Post-traumatic stres disorder (PTSD...

Post-traumatic stres disorder (PTSD) is an anxiety disorder that offers following exposure to a traumatic consequence The disorder has not been extensively studied in primary care; however, the ends of September 11, 2001, raised the pair public and professional awareness of PTSD Many more cases may now be diagnosed in family practice patients, because they are more apt to disclose information to their physicians and because physicians are more aware of the diagnosis. united study (1) estimated that 118 percent of patients presenting to a primary care clinic met the diagnostic criteria for PTSD

Patients with PTSD use health care resources more many times than patients without PTSD, including those who have other anxiety disorders. (12) Because of frustrations in diagnosing and managing their patient's returning medical complaints, some physicians characterize patients with PTSD as "difficult" or "heart-sink" patients--that is, patients who rouse "an overwhelming mixture of exasperation, defeat, and sometimes plain dislike." (3) active recognition and effective treatment of PTSD can greatly benefit these patients, their families, and those who work with them.

Background

The psychologic general intents of trauma have been described quite through military history. Da Costa syndrome ("soldier's heart"), which is characterized by the agency of cardiac symptoms associated with irritability and increased arousal, was described in veterans of the American Civil War. During World War I, it was hypothesized that "shell shock" springed from brain trauma caused from exploding shells. During World War II, seasons such as "combat neurosis" and "operational fatigue" were used to describe combat-related symptoms.

The Vietnam War significantly influenced the now passing concept of PTSD. In 1980 the Diagnostic and Statistical Manual of Mental Disorders, 3d ed (DSM-III) (4) established criteria for the diagnosis of PTSD Modifications were made in posterior editions. (5,6) This article reviews the present diagnostic criteria for PTSD as contained in the 4th edition, sentence revision (DSM-IV-TR) (7) and focuses in succession diagnosis and management, including the detection and treatment of comorbidities.

Diagnosis

A precipitating traumatic fact is necessary, but not sufficient, to make the diagnosis of PTSD The criteria for diagnosis specify factors concerning the victim's perception of the trauma as well as the duration and impact of associated symptoms, including persistent re-experiencing of the traumatic consequence marked avoidance of usual activities, and symptoms of increased arousal (Table 1) (7)

Before a diagnosis of PTSD can be made, symptoms must last for at least single month and must significantly disrupt normal activities. In [i]role[/i]s who have survived a traumatic result an anxiety syndrome that lasts for les than single month is termed "acute stres disorder"; this condition requires three or more dissociative symptoms in addition to the persistent symptoms associated with PTSD Symptoms of PTSD that last les than three month indicate an acute condition. A delayed picture happens in patients who begin experiencing symptoms six month or more after the traumatic issue (7)

The diagnosis of PTSD may be difficult to make for many reasons. Patients may not recognize the link between their symptoms and an experienced traumatic event; patients may be unwilling to disclose the event; or the presentation may be obscur by the agency of depression, substance abuse, or other comorbidities. (8) Direct, empathic, and nonjudgmental questioning is commended when physicians take a patient history. For example, the physician might ask, "Have you to the end of time been attacked or threatened?" or, "Have you at any time been in a severe accident or natural disaster?" (8)

Making a connection between a patient's symptoms and a trauma that occurr in childhood may be particularly difficult to establish. An appropriate question to establish this connection is, "Many the community are troubled by frightening circumstances that occurred in their childhood. Do you have this problem?" (9)

A screening questionnaire for PTSD reportedly has a sensitivity of 80 percent and a specificity of 97 percent for the diagnosis of PTSD (10) Examples of the questions include: "Do you have diminished interest in activities"; "Do you have vexed questions sleeping?"; and "Do you find it hard to perceive or show affection for others?" (10)

Epidemiology

PREVALENCE

The overall lifetime prevalence of PTSD in the United States is approximately 8 to 9 percent and the condition is twice as often met with in women. (7,11,12) Symptoms that do not appropriate the full criteria for PTSD appear to be frequent in the general population and can be quite everyday in groups at high risk of PTSD (13) For example, although the lifetime prevalence of PTSD in veterans of the Vietnam War is around 30 percent about 50 percent of Vietnam veterans had a certain clinically significant symptoms of PTSD (14)

RISK FACTORS

The epidemiology of PTSD is directly linked to the epidemiology of trauma. (11) The likelihood of developing PTSD varies with severity, duration, and proximity of the experienced trauma. (4) Approximately 25 to 30 percent of victims of traumatic consequences develop symptoms of PTSD; however, reply to trauma varies with the severity and the subjective experience associated with the trauma. (121516) In men prospect to military combat and witnessing someone being badly injured or killed are the symbols of trauma most commonly associated with a diagnosis of PTSD The greatest in quantity common traumatic events associated with PTSD in women are rape and sexual molestation. (11)