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PTSD
Approach to PTSD diagnosis
Extended follow-up of survivors of ICU treatment has shown many patients suffer long-term physical and psychological consequences that affect their quality of life. One form of psychological morbidity, post traumatic stress disorder (PTSD), is increasingly reported in ICU survivors. PTSD is a condition categorised by an individual experiencing or witnessing a traumatic event involving actual or threatened death or serious injury. The event itself elicits a reaction of intense fear, helplessness and horror, and subsequently symptoms of intrusion, avoidance and arousal. The events preceding an ICU admission and the subsequent ‘ICU experience’ expose a patient to numerous physiological and psychological stressors that could initiate or intensify a ‘stress reaction’ that may lead to PTSD. PTSD should ideally be diagnosed using consistent criteria and reliable instruments that exhibit high inter-rater reliability, are stable over time and are able to assess individual patients presenting with wide symptom variance. At the current time, the PTSD diagnostic gold standard remains structured clinical interview to predefined criteria (DSM-IV). For obvious reasons, standardised interview is not always practically possible at ICU follow-up, and the administration of self-report inventories allows the identification of PTSD symptomatology. Thus, a variety of self-report measures have been used to screen for the symptoms of PTSD, and some of these are described below. It has been proposed that these self-report measures can 'diagnose' PTSD if an inventory 'threshold' score is reached.
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