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STANLEY L. GOODMAN, M.D. – Qualified Medical Examiner #962948

Diplomate, American Board of Psychiatry & Neurology

in Forensic, Child, Adolescent, Adult, Addiction, and Geriatric Psychiatry

MAIN OFFICE – 5535 Balboa Boulevard, Suite 215, Encino, California 91316 Phone: 818-986-7826 Fax: 818-986-7834

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Post-Traumatic Stress Disorder occurs after a trauma in which a patient thinks they might be killed.  The treatment is complex because patients have significant anxiety symptoms.  At least 50% will develop Major Depressive Disorder.  This disorder should only be treated by a Board Certified Psychiatrist with extensive experience.  This disorder should not be treated by a family practitioner. 


The reason the treatment is critical is that studies have shown that patients will have double the risk of developing a serious possibly lifetime autoimmune disorder, such as Lupus, ulcerative or other bowel disease, etc.  The cost of treating these PTSD-associated medical disorders can be staggering.  Therefore, whenever there is an industrial trauma, prompt, usually long-term treatment is mandatory.     


Psychological treatment may also be helpful. 


There should be treatment of anxiety disorders.  Overwhelming anxiety can increase the risk of a later injury.  Although benzodiazepines; e.g., clonazepam, alprazolam, can be used, patients should be given lower doses; if, for example, clonidine, is utilized. 


Clonazepam has a much longer half-life than, for example, alprazolam, Xanax, or lorazepam (Ativan) and is preferable. 


Psychological treatment of anxiety is helpful and should be utilized with medication. 


Pharmacological treatment of sleep disorders.  Sleep disorders occur frequently after a serious orthopedic injury.  However, the orthopedists or pain specialists must decrease the pain to the point where the patient can sleep. 


Sleep deficits must be aggressively treated for the following reasons.  When the patient only sleeps four hours, there is double the risk of an infection.  Sleep disorders are associated with fibromyalgia and chronic fatigue syndrome which are both difficult to treat and expensive to treat.  They are both disabling to the patient. 


Sleep deficits double the risk of developing a motor vehicular accident which would be industrially related. 


Studies are shown that patients with sleep disorders will have damage to their neurons. 


In summary, sleep disorders should be immediately treated.  This will hasten the patients return to gainful employment.  Zolpidem (Ambien), a benzodiazepine, is a very effective medication.  However, in injured patients, with classic tricyclics; e.g., nortriptyline (Pamelor), may induce sleep, decrease depression/anxiety, and may decrease the perception of pain.  They are preferable to a benzodiazepine.  (Catapres) decreases adrenergic tone and may be very helpful for both sleep and anxiety.  It may also be useful in anxiety.  Clonidine will not decrease memory, impair coordination, and can be used in patients with a substance abuse problem.                     

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