Post-traumatic stress disorder, a psychiatric disorder, arises following exposure to perceived life-threatening trauma. Its symptoms can mimic those of anxiety or depressive disorders, but with appropriate screening, the diagnosis is easily made. Current treatment strategies combine patient education; pharmacologic interventions, such as selective serotonin reuptake inhibitors, trazodone and clonidine; and psychotherapy. As soon after the trauma as possible, techniques to prevent the development of post-traumatic stress disorder, such as structured stress debriefings, should be administered. A high index of suspicion for post-traumatic stress disorder is needed in patients with a history of significant trauma.
Post-traumatic stress disorder (PTSD) can affect a wide range of patients in family practice, regardless of culture, age, sex or socioeconomic class. Busy clinicians need to be aware of its possible diagnosis to provide compassionate and effective care to affected patients or to initiate preventive interventions to those at risk.
The overall prevalence of this disease in the U.S. population is estimated to be between 1 and 12 percent.(Solomon 5-11) In populations at risk, it ranges from 0.2 percent in postpartum women to 18 percent in professional firefighters, 34 percent in adolescent survivors of motor vehicle crashes, 48 percent in female rape victims and 67 percent in prisoners of war.(Reynolds 831-5)
The clinical course is variable. Symptoms may emerge immediately and disappear after several months, or they may take longer than six months to appear and last indefinitely. In prevalence studies, one half of those suffering from PTSD have been estimated to still meet the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV 424-9), after one year, and up to one third still have weekly symptoms 10 years after the trauma.
Four categories of criteria are needed to accurately diagnose PTSD. First, a traumatic event occurred in which the person witnessed or experienced actual or threatened death or serious injury and responded with intense fear, horror or helplessness........
