Mindful Continuing Education

1. According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR), which of the following is NOT one of the characteristics of Posttraumatic stress disorder (PTSD)?

2. While universal prevention of PTSD is designed to deliver interventions to all people exposed to a trauma, regardless of symptoms or risk of developing PTSD, ______________ is based on the fact that although many people experience some symptoms of PTSD after trauma, only a relatively small percentage develop the psychiatric disorder of PTSD and its associated disability.

3. One of the key questions for PTSD prevention is, "For adults exposed to psychological trauma, what is the efficacy or comparative effectiveness (or both) of early interventions to prevent PTSD or to improve health outcomes?"

4. Research clearly indicates that debriefing is an effective strategy in preventing PTSD or reducing the severity of PTSD symptoms in civilian victims of crime, assault, or accident trauma at 6-month follow-up.

5. Several studies concluded that a stepped combination of care management, psychopharmacology, and CBT, known as integrated care (IC), produces a greater decrease in PTSD symptom severity at 3, 6, and 9 months after injury than usual care.

6. Although the evidence is scarce on the impact of timing, intensity, and dosing on the effectiveness or risk of harms of interventions used to prevent PTSD, one randomized controlled trial showed that Immediate debriefing (within 10 hours) compared with late debriefing (after 48 hours) led to significantly fewer posttraumatic symptoms that victims experienced.

7. Two trials that reported outcomes in terms of whether the subgroup characteristic, such as sex, modified the effect of any intervention, found that effects of early psychological interventions on PTSD symptoms were similar for men and women.

8. Conclusions from the systematic review of the efficacy, comparative effectiveness, and harms of psychological, pharmacological, and emerging interventions for the prevention of PTSD in adults exposed to psychological trauma indicated each of the following EXCEPT:

9. Psychological first aid has gained rapid acceptance as a universal intervention for people in the acute aftermath of trauma, and several recent studies have demonstrated its beneficial effects on mental health among trauma survivors.

10. PTSD develops in up to _______ of individuals who are exposed to extreme stressors, and symptoms almost always emerge within days of the exposure.

11. According to the DSM-IV-TR, re-experiencing symptoms of PTSD include each of the following EXCEPT:

12. PTSD therapies are designed to minimize the intrusion, avoidance, and hyperarousal symptoms of PTSD by some combination of re-experiencing and working through trauma-related memories and emotions and teaching better methods of managing trauma-related stressors.

13. Studies that compared the effectiveness and harms of psychological and pharmacological interventions for adults with PTSD were required to assess at least one of the following outcomes: PTSD symptoms, remission, loss of PTSD diagnosis, quality of life, disability or functional impairment, return to work or to active duty, or adverse events.

14. Among the psychological treatments, the strongest evidence of efficacy for improving PTSD symptoms and achieving loss of PTSD diagnosis was for cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), cognitive therapy (CT), or CBT-mixed therapies.

15. Among pharmacological treatments, evidence of moderate strength was found to support the efficacy of the following medications to improve PTSD symptoms EXCEPT:

16. Although evidence comparing psychotherapy to pharmacotherapy is very limited, one trial found that eye movement desensitization and reprocessing (EMDR) and fluoxetine-treated subjects had similar improvements in PTSD symptoms, rates of remission, and loss of PTSD diagnosis at the end of treatment.

17. Overall, evidence was insufficient to make definitive conclusions about whether any treatment approaches are more effective for victims of particular types of trauma, and to determine comparative rates of adverse events for various interventions.

18. Since clinical uncertainty exists about what treatment to select for individual PTSD patients, practical considerations, such as presence or lack of availability of psychological treatments and ______________ may guide treatment decisions.

19. In studies that measured the efficacy of pharmacological treatments for PTSD, trials generally reported outcomes after 12 to 16 weeks of treatment, which was not sufficient time to assess whether benefits were maintained.

20. In order to more completely assess benefits of treatments, experts recommend including measures of remission and loss of PTSD diagnosis, which are frequently not reported, in addition to measures of PTSD symptoms.