Posttraumatic Stress Disorder Diagnosis and Assessment (2006) / Chapter Skim
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2 Diagnosis and Assessment
2 Diagnosis and Assessment
Pages 13-28
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From page 13... ...
. In some cases, it occurs alone, but most people who have PTSD also have other psychiatric disorders, such as major depressive disorder (Black et al.
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, also includes diagnostic criteria for PTSD. The ICD diagnostic criteria for PTSD are similar to those in DSM-IV but do not include the DSM-IV criterion A2, that a response to a traumatic event involves intense fear, helplessness, or horror.
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physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event C Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma)
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In other cases, a patient might present to a mental health professional who is conversant with the diagnosis of PTSD and is better able to elicit a narrative of exposure and symptoms, or a family member or other person familiar with the veteran might seek advice from a health professional about coping with a veteran who might be suffering from PTSD. The presenting symptoms and initial diagnostic process are variable and will necessitate a brief or long assessment, depending on the veteran's symptoms, mental and physical health, willingness and capacity to work with the health professional, and the presence of other physical or psychiatric disorders.
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Depending on the mental and physical health of the veteran, the veteran's willingness and capacity to work with the health professional, and the presence of comorbid disorders, the process of diagnosis and assessment will likely take at least an hour or could take many hours to complete. Unfortunately, many health professionals do not have the time or experience to assess psychiatric disorders adequately or are reluctant to attribute symptoms to a psychiatric disorder.
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From page 18... ...
. Types of traumatic stressors related to war include serving in dangerous military roles, such as driving a truck at risk for encountering roadside bombs, patrolling the streets, and searching homes for enemy combatants, suicide attacks, sexual assaults or severe sexual harassment, physical assault, duties involving graves registration, accidents causing serious injuries or death, friendly fire, serving in medical units, killing or injuring someone, seeing someone being killed, injured, or tortured, and being taken hostage.
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(N = 815) Being attacked or 58 89 95 ambushed Receiving incoming 84 86 92 artillery, rocket, or mortar fire Being shot at or 66 93 97 receiving small arms fire Shooting or directing 27 77 87 fire at the enemy Being responsible for 12 48 65 the death of an enemy combatant Being responsible for 1 14 28 the death of a noncombatant Seeing dead bodies or 39 95 94 human remains Handling or 12 50 57 uncovering human remains Seeing dead or 30 65 75 seriously injured Americans Knowing someone 43 86 87 seriously injured or killed Participating in 16 38 34 demining operations
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2004. ASSESSMENT In addition to the formal diagnostic process, a more comprehensive assessment of a PTSD patient would include a determination of comorbidity, symptom severity, functional status, neuropsychologic impairments, and malingering.
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While a thorough clinical interview is likely to uncover existing comorbidities, some diagnostic instruments, such as the Structured Clinical Interview for DSM-IV, might also be used. A comprehensive evaluation also will assess symptom severity (frequency and intensity)
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. The DSM acknowledges the potential for malingering in the presentation of PTSD and recommends that health professionals keep several factors in mind when assessing a patient, particularly in a medicolegal context; these include any significant discrepancies between a patient's reports of his or her symptoms and the clinical findings, a lack of cooperation on the patient's part in the diagnostic process or in following prescribed treatment, and the presence of antisocial personality disorder (APA 2000)
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BIOMARKERS OF POSTTRAUMATIC STRESS DISORDER A biomarker is a measurable biologic change that occurs in association with a disease before, simultaneously with, or as a consequence of the disease. A biomarker is not a diagnostic marker.
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1995. MRI based measurement of hippocampal volume in patients with combat related posttraumatic stress disorder.
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1995. Posttraumatic stress disorder in the National Comorbidity Survey.
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2005. Delayed onset of posttraumatic stress disorder among male combat veterans: A case series.
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From page 27... ...
II. Applications to neurobiology and treatment in posttraumatic stress disorder.
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