Treatment of longterm psychiatric problems

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If the patient suffers from isolated distressing images specifically related to the accident or injury, the video playback technique may be the first choice of treatment. When the content of the images is more complex, eye-movement desensitization may be more helpful. If the psychological themes are related to conflicts, family issues, or secondary events, short-term psychotherapy as outlined by Horowitz(5) should be tried. The results from manual-based treatment protocols for post-traumatic mental disorders after motor vehicle accidents are encouraging, (!5> as are other cognitive-behavioural techniques. However, there have been few randomized controlled trials, and these are urgently needed.

Psychotropic drugs may help some subjects. Antidepressants should be given if there is a major depressive episode. Benzodiazepines may reduce PTSD-related anxiety, but drug treatment should be supplemented with psychological interventions. The serotonin antagonist cyproheptadine has been reported to relieve nightmares, but its efficacy compared with psychological techniques and other drugs is not known.

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