1. Detecting and Diagnosing PTSD in Primary Care Joseph Sego Advisor Dr. Grimes

2. 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

3. 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

4. Events that trigger PTSD. violent personal assaults natural or human caused disasters accidents military combat

5. 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 survivors of unexpected dangerous events, such as a car accident, natural disaster, or terrorist attack

6. 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).

7. 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

8. 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

9. 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)re-experiencing the event (in flashbacks, dreams, or distress at cues that resemble the event) (2)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) (3)and increased arousal (sleep disturbance, irritability, difficulty concentrating, hyper vigilance, or startles easily)

10. Now what? Make the diagnosis of PTSD. This done by using the DSM-IV. (1)Criterion A: stressor (2)Criterion B: intrusive recollection (3)Criterion C: avoidant/numbing (4)Criterion D: hyper-arousal (5) Criterion E: duration Duration of the disturbance (symptoms in B, C, and D) is more than one month. (6) Criterion F: functional significance The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

11. Treatment Treatment is a multidisciplinary approach done with psychological intervention and pharmacotherapy Examples of psychotherpy used are: (1)cognitive behavior therapy (CBT) (2)exposure therapy (3)eye movement desensitization reprocessing (EMDR) (4)group therapy Pharmacotherapy (1)SSRIs (2)TCAs (3)MOAIs

12. 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

13. Practical Guideline for Detecting and diagnosing PTSD 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.

14. 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.