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Assessment & Management of Post-traumatic stress disorder (PTSD)
Posttraumatic stress disorder (PTSD) occurs in an estimated 8% of men and 20% of women who are exposed to traumatic events. PTSD is a trauma- and stress-related disorder associated with significant psychosocial morbidity, substance abuse, and other negative physical health outcomes. The hallmarks of PTSD include exposure to a traumatic event; reexperiencing the event or intrusion symptoms; avoidance of people, places, or things that serve as a reminder of the trauma; negative mood and thoughts associated with the trauma; and chronic hyperarousal symptoms. Self-report questionnaires can assist clinicians in identifying anxiety problems associated with traumatic events. For patients who meet criteria for PTSD, trauma-focused psychotherapy and pharmacotherapy improve symptoms. Primary care physicians should monitor patients with PTSD for comorbid conditions such as substance abuse, mood disorders, and suicidality, and should refer patients to behavioral health specialists and support groups when appropriate.
The physician should educate the patient and his or her family about PTSD symptoms, other potential consequences of trauma exposure, and any comorbid conditions. Because patients often are reluctant to discuss traumatic events and may avoid treatment as a result, it is important to elicit patient preferences for treatment interventions. Other factors that influence treatment choices include locally available resources, individual physicians' comfort level and experience, and severity of symptoms.
Trauma-focused psychotherapy and pharmacotherapy are first-line treatment options, but often must be combined with management of comorbid medical problems, such as chronic pain or sleep disturbance. Many persons with PTSD will attempt self-treatment methods, such as substance use. Physicians should have a low threshold for involving behavioral health specialists in PTSD management in the presence of comorbid substance abuse or psychiatric conditions. Patients who have substance use disorders should attempt a detoxification program, if necessary, and should be referred to a substance abuse or dual-diagnosis treatment program.