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Physical assault with or without a weapon

Sexual assault

Patient responses

Review the results of the screening instrument; you need not go into detail. If someone screens positive, also screen for suicidal ideation (anxious people also attempt suicide). If you believe the patient needs a referral, suggest a consultation rather than treatment, such as “I think you have this, but I’m not sure. I’d like you to see someone who is more familiar with PTSD.”
It is important to normalize the idea of treatment; explain that treatment involves education, learning to cope with symptoms, and so on. Provide handouts about PTSD. Follow up at the next session. If the patient hasn’t followed through, ask, “What kept you from doing so?” or “What are your thoughts about treatment?” You may wish to include the patient’s spouse or significant other, if appropriate, and if the patient gives permission. Ask the patient how he or she copes with the symptoms. If there are on-going threats to the patient, determine if reporting is legally mandated. Help the patient with a plan to file a report in a way that increases his or her safety, if needed.

Treatment

Treatment involves education, pharmacotherapy, and psychotherapy, which can all be provided locally. NAMI and The National Center for Post-Traumatic Stress Disorder both have informational websites:

www.NAMI.org

www.ncptsd.va.gov

Pharmacotherapy can involve serotonergic agents, tricyclic antidepressants, antiadrenergic agents (may be effective for autonomic hyperactivity), and benzodiazepines (used extensively, but efficacy has not been proven). Psychotherapy helps the patient to break the pattern of reexamining the traumatic event. It also provides education, teaches other ways of coping, and helps the patient improve relationships.

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