Post-traumatic stress disorder: A review for the general psychiatrist

Post-traumatic stress disorder affects about one in every hundred of the population at any particular time. Aetiological factors include genetics, personality, a background of psychiatric problems, the personal meaning of the traumatic event, issues of proximity or intensity, childhood abuse, and the initial emotional response to stress. Many precipitants are known, ranging from combat through rape or torture to difficult parturition. Core symptoms are reflective of the traumatic precipitant. Prolonged symptoms are associated with prior psychiatric or physical problems, poverty, repeated assault, alcohol or drug abuse, and cultural factors. Co-morbidity is high, especially for depression, alcohol and drug misuse. Reduced hippocampal volume, corticosteroid abnormalities, and adrenergic overactivity have been described. The use of official criteria and specific measuring instruments help in differential diagnosis. Management needs to be tailored to the needs of the individual and the stage of the disorder, and includes psychotherapy, antidepressants, and the newer eye-movement desensitization and reprocessing approach. ( Int J Psych Clin Pract 2001; 5:11-18).