Text adapted from: "The adult patient with posttraumatic stress disorder," in Psychiatry in primary care by Francesca L. Schiavone and Ruth A. Lanius (CAMH, 2019).
The risk of developing PTSD is higher in people with a history of mental illness, emotional problems, childhood trauma or adversity, and in females and people of lower socio-economic status. More severe trauma (particularly sexual and military trauma), dissociation during and after the trauma, chronic interpersonal trauma and lack of social support are also risk factors.
People with PTSD often experience shame and isolation and may not seek help or be identified because they find it difficult to disclose trauma. While PTSD can have significant impacts on a person’s quality of life, proper screening and treatment can significantly improve functioning and quality of life.
What is reasonable to expect of a primary care practitioner?
- Take a basic trauma history, screen for PTSD and make an initial diagnosis.
- Identify common comorbidities and arrange for parallel management.
- Conduct a careful risk assessment with particular attention to suicidality.
- Provide basic psychoeducation on PTSD and dissociation.
- Counsel patients about psychotherapy and pharmacotherapy options.
- Be aware of local PTSD treatment resources, and refer patients to appropriate psychotherapy.
- Initiate an SSRI or venlafaxine.
- Initiate an adjunctive agent, such as prazosin or an atypical antipsychotic, if an SSRI or venlafaxine is not adequate.
When to refer to a specialist
Patients who require psychotherapy should be referred to a psychotherapist (MD or non-MD) who is experienced in treating psychological trauma and who practises in a modality that is acceptable to the patient. Consider referring patients for specialist consultation in the following situations:
- extensive comorbidity or severe illness
- diagnostic uncertainty
- no response to or intolerance of at least two medications
- severe dissociative symptoms.