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% Document Info
\author{Shelbi (kfisher17)}
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  /Title (ptsd-therapeutics.pdf)
  /Creator (Cheatography)
  /Author (Shelbi (kfisher17))
  /Subject (PTSD Therapeutics Cheat Sheet)
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\noindent
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        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{PTSD Therapeutics Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Shelbi (kfisher17)} via \textcolor{DarkBackground}{\uline{cheatography.com/79317/cs/21864/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Shelbi (kfisher17) \\
  \uline{cheatography.com/kfisher17} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 23rd February, 2020.\\
   Updated 24th February, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{x{6 cm} x{2 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Diagnosis | Four Core Symptoms}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Intrusive}} & Must have 1 \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Recurrent memories, disturbing dreams, flashbacks, reminders that evoke emotional distress, physical reactivity}}} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
{\bf{Avoidance}} & Must Have 1 \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Reminders of event, \seqsplit{feelings/conversations/thoughts} of event}}} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
{\bf{Negative Cog/Mood Changes}} & Must Have 2 \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Inability to recall trauma aspects, negative expectations, distorted cognitions about trauma and self-blame, greatly ⬇ interest in activities, detachment or estrangement, inability to experience positivity}}} \tn 
% Row Count 16 (+ 5)
% Row 6
\SetRowColor{LightBackground}
{\bf{Changes in Arousal/Reactivity}} & Must Have 2 \tn 
% Row Count 18 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{⬇ concentration, easily startled, hypervigilance, sleep disturbances, irritability or anger, reckless behavior}}} \tn 
% Row Count 21 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Symptoms must occur ≥ 1 MONTH}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.356 cm} x{4.256 cm} p{0.988 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Non-Pharm | FIRST LINE}}  \tn
% Row 0
\SetRowColor{LightBackground}
PE & BEP & CPT \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Written NE & Narrative Exposure & EDMR \tn 
% Row Count 2 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.16 cm} x{5.84 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Pharm | SECOND LINE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\seqsplit{Nefazodone} & Avoid in liver dysfunction \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & CYP3A4 DDIs \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Phenelzine} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\seqsplit{Imipramine} & Avoid w/ acute MI \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & CI in CAS and prostatic enlargement \tn 
% Row Count 6 (+ 2)
% Row 5
\SetRowColor{white}
\seqsplit{Amitriptyline} & Avoid w/ acute MI \tn 
% Row Count 8 (+ 2)
% Row 6
\SetRowColor{LightBackground}
 & CI in CAS and prostatic enlargement \tn 
% Row Count 10 (+ 2)
% Row 7
\SetRowColor{white}
\seqsplit{Nortriptyline} & Avoid w/ acute MI \tn 
% Row Count 12 (+ 2)
% Row 8
\SetRowColor{LightBackground}
 & CI in CAS and prostatic enlargement \tn 
% Row Count 14 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Mirtazapine} \tn 
% Row Count 15 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.96 cm} x{5.04 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Pharm | ADJUNCT}}  \tn
% Row 0
\SetRowColor{LightBackground}
Prazosin & Nightmares \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Antiseizure & irritability, aggression, hyperarousal \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Atypical \seqsplit{Antipsychotics} & sleep, irritability, aggression, hyper-arousal, psychosis \tn 
% Row Count 6 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.72 cm} x{5.28 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Anticonvulsants | Adjunctive Tx}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA & modulates GABA and glutamiate \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Target symptoms & Irritability \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Aggression \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
 & Hyperarousal \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & {\emph{off-label use}} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
Examples & Carbamazepine \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Lamotrigine \tn 
% Row Count 9 (+ 1)
% Row 7
\SetRowColor{white}
 & Topiramate \tn 
% Row Count 10 (+ 1)
% Row 8
\SetRowColor{LightBackground}
 & Valproic Acid \tn 
% Row Count 11 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{VA/DOD guideline recommends AGAINST use due to low-quality evidence}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.16 cm} x{5.84 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Atypical Antipsychotics | Adjunctive Tx}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA & Dopamine antagonism \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Histamine antagonist provides sedative-like effects \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & ⍺ adrenergic antagonist properties in risperidone similar to prazosin \tn 
% Row Count 6 (+ 3)
% Row 3
\SetRowColor{white}
Target Symptoms & ⬇ irritability, aggression, and hyperarousal \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Sleep \tn 
% Row Count 9 (+ 1)
% Row 5
\SetRowColor{white}
 & Psychosis \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
Examples & Quetiapine \tn 
% Row Count 11 (+ 1)
% Row 7
\SetRowColor{white}
 & Olanzapine \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
 & Risperidone \tn 
% Row Count 13 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{VA/DOD guideline recommends AGAINST use due to low-quality evidence}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} x{7.2 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{{\bf{SUMMARY}}}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{4 core sx make up the diagnostic criterion}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
 & Intrusion \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & Avoidance \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
 & Negative Mood or Cognition \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Reactivity \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{First-Line Tx}}} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & SSRIs \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
 & SNRIs \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
 & Psychotherapy \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Prazosin}}} \tn 
% Row Count 10 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & Showed no significant difference in nightmares or sleep quality in a large clinical trial \tn 
% Row Count 13 (+ 3)
% Row 11
\SetRowColor{white}
 & Use should be individualized when nightmare affect QOL \tn 
% Row Count 15 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{Diagnosis and Sx remission can be monitored by CAPS}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.48 cm} x{5.52 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Diagnosis and Assessment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{CAPS (Gold Standard)}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Remission & 70\% ⬇ in sx for ≥ 3 months \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
Partial Response & 25 to 50\% ⬇ in sx for ≥ 3 months \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\seqsplit{Non-Response} & \textless{}25\% ⬇ in sx for ≥ 3 months \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.6 cm} x{6.4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Goals of Treatment}}  \tn
% Row 0
\SetRowColor{LightBackground}
Short Term & ⬇ in core Sx; ⬆ QOL; manage comorbid psych conditions \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Long Term & Remission \tn 
% Row Count 4 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Remission = 70\% ⬇ in sx for ≥ 3 months}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.04 cm} x{4.96 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Pharm | FIRST LINE}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Fluoxetine} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Sertraline & ⇦ FDA APPROVED \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Paroxetine & ⇦ FDA APPROVED \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{Venlafaxine XR} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Duloxetine} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Monitoring}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Use CAPS} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Med Trial: 8 to 12 weeks at maintenance dose} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Duration: 12 months of Tx} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{0-3 mo: monitor Q week to QOW} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{3 to 6 mo: monitor Q month} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{6 to 12 mo: Q 1 to 2 months} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Benzodiazepines}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\bf{Do not use in PTSD!}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{☹ This can worsen the response and doesn't provide sx relief} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{☹ No evidence of reduction in core sx} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{☹ No positive long-term data reported} \tn 
% Row Count 5 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{{\emph{All PTSD guidelines recommend {\bf{against}} use of benzo's}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.08 cm} x{5.92 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Prazosin | Adjunctive Tx}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA & ⍺-1 adrenergic antagonists \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Target Symptom & PTSD nightmares \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & {\emph{off-label use}} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
ADRs & First-dose syncope \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Orthostatic hypotension \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
 & Dizziness \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Somnolence \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
 & Headache \tn 
% Row Count 9 (+ 1)
% Row 8
\SetRowColor{LightBackground}
Dosing & Titrate slowly to minimize hypotension and syncope \tn 
% Row Count 11 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\emph{May be used as an adjunctive agent to an antidepressant to help reduce the frequency of nightmares}}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Prazosin | VA/DOD Guideline Trial}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Largest trial to date; 13 VA medical centers} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Conclusion: No significant difference in nightmares or sleep quality after 10 and 26 weeks of treatment} \tn 
% Row Count 4 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{VA/DOD Guideline: no recommendation for {\emph{OR}} against} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Evaluate benefits, risks, and medication tolerability}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4.32 cm} x{3.68 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Duration of Treatment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Pharmacotherapy should be continued for {\bf{≥ 12 months}}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Monitoring}}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
• 0 to 3 months & Monitor QW to QOW \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
• 3 to 6 months & Monitor Q month \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
• 6 to 12 months & Monitor Q 1 to 2 months \tn 
% Row Count 7 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\emph{If symptoms persist, indefinite pharmacotherapy is an option}}} \tn 
% Row Count 9 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Discontinuation of Treatment}}} \tn 
% Row Count 10 (+ 1)
% Row 7
\SetRowColor{white}
⇨   ⇨   ⇨   ⇨   ⇨ & Individualized \tn 
% Row Count 12 (+ 2)
% Row 8
\SetRowColor{LightBackground}
⇨   ⇨   ⇨   ⇨   ⇨ & Taper Slowly \tn 
% Row Count 14 (+ 2)
% Row 9
\SetRowColor{white}
⇨   ⇨   ⇨   ⇨   ⇨ & Monitor for Relapse \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}