How is ptsd diagnosed?

For physical health problems, this could include laboratory tests (such as blood tests), tests (such as an X-ray, scan, or biopsy), or a physical exam. For post-traumatic stress disorder, an evaluation includes answering questions about your thoughts, feelings, and behaviors. PTSD is often diagnosed or confirmed by a mental health provider. A doctor with experience helping people with mental illness, such as a psychiatrist or psychologist, can diagnose PTSD.

Post-traumatic stress disorder (PTSD) is an anxiety disorder that occurs after exposure to a traumatic event. The disorder has not been studied exhaustively in primary care; however, the events of September 11, 2001 raised public and professional awareness about PTSD. Now many more cases can be diagnosed in family medicine patients, because they are more likely to disclose information to their doctors and because doctors know the diagnosis better. A study1 estimated that 11.8 percent of patients who went to a primary care clinic met the diagnostic criteria for PTSD.

Patients with PTSD use health care resources more frequently than patients without PTSD, including those with other anxiety disorders. 1,2 Because of the frustration of diagnosing and treating their patients' recurring medical complaints, some doctors characterize patients with PTSD as “difficult patients” or “sunken”, that is, patients who evoke “an overwhelming mix of exasperation, defeat and, sometimes, simply aversion”. The overall lifetime prevalence of PTSD in the United States is approximately 8 to 9 percent, and the condition is twice as common in women, 7,11,12 Symptoms that do not meet all the criteria for PTSD appear to be common in the general population and may be quite common in groups at high risk of suffering from PTSD, 13 For example, although the lifetime prevalence of PTSD among Vietnam War veterans is around 30 percent, about 50 percent Vietnam veterans experienced some clinically significant symptoms of PTSD, 14 The epidemiology of PTSD is directly related to the epidemiology of trauma, 11 The likelihood of developing PTSD varies depending on the severity, duration, and proximity of the trauma experienced4. Approximately 25 to 30 percent of victims of traumatic events develop symptoms of PTSD; however, the response to trauma varies depending on the severity and subjective experience associated with the trauma. 12,15,16 In men, exposure to military combat and witnessing someone seriously injured or killed are the types of trauma most commonly associated with a diagnosis of PTSD.

The most common traumatic events associated with PTSD in women are rape and sexual abuse. 11 Although PTSD is the least studied anxiety disorder, data suggest that genetic factors may increase vulnerability to PTSD if the person is exposed to an appropriate threat. 13 Age and ethnicity do not seem to affect morbidity, 12,19 Although the etiology of PTSD is unknown, most researchers believe that a personal predisposition is necessary for symptoms to develop after a traumatic event. Clinically significant symptoms after a traumatic event occur in a minority of people.

People who are likely to develop PTSD tend to have pre-existing depression or anxiety disorder, or a family history of anxiety and neuroticism. 20 In patients with PTSD, environmental cortisol levels are lower than normal; this condition has been attributed to chronic “adrenal exhaustion” due to inhibition of the HPA axis by severe and persistent anxiety. However, recent data21 indicate that cortisol levels immediately after a car accident were significantly lower in people who developed PTSD. In a related study,22 cortisol levels immediately after rape were lower in women with a history of rape.

Some researchers have hypothesized that the HPA axis and the sympathetic nervous system are dissociated in people who develop PTSD, which may allow an uncontrolled release of catecholamines that affects the formation of memories during trauma and may exacerbate symptoms when that person is exposed to post-trauma signs. 15 More than half of men with PTSD also have a comorbid alcohol problem, and a significant proportion of men and women who have PTSD Posttraumatic stress have a comorbid problem of illicit substance use, 12 In patients with PTSD, phobias tend to be more prevalent than generalized anxiety disorder or panic disorder; the risk of almost all anxiety disorders increases markedly in these patients23 (table). The duration of symptoms is variable and is affected by the proximity, duration and intensity of the trauma, as well as by comorbidity with other psychiatric disorders, 7,20 The patient's subjective interpretation of trauma also influences symptoms. 18 In patients receiving treatment, the average duration of symptoms is approximately 36 months.

In patients who do not receive treatment, the average duration of symptoms increases to 64 months. More than a third of PTSD patients never fully recover. 12 Factors associated with a good prognosis include rapid participation in treatment, early and ongoing social support, avoidance of retraumatization, positive premorbid function, and the absence of other psychiatric disorders or substance abuse, 19,25 The treatment of patients with PTSD is based on a multidimensional approach, 26 treatment options include patient education, social support, and anxiety management through psychotherapy and psychotherapy (pharmacological intervention). Patient education and social support are important initial interventions to engage the patient and mitigate the impact of the traumatic event.

Local and national support groups can help to de-stigmatize mental health diagnoses and to reaffirm that the symptoms of PTSD involve more than just a reaction to stress and require treatment. Support from family and friends encourages understanding and acceptance, which can alleviate the survivor's guilt. However, the mainstay of treatment is psychopharmacological and psychotherapeutic intervention (Figure. Studies show that cognitive-behavioral treatment is effective in improving PTSD symptoms.

In a study27 of patients who received various forms of cognitive-behavioral treatment in nine sessions over a six-week period, the percentage of patients who achieved positive terminal function (defined as a 50 percent reduction in the severity of PTSD symptoms) ranged from 21 to 46 percent. A similar study showed that between 32 and 53 percent of patients who received 10 sessions of cognitive-behavioral treatment over a period of 16 weeks achieved positive terminal function, 27 (approximately 14 percent) of patients with PTSD discontinued psychotherapy. The highest school dropout rates (up to 50 percent) occur with exposure therapy, indicating that many patients have difficulty re-experiencing trauma.26,27 The treating physician can provide a robust therapeutic intervention with good listening skills and empathic support. If the symptoms of PTSD do not resolve with initial support and medication, referring the patient to a therapist may be justified.

Because PTSD can have devastating effects on family members and people close to the patient, family and other group therapies may be indicated as a complement to the individual treatment of the patient with PTSD. 29 Another study32 demonstrated that sertraline was effective in preventing the relapse of PTSD symptoms during a 28-week maintenance phase after 24 weeks of acute treatment. This study also showed that continuous treatment with sertraline at an average daily dose of 137 mg produced a relapse rate of 5 percent, compared to a relapse rate of 26 percent in those who received a placebo. Another 32 trials (33) were conducted, including four open trials and two controlled trials with fluoxetine, and five open trials with fluvoxamine.

These studies suggest that several SSRIs are useful in improving the acute symptoms of PTSD 33. Research on the use of neuroleptic medications in patients with PTSD is mostly limited to case studies. Approximately 10 percent of patients with PTSD are treated with an antipsychotic medication; these patients tend to have symptoms of PTSD that are more intrusive and severe. 34 Case reports indicate a reduction in memories and nightmares with the use of risperidone. Clozapine was reported to be effective in a patient with concomitant psychosis who was a Vietnam War veteran.

The results of an open-label trial with olanzapine in 46 patients with combat-induced PTSD suggest possible efficacy in treating PTSD. 34 Previous studies33 indicate that the use of tricyclic antidepressants and monoamine oxidase inhibitors are moderately effective in treating PTSD and are superior to placebo; however, due to their side effect profiles, these drugs are currently considered second- or third-line agents. Open research33 on the use of mood stabilizers lamotrigine, valproate and carbamazepine shows promise in reducing the symptoms of PTSD. In addition, buspirone and clonazepam have demonstrated some benefits in reducing anxiety in patients with PTSD.

33 A recent pilot study suggests that propranolol, administered after an acute traumatic event, may have a preventive effect on the subsequent development of PTSD. 35. The psychiatrist diagnoses PTSD through a mental health evaluation. Your family doctor should perform an initial evaluation to decide what care you need. Your evaluation should include information about your physical, mental, social needs and risks.

The doctor will perform a mental health evaluation. This means that they will ask about current symptoms, history and family history. You may have a physical exam to check that there are no other reasons for your symptoms. PTSD isn't the only mental health disorder caused by traumatic experiences, and depression and anxiety disorders can be just as common.

Learn how to treat trauma and understand the signs, symptoms and treatment options for post-traumatic stress disorder (PTSD). In people who have survived a traumatic event, an anxiety syndrome that lasts less than a month is called “acute stress disorder”; this condition requires three or more dissociative symptoms, in addition to the persistent symptoms associated with PTSD. Quick facts Posttraumatic stress disorder (PTSD) can develop in response to traumatic situations, especially to highly impactful, extreme, or sudden events. While post-traumatic stress disorder (PTSD) is a debilitating anxiety disorder that can cause significant distress and increased use of health resources, the condition often goes undiagnosed.

This audio story follows Sam, a rural high school student, as he struggles with the symptoms of post-traumatic stress disorder (PTSD). This booklet provides information about post-traumatic stress disorder (PTSD), including what it is, who develops it, symptoms, treatment options, and how to find help for yourself or for another person who may have PTSD. Post-traumatic stress disorder (PTSD) is a particular set of reactions that can develop in people who have experienced a traumatic event. For detailed information on the most effective treatments for PTSD, see the Australian Guidelines for the Treatment of Acute Stress Disorder and Post-Traumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) is the term given to a specific set of reactions and health complications that occur after the experience of an event that endangered the life or safety of a person, or the safety of those around them. Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, frightening, or dangerous event. Depression, generalized anxiety, PTSD and agoraphobia are the most common disorders that can be caused by traumatic events. Symptoms that persist more than a month after the incident may indicate post-traumatic stress disorder (PTSD); learn more about symptoms and treatment.


Carole Gitlin
Carole Gitlin

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