1 November 2004
American Psychiatric Association - Medical Specialty Society
Summary,

GUIDELINE OBJECTIVE(S)

To assist psychiatrists in the assessment and care of adult patients with acute stress disorder (ASD) and posttraumatic stress disorder (PTSD)

TARGET POPULATION

Adults (18 years of age and older) with suspected acute stress disorder or posttraumatic stress disorder, according to the criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)

INTERVENTIONS AND PRACTICES CONSIDERED

Assessment/Diagnosis

1. Differential diagnosis of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) according to Diagnostic and Statistical Manual of Depression, 4th Edition (DSM-IV) criteria
2. History of traumatic experience
3. Complete psychiatric evaluation
4. Functional assessment
5. Determination of and treatment of comorbid physical or psychiatric disorders (including major depressive disorders, anxiety disorders, and substance use disorders)
6. Determination of comorbid somatization disorder or other somatoform disorders
7. Assessment of patients risk for suicide
8. Assessment of patients potential to harm others

Psychiatric Management

1. Establishment of a therapeutic alliance with the patient
2. Patient education regarding acute stress disorder (and posttraumatic stress disorder)
3. Enhancement of treatment adherence
4. Coordination of care by collaborating with other clinicians
5. Psychotherapeutic and psychoeducational interventions
6. Monitoring of patient's treatment response
7. Monitoring for comorbid medical conditions or substance abuse disorders
8. Clinical assistance for family members who may require intervention
9. Assistance with life issues (e.g., family and social relationships, living conditions, vocational issues, and financial support)

Pharmacotherapy

1. Selective serotonin reuptake inhibitors (SSRIs)
* Fluoxetine
* Sertraline
* Paroxetine
* Fluvoxamine
* Citalopram
2. Tricyclic antidepressants
* Amitriptyline
* Imipramine
* Desipramine
* Phenelzine
3. Monoamine oxidase inhibitors (MAOIs)
* Phenelzine
* Brofaromine
* Moclobemide
4. Other antidepressants
* Nefazodone
* Trazodone
* Bupropion
* Venlafaxine
* Mirtazapine
5. Second-generation antipsychotic medications
* Olanzapine
* Quetiapine
* Risperidone
6. Anticonvulsants
* Divalproex
* Carbamazepine
* Topiramate
* Lamotrigine
* Tiagabine
7. Other therapeutic agents
* Benzodiazepines, including alprazolam
* Valproic acid
* Cyproheptadine
* Inositol
* Alpha-adrenergic blockers, including prazosin and clonidine
* Beta-adrenergic blockers, including propranolol
* Chloral hydrate
* Lithium carbonate

Psychotherapeutic Interventions

1. Cognitive behavior therapy
2. Patient utilization of existing support network
3. Psychological debriefing
4. Single-session therapy
5. Eye movement desensitization and reprocessing (EMDR)
6. Reactive eye dilation desensitization and reprocessing (REDDR)
7. Hypnotherapy
8. Desensitization
9. Stress inoculation
10. Imagery rehearsal
11. Prolonged exposure techniques
12. Case management
13. Group therapies including present-centered and trauma-focused group therapies
14. Optimism training
15. Goal setting and achievement
16. Biofeedback
17. Multiple channel exposure therapy
18. Assertiveness training
19. Relaxation exercises
20. Internet based therapies
21. Outward Bound group recreational therapies

MAJOR OUTCOMES CONSIDERED

* Reduction in severity of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) symptoms
* Prevention/reduction of trauma-related comorbid conditions
* Patient adherence to treatment plan
* Response to treatment
* Speed of recovery
* Social, occupational, adaptive, and interpersonal functioning
* Length of hospitalization
* Quality of life
* Rate of relapse