Public - Posttraumatic Stress Disorder

Posttraumatic Stress Disorder

Author: Jeffrey P. Staab, MD, MS
Editorial changes - 2009-10-13
Author information and module status



		Prevention
		Screening
		Diagnosis
		Consultation for Diagnosis
		Hospitalization
		Non-drug Therapy
		Drug Therapy
		Patient Education
		Consultation for Management
		Follow-up

	Tables
	References
	Glossary
	What's New
	Patient Information
	Additional Resources
	Tools

Diagnosis
Obtain the relevant history of traumatic stress exposure and posttraumatic stress symptoms. Evaluate patients with PTSD for other psychiatric disorders that commonly follow traumatic events. Consider ordering a TSH, urine drug screen, and other tests as dictated by the clinical situation, even though laboratory tests are not absolutely indicated for healthy individuals without physical injuries. Consider depressive, anxiety, psychotic, and personality disorders in the psychiatric differential diagnosis of PTSD. Focus the physical examination on possible medical sequelae of the traumatic event and medical illnesses that can mimic individual PTSD symptoms, even though there are no physical illnesses that cause the full spectrum of PTSD.
Simplified Diagnostic Criteria for Posttraumatic Stress Disorder (PTSD) (table)
Laboratory and Other Studies for Posttraumatic Stress Disorder (table)
Differential Diagnosis of Posttraumatic Stress Disorder (table)


Obtain the relevant history of traumatic stress exposure and posttraumatic stress symptoms.
Ask patients about any exposure to traumatic stressors. Focus on active posttraumatic stress symptoms in the following four areas: Emotional or physical reactions as if the event is recurring Attempts to avoid reminders of the event Sense of being emotionally numb or detached from feelings Irritability, feeling tense or edgy, exaggerated startle reactions Note that in recently traumatized patients, serial exams may be needed to follow evolving symptoms. See table Simplified Diagnostic Criteria for Posttraumatic Stress Disorder. See table Types of Traumatic Stressors and Rates of Posttraumatic Stress Disorder.
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Evaluate patients with PTSD for other psychiatric disorders that commonly follow traumatic events.
Use screening tools or specific questions to examine patients with PTSD for other psychiatric conditions as well, particularly depression and anxiety disorders, substance abuse, and family violence. See table Screening Instruments for Posttraumatic Stress Disorder
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Consider ordering a TSH, urine drug screen, and other tests as dictated by the clinical situation, even though laboratory tests are not absolutely indicated for healthy individuals without physical injuries.
Consider screening all patients with PTSD for thyroid abnormalities and substance abuse. When cognitive symptoms are prominent, consider head imaging and neuropsychological testing. When insomnia or daytime somnolence is marked, consider a sleep study. See table Laboratory and Other Studies for Posttraumatic Stress Disorder.
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Consider depressive, anxiety, psychotic, and personality disorders in the psychiatric differential diagnosis of PTSD.
Strongly consider major and minor depressive disorders, generalized anxiety, panic disorder, phobias, substance abuse, and personality disorders in the differential diagnosis of PTSD. Note that schizophrenia and delusional disorders are much less common. See table Differential Diagnosis of Posttraumatic Stress Disorder.
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Focus the physical examination on possible medical sequelae of the traumatic event and medical illnesses that can mimic individual PTSD symptoms, even though there are no physical illnesses that cause the full spectrum of PTSD.
Focus the history and examination on medical problems that may be causing the patient's most significant symptoms (e.g., insomnia, restlessness, or fatigue), including an exacerbation of medical problems that existed before the patient's traumatic experience or newly developed conditions. See table Differential Diagnosis of Posttraumatic Stress Disorder.
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FAQs

Jeffrey P. Staab, MD, MS, is a consultant for Eli Lilly, Forest Laboratories, received honorarium from Abbott Laboratories, received grants from GlaxoSmithKline, Pfizer. Michael Roy, MD, editorial consultant, received honorarium from PFizer.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott.

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