F43.1
DESCRIPTION
The core features of experiences which place patients at risk of PTSD are:
- exposure to a traumatic event (directly, witnessing or learning of it happening to someone else).
- there is threat of serious injury or death.
- violent personal assault, such as sexual violence.
DSM 5 DIAGNOSTIC CRITERIA
- Intrusive symptoms:
- Persistently re-experiencing:
- Recurrent memories and dreams of the traumatic event
- Dissociative reactions e.g. flashbacks, reliving experiences
- Physiological or psychological distress to traumatic cues
- Marked avoidance:
- Avoiding memories, thoughts or feelings related to trauma
- Avoiding external reminders
- Negative alterations in mood and cognitions e.g. amnesia, detachment
- Marked alterations in arousal and reactivity e.g. hypervigilance, sleep disturbance
- Significant distress/impairment
- Duration more than a month
GENERAL AND SUPPORTIVE MEASURES
Debriefing in the immediate aftermath of the trauma is not recommended, often having worse outcomes.
Psychological interventions should be made available, including:
- general supportive counselling
- cognitive behavioural strategies
- group and family interventions
MEDICATION TREATMENT
Consider medication when other interventions have not been effective or there is severe impairment in functioning
- Fluoxetine, oral, 0.5 mg/kg/day.
- Dose range: 20–40 mg daily.
However, fluoxetine may only be available in 20 mg capsules, in which case citalopram tablets can be used initially, titrated to 20 mg and then changed to Fluoxetine 20 mg.
If poor response, consider higher doses in consultation with a child psychiatrist.
OR
- Citalopram, oral, 0.4 mg/kg/day.
- Dose range: 5–40 mg daily.
- Recommended average dose: 10–20 mg/day.
REFERRAL
- Persistent symptoms despite therapy.