Post traumatic stress disorder (PTSD) significantly affects daily life. Symptoms can be managed with medications to restore functionality and therapy which can result in positive outcomes for all.
It is estimated that 5-10% of general population will suffer from PTSD at some point in their lives. Patients will often present to health services with a variety of physical and psychological complaints. Stigma towards mental health conditions can preclude patients being forthcoming with their trauma history.
If a patient presents with non-specific physical health problems this should prompt the practitioner to routinely ask about stressful or traumatic experiences. Organisations such as Phoenix Australia provide free useful resources for health professionals.
To diagnose PTSD symptoms must be present for at least a month and led to significant distress or impairment in important areas of functioning:
- Re-experiencing – intrusive distressing recollections of the traumatic event; flashbacks; nightmares; intense psychological distress; or physical reactions, such as sweating, heart palpitations or panic when faced with reminders of the event.
- Avoidance and emotional numbing – avoidance of activities, places, thoughts, feelings, or conversations related to the event; restricted emotions; loss of interest in normal activities; feeling detached from others.
- Hyperarousal – difficulty sleeping; irritability; difficulty concentrating; hypervigilance; exaggerated startle response.
Management is a multi-pronged approach. Assessment is the first and most crucial component – patients must be urgently and thoroughly assessed from both a medical and psychiatric perspective.
Medications are essential in managing symptoms that interfere with daily functioning, correcting sleep patterns and managing anxieties or flashbacks. Continuing to work and function on a daily basis aids long-term recovery. Individual therapy with a trained psychologist is important and group therapy provides essential support, providing patients the opportunity to see they are not alone and that others face similar challenges.
Traps:
- Not asking about trauma exposure. Many patients present with a variety of symptoms and often won’t reveal a trauma history unless prompted. It is easy to miss if you don’t ask.
- Ensure treating therapists have experience in trauma.
- Beware comorbid conditions – in PTSD, 86% of men and 77% of women may have another disorder (e.g. depression, substance misuse or anxiety). Assessments should always go beyond PTSD symptomatology.
- Don’t forget the families – those supporting patients with a traumatic experience are often burnt-out, depressed or anxious themselves from being a carer. Interview the main supports individually to obtain collateral history and ensure they have their own support in place (own GP/therapist) so they can continue to care for your patient.
Key messages:
- PTSD is under recognised and patients present to any doctor with comorbidities such as alcohol abuse and anxiety disorders
- Always ask your patient about history of trauma from childhood until now
- PTSD can be treated with good combination of medications and therapy such as Eye Movement Desensitisation and Reprocessing (EMDR)
The author acknowledges the contribution of Consultant Psychiatrist Dr Mathew Samuel in the writing of this update.
Author competing interests – nil relevant disclosures. Questions? Contact the editor.
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