Post-Traumatic Stress Disorder

Definition/diagnostic criteria Post-traumatic stress disorder (PTSD) is characterised by the development of a set of psychological symptoms following exposure to a traumatic event. According to the Royal College of Psychiatrists, the event often involves a threat to life or serious injury, but can also involve witnessing traumatic events or learning about events that happened to close relatives or friends. Symptoms include re-experiencing the trauma through flashbacks or nightmares, avoidance of reminders of the event, alterations in cognition and mood, and hyperarousal.

Epidemiology PTSD is estimated to affect about 3% of people in the UK at some point in their life. The condition can occur at any age, including during childhood. Factors that increase the risk of PTSD include the severity of the trauma, repeated trauma, pre-existing mental health conditions, and lack of support after the traumatic event.

Diagnosis
Clinical features: The clinical features of PTSD can be diverse. Patients may present with involuntary and intrusive distressing memories of the traumatic events, recurrent distressing dreams, dissociative reactions such as flashbacks, intense psychological distress, and marked physiological reactions to cues that symbolise or resemble an aspect of the traumatic events.

Investigations: There are no specific laboratory tests for diagnosing PTSD. Diagnosis is primarily clinical, informed by the patient’s history and the presence of characteristic symptoms following exposure to a traumatic event. The use of validated screening tools, such as the PTSD Checklist (PCL) or the Impact of Event Scale-Revised (IES-R), may assist in the diagnostic process.

Treatment Treatment options for PTSD include psychological therapies and pharmacological interventions. The GP should refer the patient to specialists services. Note that armed forces veterans PTSD arising from their service can be referred to secondary care more rapidly under the veterans’ priority scheme.

The first-line treatment for adults is trauma-focused psychological therapies, such as cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR).

Pharmacological treatment such as an SSRI or venlafaxine is usually considered when trauma-focused psychological treatments are not effective, not preferred by the patient or not available.

Prognosis The prognosis for PTSD varies. Some individuals recover completely with appropriate treatment, while others experience a chronic course that can last for years. Factors associated with a better prognosis include early intervention, effective social support and the absence of other comorbid conditions. However, some individuals may experience a severe and persistent form of PTSD that can have a significant impact on their functioning and quality of life.