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By Peter Yellowlees
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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:
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.