Posttraumatic stress disorder in the primary care medical setting

Stein, Murray B.; McQuaid, John R.; Pedrelli, Paola; Lenox, Rebecca; McCahill, Margaret E.

doi:10.1016/s0163-8343(00)00080-3

Cited by 296 publications

(220 citation statements)

References 38 publications

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“…14 Rates of PTSD in the general public have been estimated at 7.8% 15 and increase further in primary care settings to approximately 11% to 12%. 16,17 PTSD rates in cardiac clinics range from 0% to 24% prevalence 18 -24 and have recently been established in an ICD clinic to be approximately 20%. 14 Ladwig et al found that experience of sudden cardiac arrest outside of the hospital setting resulted in an even greater prevalence of PTSD (27% to 38%).…”

Section: Prevalence and Clinical Impact Of Ptsdmentioning

confidence: 99%

Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient

Sears

Hauf

Kirian

et al. 2011

Circ: Arrhythmia and Electrophysiology

117

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he implantable cardioverter-defibrillator (ICD) has revolutionized the care of patients at risk for life-threatening arrhythmias. Large-scale clinical trials established mortality benefits for the ICD over usual care or medications 1,2 and led to wider use for both primary and secondary prevention indications. More recent research confirms that the mortality benefits of the ICD extend over 8-year follow-up when compared with usual care. 3 These clinical trial successes, in terms of mortality, have allowed for greater focus on patientcentered outcomes, such as quality of life, device acceptance, psychological well-being, and trauma reactions in research and clinical care. 4 Shock has been a primary focus in this work because of its potentially traumatic impact on the patient experience. Although there is mixed evidence on the effect of single ICD shocks, 5,6 the literature consistently supports the negative impact of Ͼ5 shocks on quality of life and emotional distress. 7,8 ICD shock has been a focus of research interest because it is a unique experience for the ICD patient and can be perceived as a traumatic event. In addition, the existence of concomitant heart disease, angina, congestive heart failure, or previous sudden death may create sensitivity to traumatic stress that warrants improved understanding by attending electrophysiologists. Although psychological distress in ICD patients has been explored, the possibility that some ICD patients have trauma reactions, up to and including posttraumatic stress disorder (PTSD), has garnered increased attention recently. Therefore, the purposes of this report are to highlight the theory and research addressing psychological distress including PTSD in electrophysiology clinics, to discuss clinical management of these sequelae, and to suggest areas of future research and development. Psychosocial Distress of ICD Patients in Electrophysiology ClinicsPrevention and identification of distress in ICD patients represents comprehensive, high-quality care, regardless of the cause (eg, depression, anxiety, trauma), consistent with the biopsychosocial model of care. 9 This model of care entails the conceptualization and treatment of health problems as an interplay between biological factors, psychological factors, and social factors culminating in the manifestation of symptoms. For an electrophysiologist, these ambitious goals can include prevention of distress through cardiac care and education, recognition of distress warranting referral, optimizing quality-of-life (QoL) outcomes, and promoting patient acceptance of the ICD. Clearly, these are not easily accomplished without sufficient awareness, clinical support, and interdisciplinary expertise. Below are some key considerations for daily clinical practice. Prevalence and Impact of Psychosocial DistressGeneral or ICD-specific anxiety as a psychological morbidity has a point prevalence of 13% to 38% of ICD recipients in cross-sectional research. 4 Longitudinal assessment of anxiety has indicated that approximately 35% of pati...

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Section: Prevalence and Clinical Impact Of Ptsdmentioning

confidence: 99%

Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient

Sears

Hauf

Kirian

et al. 2011

Circ: Arrhythmia and Electrophysiology

117

View full text Add to dashboard Cite

show abstract

“…Posttraumatic stress disorder (PTSD) affects over 10 % of adults, 1,2 up to 23 % in primary care settings, [3][4][5][6][7][8] and is associated with poor functioning, quality of life, [9][10][11][12] and financial costs to society. 13,14 Evidence-based treatments for PTSD include the use of selected serotonin reuptake inhibitors, especially sertraline but also fluoxetine, as the first line of pharmacological treatment, and evidence-based psychotherapies-exposure therapy, cognitive-behavioral therapy, and eye movement desensitization and reprocessing, along with patient education and adjunctive support services.…”

Section: Introductionmentioning

confidence: 99%

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

et al. 2016

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BACKGROUND:The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs). OBJECTIVE: We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM). DESIGN: This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year. PARTICIPANTS: We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD. MAIN MEASURES: The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months. KEY RESULTS: Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7 % for PCM patients and 60.6 % for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14 % higher (p < 0.01) and mental health medication prescription rates that were 15.2 % higher (p < 0.01) than patients with no engagement. CONCLUSIONS:A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.

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“…Prevalence estimates among medical patients range from 7% to 36%. [15][16][17][18][19] Although PTSD confers significant psychiatric disturbance, functional impairment, and morbidity as a singular diagnosis, 18,20,21 depression and PTSD commonly co-occur.…”

Section: Introductionmentioning

confidence: 99%