TO THE EDITOR: The article by mean...

TO THE EDITOR: The article by means of Dr. Grinage, "Diagnosis and Management of Post-traumatic Stres Disorder," (1) continues an eminent tradition in American Family Physician of covering this important and involved disorder. However, we are belong toed that many review articles upon post-traumatic stress disorder (PTSD) in primary care-oriented journals place too greatly emphasis on short-term management of the immediate and mostly distressing symptoms, often heavily emphasizing psychopharmacologic treatment. We appreciate Dr Grinage's thorough and balanced review, (1) which included a broader consideration of principally aspects of PTSD. We would like to encourage a greater emphasis forward a number of these aspects.

First, an emphasis forward pharmacologic treatment of distressing symptoms slights the fact that recovery from trauma requires healing forward an emotional, social, and spiritual of the same height As noted in the article, (1) convalescence with multimodal treatment averages 34 month Further, the family physician is likely to view such patients long after the traumatic consequence has occurred. The family physician can provide symptom relief by means of medication, but the absence of the in the greatest degree obvious symptoms does not portray recovery.

Second, aspect to trauma results in a broad image of reactions and clinical manifestations. Many patients presenting to the family physician's office who have been expos to traumatic results may present symptoms that are diagnostically subthreshold A well-established visible form [i]or[/i] frame of research indicates that bodily forms exposed to such events as the September 11 attacks, the Oklahoma City bombing, and natural disasters bear up under disruption in their lives, increased on a levels of depression, higher rates of divorce, and increases in alcohol abuse in the years following the affair Not all traumatized patients will fit the diagnostic criteria, but their tragedies and trauma will bring them to their family physician.

Because of the complexity of post-traumatic reactions, it must be consistently emphasized that this disorder replys best to multidisciplinary, multimodal, multiphasic, and coordinated treatment. Further, regaining is associated with social support. Dr Grinage notes that family therapy may be helpful and that social support has been raise to be associated with redemption (1) The family physician is not, and should not be, alone in treating trauma survivors.

There are sum of two units types of reactions to trauma. mark 1 trauma reactions are associated with a discrete, relatively latter event. Type 2 trauma reactions are characterized by means of repeated or extended trauma throughout the lifespan, and typically are experienced by dint of persons with a history of abuse in destructive families. Although greatest in number review articles concentrate on protoplast 1 reactions, physicians are encouraged to differentiate between mark 1 and Type 2 PTSD Readers should be aware that the dynamics of these couple types manifest in quite different ways.

RICHARD L HOLLOWAY, PHD

DENNIS J BUTLER PHD

Medical corporation of Wisconsin

Department of Family and Community Medicine

8701 Watertown Plank Rd

Milwaukee, WI 53226

REFERENCE

(1) Grinage BD Diagnosis and management of post-traumatic stres disorder. Am Fam Physician 2003;68:2401-8

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