Home | | Psychiatry | Post Traumatic Stress Disorder: Assessment, Course and Natural History

Chapter: Essentials of Psychiatry: Anxiety Disorders: Traumatic Stress Disorders

Post Traumatic Stress Disorder: Assessment, Course and Natural History

The comprehensive evaluation of PTSD should include information from the individual, collaterals, psychometric indices (such as self-reported questionnaires) and a clinical interview.

Assessment

 

The comprehensive evaluation of PTSD should include information from the individual, collaterals, psychometric indices (such as self-reported questionnaires) and a clinical interview. The standard for diagnosis in clinical research studies is always to use a structured clinical interview. The use of self-report instruments can be used to corroborate information obtained in the clinical interview, or can be used as a screening assessment for a clinical interview. All information would then be integrated on the basis of clinical judg-ment, especially if discrepancies existed. A number of structured interviews exist, along with other self-rating scales. The “gold standard” of clinical interviewing is the Clinician-Administered PTSD scale (Blake et al., 1990). Other instruments that have been used to evaluate PTSD are the Structured Clinical Interview for DSM-IV, the Diagnostic Interview Schedule and the Structured Interview for PTSD. Self-rated measures that can be used in-clude self-rating psychometric assessments, such as the Davidson Trauma Scale, the Short PTSD Rating Instrument (SPRINT), the PTSD Checklist, the PK scale on the Minnesota Multiphasic Personality Inventory, the Mississippi Scale for Combat-Related PTSD, the Impact of Events Scale and the PTSD Scale.

 

Structured interview and psychometric measures are also available for children with PTSD but are less well developed with regard to validity and reliability. A version of the Clinician-Administered PTSD Scale for children and adolescents allowsfor current and lifetime diagnoses as well as the dimensional assessment of PTSD symptoms and related psychopathology. It has also been suggested that the use of additional measures (such as the Conners Parent Rating Scale and Conners Teacher Rating Scale) are important adjuncts to assess externalizing collateral symptoms, whereas the Children’s Depression Inventory can be used to assess internalizing symptoms found in PTSD.

 

Course and Natural History

 

Immediately following traumatic exposure, a high percentage of individuals develop a mixed symptom picture, which includes disorganized behavior, dissociative symptoms, psychomotor change and, sometimes, paranoia. The diagnosis of ASD (de-scribed later) accounts for many of these reactions. These reac-tions are generally short-lived, although by 1 month the symptom picture often settles into a more classic PTSD presentation, such that after rape, for example, as many as 90% of individuals may qualify for the diagnosis of PTSD. Approximately 50% of people with PTSD recover, and approximately 50% develop a persist-ent, chronic form of the illness still present 1 year following the traumatic event.

 

The longitudinal course of PTSD is variable and perma-nent recovery occurs in some people, whereas others show a relatively unchanging course with only mild fluctuation. Still others show a more obvious fluctuation with intermittent periods of well-being and recurrences of major symptoms. In a limited number of cases, the passage of time does not bring a resolu-tion of symptoms, and the patient’s condition tends to deteriorate with age. Particular symptoms that have been noted to increase with time in many people include startle response, nightmares, irritability and depression. Clinicians during World War II also observed that the existence of marked startle response and hy-pervigilance in the acute aftermath of exposure to combat often represented a comparatively poor prognostic sign. In children, PTSD can be, and often is, chronic and debilitating.

 

General medical conditions may occur as a direct con-sequence of the trauma (e.g., head injury, burns). In addition, chronic PTSD may be associated with increased rates of adverse physical outcomes, including musculoskeletal problems and car-diovascular morbidity.

 

Overall Goals of Treatment

 

General principles of treating PTSD involve explanation and destigmatization, which can be provided both to the patient and to family members. This often includes a description of the symptoms of PTSD and the way in which it can affect behaviors and relation-ships. Information can be given about general treatment principles, pointing out that sometimes cure is attainable but that at other times symptom containment is a more realistic treatment goal, par-ticularly in chronic and severe PTSD. Regaining self-esteem and attaining greater control over impulses and affect are also desired in many instances. Information can be provided as to appropriate literature, local support groups and resources, and names and ad-dresses of national advocacy organizations. If the therapist attends to these important issues early in treatment, the patient is able more readily to build trust and also to appreciate that the therapist shows a good understanding both of the condition and of the patient.

 

PTSD is sometimes comparatively straightforward to treat and at other times it is more complicated. However, treatment by a mental health provider (rather than a primary care provider) is almost always indicated. The initial history taking can evoke strong affect to a greater degree than is customarily found in otherdisorders. In fact, it may take several interviews for the details to emerge. A sensitive yet persistent approach is needed on the part of the interviewer. During treatment, although the mental health care provider will clearly want to impart a sense of optimism to the patient, it is also a reflection of reality to point out early that recovery may be a slow process and that some symptoms (e.g., phobic avoidance, startle response) may persist. It is important for the mental health care provider to be comfortable in hearing and tolerating unpleasant affect and often horrifying stories. All these must take place in a noncritical and accepting manner.

 

Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail
Essentials of Psychiatry: Anxiety Disorders: Traumatic Stress Disorders : Post Traumatic Stress Disorder: Assessment, Course and Natural History |


Privacy Policy, Terms and Conditions, DMCA Policy and Compliant

Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.