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Detecting and Diagnosing
PTSD in Primary Care
Joseph Sego
Advisor Dr. Grimes
Introduction
What is PTSD?
• According to the National Institute of Mental Health, PTSD, is an
anxiety disorder that can develop after exposure to a terrifying event
or ordeal in which grave physical harm occurred or was threatened
• It accounts for an estimated 12% to 25% of patients seen in primary
care
• In any year there are 5.2 million Americans that have PTSD
• An individual’s chance of being exposed to a traumatic experience
over their life is 60.7% for men and 51.2% for women
• It was not until 1980 that the Diagnostic and
Statistical Manual of Mental Disorders, Third
Edition, made its official diagnosis PTSD has
been labeled several different names, dating
back as early as the American Civil War
• The terrorist attacks on September 11, 2001,
brought the diagnosis to the forefront of civilian
mental health
Events that trigger PTSD.
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violent personal assaults
natural or human caused disasters
accidents
military combat
Increased risk for developing
PTSD
• anyone who was a victim of, witnessed or has
been exposed to a life threatening situation
• survivors of violent acts, such as domestic
violence, rape, sexual physical and/or verbal
abuse or physical attacks
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• survivors of unexpected dangerous events, such
as a car accident, natural disaster, or terrorist
attack
• combat veterans or civilians exposed to war accidents
• people who have learned of or experienced an
unexpected and sudden death of a friend or relative
• emergency responders who help victims during
traumatic events
•
children who are neglected and/or abused (physically,
sexually, or verbally).
The likelihood of developing this
disorder.
• how intense the trauma was or how long it lasted
• if you lost someone you were close to or were hurt
• how close you were to the event
• how strong your reaction was
• how much you felt in control of events
• how much help and support you got after the event
How will the patient present?
• their symptoms are often vague, complex,
and difficult to interpret
• may present with general health
complaints, including headaches,
gastrointestinal problems, rheumatic
pains, and skin problems
Symptoms
Remember symptoms can begin soon after a traumatic experience or it
may take months or even years
There are three principle symptoms of PTSD
(1)
(2)
(3)
re-experiencing the event (in flashbacks, dreams, or distress at
cues that resemble the event)
avoidance and numbing (avoiding remembering, inability to
remember the event, feelings of detachment, diminished interest
in activities, or a sense of a fore shortened future)
and increased arousal (sleep disturbance, irritability, difficulty
concentrating, hyper vigilance, or startles easily)
Now what?
Make the diagnosis of PTSD.
This done by using the DSM-IV.
(1)
(2)
(3)
(4)
(5)
(6)
Criterion A: stressor
Criterion B: intrusive recollection
Criterion C: avoidant/numbing
Criterion D: hyper-arousal
Criterion E: duration
Duration of the disturbance (symptoms in B, C, and D) is more than one
month.
Criterion F: functional significance
The disturbance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
Treatment
•
Treatment is a multidisciplinary approach done with psychological
intervention and pharmacotherapy
•
(1)
(2)
(3)
(4)
Examples of psychotherpy used are:
cognitive behavior therapy (CBT)
exposure therapy
eye movement desensitization reprocessing (EMDR)
group therapy
Pharmacotherapy
(1)
(2)
(3)
SSRIs
TCAs
MOAIs
Management and referral of
PTSD patients
• General practitioners and physician assistants
are capable of treating PTSD patients
• However, the health care provider must know
their limitations
• If or when a PTSD patient’s symptoms are
severe, associated with high levels of prolonged
distress, or interfere in social and occupational
function, this is the time for referral to a mental
health provide
Practical Guideline for Detecting
and diagnosing PTSD
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Remember these patients are more than likely not going to
come in for an office visit due to their traumatic experience and
these patients may have personal or family history of psychiatric
illnesses.
Get a good history.
Must have suffered a traumatic event.
Must have symptoms of re-experiencing the event, avoidance,
and increased arousal.
These symptoms must be going on longer than one month.
If your patient presents with the above history and symptoms go
to the DSM IV for making a diagnosis of PTSD or refer to the
patient to a psychiatrist.
After diagnosis is made, start treatment.
Conclusion
• With traumatic experiences happening on
a daily basis, there seems to be no end in
sight for this disorder. This means that
primary care providers will continue to see
more patients that have PTSD.
• Remember PTSD is a real and unforgiving
problem.