Spotting - and treating - PTSD in primary care

Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA.
The Journal of family practice (Impact Factor: 0.89). 02/2010; 59(2):75-80.
Source: PubMed


Adopt a staged screening approach to PTSD, starting with a validated 4-question screen for patients with risk factors, and following up, as needed, with a longer (17-item) symptom checklist. Prescribe SSRIs as first-line medication for PTSD, augmented by other agents, if necessary, for symptom control. Enhance your ability to recognize and respond to patients with PTSD through continuing education, psychotherapy, participation in a Balint group, and/or expert consultation.

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    ABSTRACT: This study evaluated gender differences in lifetime traumatic events, PTSD, and depression among VA primary care patients. Participants were 865 adults attending primary care at one of four VA health centers (n = 681 males, 184 females). Mental health findings included: male PTSD 12.3% vs. female PTSD 9.2% (p > 0.05); male depression 15.9% vs. female depression 29.3% (p < 0.001). Men reported more war zone exposure (p < 0.001). Women reported more physical and sexual victimization (p < 0.001). Male logistic regression equations determined PTSD was associated with disability (OR = 3.42; 1.74-6.72, 95% CI) and war zone exposure (OR = 7.14; 3.82-13.30, 95% CI); depression was associated with war zone exposure (OR = 2.27; 1.40-3.68, 95% CI) and interpersonal violence (OR = 1.75; 1.10-2.79, 95% CI). Female PTSD was associated with sexual victimization (OR = 4.50; 1.20-16.80, 95% CI); depression was not predicted. We discuss findings in terms of the crucial need to improve identification and management of PTSD within VA primary care settings.
    Preview · Article · Oct 2010 · Military medicine
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    ABSTRACT: we determined the test performance characteristics of four brief post-traumatic stress disorder (PTSD) screening tests in a civilian primary care setting. this was a cross-sectional cohort study of adults attending a family medicine residency training clinic in the southeastern USA. Four hundred and eleven participants completed a structured telephone interview that followed an index clinic visit. Screening tests included: PTSD Symptom Checklist-Civilian Version (17 items), SPAN (four items), Breslau's scale (seven items) and Primary Care PTSD screen (PC-PTSD) (four items). A modified Clinician-Administered PTSD Scale was used to determine past month PTSD for comparison. Receiver operating characteristic analysis based on area under the curve (AUC) was used to assess diagnostic efficiency (>0.80 desired). Cut-off scores were selected to yield optimal sensitivity and specificity (>80%). past month PTSD was substantial (women = 35.8% and men = 20.0%; P < 0.01). AUC values were PTSD Symptom Checklist (PCL) (0.897), SPAN (0.806), Breslau's scale (0.886) and PC-PTSD (0.885). Optimal cut-scores yielded the following sensitivities and specificities: PCL (80.0% and 80.7%; cut-off = 43), SPAN (75.9% and 71.6%; cut-off = 3), Breslau's scale (84.5% and 76.4%; cut-off = 4) and PC-PTSD (85.1% and 82.0%; cut-off = 3). Overall and gender-specific screening test performances were explored. results confirm: (i) PTSD was common, especially among women; (ii) all four PTSD screening tests were diagnostically adequate; (iii) Two of four PTSD screening tests showed adequate sensitivity and specificity (>80%) and (iv) The PC-PTSD screening test (four items) appeared to be the best single screening test. There are few studies to establish the utility of PTSD screening tests within civilian primary care.
    Full-text · Article · Dec 2010 · Family Practice
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