults, adolescents, and children)


11. As part of the patient-centered care approach, clinicians should:

A. Review the outcomes of previous self-change efforts, past treatment experiences, and outcomes with the patient.

B. Explain treatment options to patients including the benefits of accepting a referral to a mental health specialist.

C. Discuss any concerns the patient has and explore any identified treatment barriers.

D. Review the outcomes of previous self-change efforts, past treatment experiences, and outcomes with the patient; explain treatment options to patients including the benefits of accepting a referral to a mental health specialist; and discuss any concerns the patient has and explore any identified treatment barriers.


12. Because of the high prevalence of psychiatric comorbidities in the PTSD population, screening for _____ and other psychiatric disorders is warranted.

A. OCD

B. Depression

C. Homicidal risk

D. OCD, depression, and homicidal risk should all be screened for in the PTSD population


Algorithm

13. When diagnosing acute stress reaction / disorder, all of the following are considered immediate needs, except for:

A. Psychological debriefing

B. Sleep

C. First aid medical care

D. Communication with unit / family, friends, and community


14. Symptoms must last for more than _____ to meet the diagnostic criteria for Posttraumatic Stress Disorder based on DSM-5.

A. 3 days

B. 14 days

C. 1 month

D. 3 months


Recommendations

15. For the selective prevention of PTSD, there is sufficient evidence to recommend the use of trauma-focused psychotherapy or pharmacotherapy in the immediate post-trauma period.

A. True

B. False


16. When individual trauma-focused psychotherapy is not readily available or not preferred, non-trauma-focused psychotherapy is recommended over pharmacotherapy.

A. True

B. False


17. For patients with PTSD, all of the following individual, manualized trauma-focused psychotherapies are recommended, except for:

A. Prolonged Exposure

B. Stress Inoculation Training

C. Eye Movement Desensitization and Reprocessing

D. Narrative Exposure Therapy


18. Which of the following is recommended as monotherapy for PTSD for patients diagnosed with PTSD who choose not to engage in or are unable to access trauma-focused psychotherapy?

A. Sertraline

B. Divalproex

C. Risperidone

D. Sertraline and divalproex are both recommended as monotherapy


19. For which complementary / integrative treatment is there sufficient evidence to recommend as a primary treatment for PTSD?

A. Acupuncture

B. Mindfulness meditation

C. Yoga

D. There is not sufficient evidence to recommend acupuncture, mindfulness meditation, or yoga as primary treatments for PTSD


20. Collaborative care typically includes which of the following?

A. Care coordination and care management.

B. Regular / proactive monitoring and treatment to achieve outcomes measured using validated clinical rating scales.

C. Regular consultation or referral to appropriate specialists for patients who do not show clinical improvement.

D. Care coordination and care management, regular / proactive monitoring and treatment to achieve outcomes measured using validated clinical rating scales, and regular consultation or referral to appropriate specialists for patients who do not show clinical improvement are all considered collaborative care.


21. Inaccurately diagnosing PTSD in a patient who does not have PTSD could result in unintended harms to the patient from:

A. Being labeled with a mental disorder

B. Side effects of treatment

C. Both being labeled with a mental disorder and from side effects of treatment

D. Inaccurately diagnosing PTSD in a patient who does not have PTSD would not result in harm to the patient


22. One-time screening is not recommended because PTSD is a disorder with a fluctuating course for many people.

A. True

B. False


23. The PC-PTSD has been revised to include five items in order to reflect changes to the PTSD diagnostic criteria in DSM-5.  Initial validation of the revised scale suggests that a score of _____ optimizes specificity.

A. 5

B. 4

C. 3

D. 2


24. The positive effects of medication treatment diminish over time.

A. True

B. False


25. Comments from participants in focus groups and a growing body of literature indicate a patient preference for pharmacotherapy over psychotherapy.

A. True

B. False


26. All of the following are trauma-focused psychotherapies with the strongest evidence from clinical trials, except for:

A. Prolonged Exposure

B. Narrative Exposure Therapy

C. Cognitive Processing Therapy

D. Eye Movement Desensitization and Reprocessing


27. Compared to placebo, antidepressants increase the risk of suicidal thinking and behavior in those aged:

A. 65 and older

B. 25 - 64

C. 24 and younger

D. Antidepressants increase the risk of suicidal thinking in all ages


28. Nefazodone and phenelzine have potentially serious toxicities and should be managed carefully.

A. True

B. False


29. Pre-clinical evidence suggest that _____ may actually interfere with the extinction of fear conditioning and/or potentiate the acquisition of fear responses and worsen recovery from trauma.

A. Benzodiazepines

B. Divalproex

C. Guanfacine

D. Benzodiazepines, divalproex, and guanfacine all interfere with the extinction of fear conditioning and/or potentiate the acquisition of fear responses and worsen recovery from trauma


30. All of the following are true with regard to D-cycloserine, except for:

A. It is inexpensive.

B. The side effect profile is low.

C. It has very good acceptability compared to placebo.

D. It has shown consistent benefit for reduction of overall PTSD symptoms when combined with exposure therapy.


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