Post-traumatic Stress Disorder Treatment in Primary Care
Post-traumatic stress disorder, a psychiatric disorder, develops after experiencing a perceived life-threatening incident. Its symptoms can be similar to those of anxiety or depression disorders, but with proper screening, the diagnosis is simple. Patient education, pharmaceutical therapies such as selective serotonin reuptake inhibitors, trazodone, and clonidine, and psychotherapy are all part of current treatment regimens. Structured stress debriefings, for example, should be delivered as soon as feasible after the trauma to prevent the development of post-traumatic stress disorder. In patients who have experienced considerable trauma, a high index of suspicion for post-traumatic stress disorder is required.
Sanax for PSTD
PTSD can affect a wide range of patients in family practise, regardless of culture, age, gender, or socioeconomic class. Busy physicians must be aware of its potential diagnosis in order to give compassionate and effective care to impacted patients or to undertake preventive actions for those who are at risk.
The overall prevalence of this condition in the United States population is estimated to be between 1 and 12%.
1 It ranges from 0.2 percent in postpartum women to 18 percent in professional firemen, 34 percent in adolescent survivors of motor vehicle crashes, 48 percent in female rape victims, and 67 percent in prisoners of war among vulnerable populations.
The clinical course varies. Symptoms may start quickly and vanish after a few months, or they may appear after six months and remain continuously. According to prevalence surveys, one-half of persons suffering from PTSD fulfil the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) after one year, and up to one-third still experience weekly symptoms ten years later. 1,6 This article provides primary care physicians with ideas for diagnosing, treating, and referring patients with PTSD.
Criteria for Diagnosis
To accurately diagnose PTSD, four types of criteria are required. First, there was a traumatic event in which the person witnessed or experienced actual or threatened death or serious injury and responded with intense fear, horror, or helplessness. Second, when the person is exposed to memory cues, they relive symptoms such as intrusive recollections, nightmares, flashbacks, or psychologic distress. Third, the patient avoids traumatic stimuli and experiences emotional numbness. Fourth, the person has hypervigilance, impatience, or difficulty sleeping, indicating heightened arousal. The symptoms last at least a month and significantly interfere with the patient's social or occupational functioning (or both).
Acute stress disorder (ASD), an anxiety condition, is related to post-traumatic stress disorder (PTSD) in that it occurs following exposure to a distressing incident. ASD symptoms appear four weeks after the trauma and last two to four weeks. They include reexperiencing, avoidance, and increased arousal, just like PTSD. However, in each category, fewer symptoms are required to make a diagnosis. ASD differs from PTSD in that it has more dissociative symptoms; patients express feeling "as though in a daze" or having momentary amnesia about the experience. ASD can proceed to PTSD, but it responds better to treatment, stressing the need of early detection and intervention.
Comorbidity
A concomitant psychologic condition affects up to 80% of PTSD sufferers.
7 Having a psychiatric diagnosis prior to a traumatic event enhances a person's likelihood of acquiring PTSD. Furthermore, having PTSD raises the likelihood of acquiring psychiatric issues later in life. 8 Major depression, dysthymia, generalised anxiety disorder, substance abuse, somatization, panic disorder, bipolar disorder, phobias, and dissociative disorders are the most frequent conditions associated with PTSD. 7 Because the specific psychologic concerns cannot be isolated, any coexisting psychiatric illnesses should be treated concurrently with PTSD.
Techniques for Screening
Diagnosing PTSD during an office visit might be difficult. Patients rarely disclose information about the traumatic event or the stereotypical PTSD symptoms, so the diagnosis is commonly missed. Although direct inquiry is required, obtaining a diagnosis entails more than simply checking off a list of symptoms. It frequently necessitates a nonjudgmental approach as well as gestures of empathy and attention. Patients' perceptions of trauma varies. Gently exploring for symptoms promotes the rapport required for patients to be more honest about their discomfort.
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