Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) may develop (either immediately or delayed) following exposure to a stressful event or situation of an exceptionally threatening or catastrophic nature.

According to DSM-5, it is characterized by 4 groups of symptoms: intrusion symptoms, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity. These symptoms must impair function for a diagnosis to be made.

More often than not, presentation is comorbid with problems such as depression, anxiety, anger, and substance misuse.

Assessment should cover physical, psychological, and social needs, and an assessment of risk: this can be facilitated by the use of screening questionnaires and a clinical interview schedule.

Trauma-focused psychological treatments are the most effective treatment. Pharmacotherapy may be used in patients who do not respond to, cannot tolerate, do not want, or do not have access to psychological therapies.

Post-traumatic stress disorder (PTSD) may develop following exposure to 1 or more traumatic events such as deliberate acts of interpersonal violence, severe accidents, disasters, or military action. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it is characterized by 4 types of symptoms: intrusions (e.g., flashbacks, intrusive images and sensory impressions, dreams/nightmares); avoidance (e.g., avoiding people, situations, or circumstances resembling or associated with the event); negative alterations in mood and cognition (e.g., feeling alienated from others, constricted affect, diminished interest in significant activities, distorted negative beliefs about oneself or the world, and inability to remember key features of the traumatic event); and alterations in arousal or reactivity (e.g., hypervigilance for threat, exaggerated startle response, irritability, difficulty concentrating, and sleep problems). These symptoms must impair function for a diagnosis to be made.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.

Complex PTSD (CPTSD) is a new diagnosis in ICD-11 that is applied to people who have experienced prolonged, repeated, or multiple forms of traumatic exposure such as childhood abuse or torture.[2]Karatzias T, Shevlin M, Fyvie C, et al. Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) based on the new ICD-11 trauma questionnaire (ICD-TQ). J Affect Disord. 2017 Jan 1;207:181-7. http://www.ncbi.nlm.nih.gov/pubmed/27723542?tool=bestpractice.com The evidence for diagnosis and treatment of CPTSD is still in its relatively early stages; at present CPTSD remains beyond scope of this topic.

This topic does not cover PTSD in children.