Posttraumatic stress disorder in women: assessment and treatment in primary care

The Occurrence of Posttraumatic Stress Disorder in Patients Following Intensive Care Treatment: A Cross-Sectional Study in a Random Sample

Posttraumatic stress disorder (PTSD) can now be applied to patients who have just had intensive care treatment. The authors tested whether the reliability of the diagnosis depends on the measuring instrument used and whether the occurrence of PTSD is related to the presence of preexisting psychic disorders or to a worsening of the patients’ general condition. The authors examined 41 former patients of an intensive care unit (ICU) with the Posttraumatic Scale (PTSS-10) and, afterward, with the Structured Clinical Interview (SCID). Screening with PTSS-10 showed that 17.07% of the patients met the recommended threshold for probable diagnosis of PTSD of 35 or more points. With SCID, PTSD could be confirmed in 9.76% of the cases. Patients with a prior psychiatric disease showed more frequent (P< .02) occurrences of PTSD. The severity of their Acute Physiology and Chronic Health Evaluation System II (Apache II) scores had no significant influence. PTSS-10 can be used for a preliminary diagnostic orientation. With the PTSD module of the SCID, a structured diagnostic tool is available. Almost twice as many PTSD cases were diagnosed among the subjects with the PTSS-10 as with SCID. Post-ICU PTSD occurred more frequently among patients with prior psychiatric diseases; however, it was not dependent on exacerbation of the patient’s Apache II scores.

The current state of intervention research for posttraumatic stress disorder within the primary care setting

Posttraumatic Stress Disorder (PTSD) is common among primary care patients and is associated with significant functional impairment, physical health concerns, and mental health comorbidities. Significant barriers to receiving adequate treatment often exist for primary care patients with PTSD. Mental health professionals operating as part of the primary care team have the potential to provide effective brief intervention services. While good PTSD screening and assessment measures are available for the primary care setting, there are currently no empirically supported primary care-based brief interventions for PTSD. This article reviews early research on the development and testing of primary care-based PTSD treatments and also reviews other brief PTSD interventions (i.e., telehealth and early intervention) that could be adapted to the primary care setting. Cognitive and behavioral therapies currently have the strongest evidence base for establishing an empirically supported brief intervention for PTSD in primary care. Recommendations are made for future research and clinical practice.

Perinatal mental health

Pregnancy is the time during which physiological and psychological preparation for motherhood takes place. It has long been considered a blessed time, free of psychiatric disorders. However, there is now strong evidence that major depressive disorder may occur not only after birth but even during the prepartum. Most often, mental illness during this period is underestimated, not assessed, therefore not diagnosed, and consequently goes untreated. Reviewing the literature on the negative impact of both maternal and infant health in case of perinatal depression, we underline that recognizing and treating prenatal depression will lead to preventive and curative treatments for mothers, enhance infant health, and therefore positively influence mother-infant relationships.

Shifting landscapes: immigrant women and postpartum depression

Utilizing an ethnographic narrative approach, we explored in the Canadian context the experiences of three groups of first-generation Punjabi-speaking, Cantonese-speaking, and Mandarin-speaking immigrant women with depression after childbirth. The information emerging from women's narratives of their experiences reveals the critical importance of the sociocultural context of childbirth in understanding postpartum depression. We suggest that an examination of women's narratives about their experiences of postpartum depression can broaden the understanding of the kinds of perinatal supports women need beyond health care provision and yet can also usefully inform the practice of health care professionals.

Adult Post-Traumatic Stress Disorder: Screening and Treating in Primary Care

Trauma and post-traumatic stress disorder (PTSD) affect patients' physical health and daily functioning. Primary care physicians should remember to screen for trauma history and symptoms of PTSD when patients present with somatization, chronic pain, or other unexplained symptoms. Perceived loss of control, including physical examinations and procedures, may be frightening, and physicians should ask the patient's permission before touching them. Patients who have PTSD benefit from treatment, including both psychopharmacology (primarily selective serotonin reuptake inhibitors) and psychotherapy. Finally, hearing patients' stories of trauma and exposure to very sick patients can be traumatizing for physicians, who are encouraged to actively engage in self-care activities.

Posttraumatic stress disorder in primary care: prevalence and relationships with physical symptoms and medical utilization

OBJECTIVE

This study estimates the prevalence of posttraumatic stress disorder (PTSD) and describes the relationships among PTSD status and health indices in a civilian primary care patient sample.

METHODS

Participants (N = 232) completed a paper-and-pencil survey of life events, PTSD symptoms, physical symptoms and health functioning. Utilization was assessed from medical records.

RESULTS

Nine percent of the participants met the criteria for full PTSD (based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) and another 25% were defined as partial PTSD. The full-PTSD group evidenced higher rates of medical utilization, more intense physical symptoms and poorer health functioning than the no-PTSD group. The partial-PTSD group more closely resembled the full-PTSD group.

CONCLUSIONS

This study, although limited by sample size and diagnosis by questionnaire vs. diagnostic interview, suggests research directions for enhancing our understanding of PTSD among civilian primary care patients and for developing appropriate interventions that can be conducted in the primary care setting.

Diagnóstico do transtorno de estresse pós-traumático

Só recentemente a Psiquiatria Brasileira começou a reconhecer a importância do diagnóstico do transtorno de estresse pós-traumático (TEPT). Embora os brasileiros tenham uma alta prevalência de exposição a eventos traumáticos, como acidentes e homicídios, há poucos estudos teóricos e empíricos sobre o TEPT em nosso país. Este artigo tem como foco descrever brevemente o diagnóstico de TEPT, detalhando sua fenomenologia. Após discutir a definição de evento traumático, nós focalizamos nos desafios do exame psíquico desses pacientes. Em seguida enfatiza-se a descrição dos sintomas do TEPT, dando exemplos clínicos para ilustrar os mais importantes conceitos psicopatológicos. Concluímos, salientando a importância do diagnóstico de TEPT para a Psiquiatria, pois ele fornece uma estrutura referencial-conceitual para a pesquisa dos efeitos do estresse e do trauma.