A pharmacotherapeutic approach to the management of chronic posttraumatic stress disorder.
ABSTRACT Due to relatively recent and ongoing world events (eg, terrorist attacks, wars, and natural disasters), there has been a shift in attention from some of the more common psychiatric illnesses to one of the more elusive, namely, posttraumatic stress disorder (PTSD). PTSD is a severe, and often chronic, condition that can lead to significant morbidity and mortality. Although originally a condition seen primarily among war veterans, PTSD is now becoming more prevalent in the general community. PTSD often presents concurrently with other conditions, such as depression, bipolar, anxiety/panic disorders, and alcohol and drug abuse. Because of this, PTSD often goes unrecognized and is underdiagnosed in clinical practice. Thus, an opportunity for pharmacist intervention exists, both in the institution and in the community. With proper education and training, pharmacists can be efficient in screening for signs and symptoms of PTSD, triaging appropriate patients, and can play an integral role in managing the diverse array of drug therapy options for PTSD.
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ABSTRACT: Current US mental disorder prevalence estimates have limited usefulness for service planning and are often discrepant. Data on clinical significance from the National Institute of Mental Health Epidemiologic Catchment Area Program (ECA) and the National Comorbidity Survey (NCS) were used to produce revised estimates, for more accurate projections of treatment need and further explication of rate discrepancies. To ascertain the prevalence of clinically significant mental disorders in each survey, responses to questions on life interference from, telling a professional about, or using medication for symptoms were applied to cases meeting symptom criteria in the ECA (n = 20,861) and NCS (n = 8098). A revised national prevalence estimate was made by selecting the lower estimate of the 2 surveys for each diagnostic category, accounting for comorbidity, and combining categories. Using data on clinical significance lowered the past-year prevalence rates of "any disorder" among 18- to 54-year-olds by 17% in the ECA and 32% in the NCS. For adults older than 18 years, the revised estimate for any disorder was 18.5%. Using the clinical significance criterion reduced disparities between estimates in the 2 surveys. Validity of the criterion was supported by associations with disabilities and suicidal behavior. Establishing the clinical significance of disorders in the community is crucial for estimating treatment need. More work should be done in defining and operationalizing clinical significance, and characterizing the utility of clinically significant symptoms in determining treatment need even when some criteria of the disorder are not met. Discrepancies in ECA and NCS results are largely due to methodologic differences.Archives of General Psychiatry 03/2002; 59(2):115-23. DOI:10.1001/archpsyc.59.2.115 · 13.75 Impact Factor
- Focus (San Francisco, Calif.) 01/2009; 7(2):1-9. DOI:10.1176/foc.7.2.foc204
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ABSTRACT: Posttraumatic stress disorder (PTSD) is a fairly common psychiatric disorder that is associated with a lifetime prevalence of approximately 9% in the United States. In light of recent war and terrorist activity worldwide, it is likely that increased numbers of individuals will be exposed to severe or life-threatening trauma, and the incidence of PTSD may be even higher than previously indicated in epidemiologic studies. PTSD may develop after exposure to a traumatic event in which the individual experienced, witnessed, or was confronted by either actual or threatened loss of life or serious injury. Patients with PTSD often reexperience intrusive recollections of the event in ways that are highly distressing and may be described as reliving the memory. Not surprisingly, symptoms of avoidance are noted because individuals with PTSD often wish to escape recollections (thoughts, feelings, conversations, places) related to the trauma. Patients also experience symptoms of hyperarousal associated with difficulty concentrating or exaggerated startle response. Notably, individuals who develop PTSD represent only a subset of those exposed to trauma. It is of interest why certain individuals are at risk for development of PTSD after traumatic exposure, whereas others appear to be more resilient to the effects of trauma. Studies suggest that previous exposure to trauma and intensity of the response to acute trauma may affect the development of PTSD. In addition, however, neuroendocrine changes, such as lower cortisol levels, also may influence formation and processing of traumatic memories and may be associated with the underlying pathology of PTSD.The Journal of Clinical Psychiatry 02/2004; 65 Suppl 1(Suppl 1):29-36. · 5.14 Impact Factor