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FOCUS, VOL. 1, No. 3

CLINICAL SYNTHESIS | July 01, 2003

Quick Reference for Posttraumatic Stress Disorder

FOCUS 2003;1:245-246.

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Differential Diagnosis of Posttraumatic Stress Disorder

Depression after trauma (numbing and avoidance may be present, but not hyperarousal or intrusive symptoms)

Panic disorder (if panic attacks are not limited to reminders or triggers of the trauma)

Generalized anxiety disorder (may have symptoms similar to PTSD hyperarousal)

Agoraphobia (if avoidance is not directly trauma related)

Specific phobia (if avoidance is not directly trauma related)

Adjustment disorder (usually has less severe stressor and different symptoms)

Acute stress disorder (if less than 1 month has elapsed since trauma)

Dissociative disorders (if prominent dissociative symptoms are present)

Factitious disorders or malingering (especially is secondary gain is apparent)

From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 58

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Risk Factors for Posttraumatic Stress Disorder

Past history of trauma prior to the index trauma

Past history of PTSD

Past history of depression

Past history of anxiety disorders

Comorbid axis II disorders (predictive of greater chronicity)

Family history of anxiety (including parental PTSD)

Disrupted parental attachments

Severity of exposure to trauma (more predictive of acute symptoms)

From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 12

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Course and Prognosis of Posttraumatic Stress Disorder

Course^a

4/5 of patients: longer than 3 months

3/4 of patients: longer than 6 months

1/2 of patients: 2 years’ duration

Minority of patients: symptomatic for many years or for decades

Predictors of worse outcome

Greater number of PTSD symptoms

Psychiatric history of other anxiety and mood disorders

Higher degree of numbing or hyperarousal to stressors

Comorbid medical illnesses

Female sex

Childhood trauma

Alcohol abuse

a Data from Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P: Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 1998; 55:626—632

From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 72

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Biological Models of Posttraumatic Stress Disorder

Heightened physiologic responses to traumatic stimuli

Noradrenergic activation

Highly sensitized hypothalamic-pituitary-adrenal axis

Endogenous opioid dysregulation

Dysregulated serotonergic modulation

Hippocampal toxicity, decreased volumes

Limbic hyperactivity (amygdala, cingulate) and cortical hyporesponsivity (prefrontal, Broca’s area) to traumatic stimuli

From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 102

View Large | Add to My POL

Differential Diagnosis of Posttraumatic Stress Disorder

Depression after trauma (numbing and avoidance may be present, but not hyperarousal or intrusive symptoms)

Panic disorder (if panic attacks are not limited to reminders or triggers of the trauma)

Generalized anxiety disorder (may have symptoms similar to PTSD hyperarousal)

Agoraphobia (if avoidance is not directly trauma related)

Specific phobia (if avoidance is not directly trauma related)

Adjustment disorder (usually has less severe stressor and different symptoms)

Acute stress disorder (if less than 1 month has elapsed since trauma)

Dissociative disorders (if prominent dissociative symptoms are present)

Factitious disorders or malingering (especially is secondary gain is apparent)

From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 58

View Large | Add to My POL

Risk Factors for Posttraumatic Stress Disorder

Past history of trauma prior to the index trauma

Past history of PTSD

Past history of depression

Past history of anxiety disorders

Comorbid axis II disorders (predictive of greater chronicity)

Family history of anxiety (including parental PTSD)

Disrupted parental attachments

Severity of exposure to trauma (more predictive of acute symptoms)

From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 12

View Large | Add to My POL

Course and Prognosis of Posttraumatic Stress Disorder

Course^a

4/5 of patients: longer than 3 months

3/4 of patients: longer than 6 months

1/2 of patients: 2 years’ duration

Minority of patients: symptomatic for many years or for decades

Predictors of worse outcome

Greater number of PTSD symptoms

Psychiatric history of other anxiety and mood disorders

Higher degree of numbing or hyperarousal to stressors

Comorbid medical illnesses

Female sex

Childhood trauma

Alcohol abuse

From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 72

View Large | Add to My POL

Biological Models of Posttraumatic Stress Disorder

Heightened physiologic responses to traumatic stimuli

Noradrenergic activation

Highly sensitized hypothalamic-pituitary-adrenal axis

Endogenous opioid dysregulation

Dysregulated serotonergic modulation

Hippocampal toxicity, decreased volumes

Limbic hyperactivity (amygdala, cingulate) and cortical hyporesponsivity (prefrontal, Broca’s area) to traumatic stimuli

From Hollander E, Simeon D: Concise Guide to Anxiety Disorders. Washington, DC, American Psychiatric Publishing, 2003, p 102

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Quick Reference for Posttraumatic Stress Disorder. FOCUS: The Journal of Lifelong Learning in Psychiatry. 2003 Jul;1(3):245-246.

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