My Orthopedic Surgery

Although post-traumatic stress disorder (PTSD) is a debilitating anxiety disorder that may cause significant distress and increased use of health resources, the condition often goes undiagnosed. The lifetime prevalence of PTSD in the United States is 8 to 9 percent, and approximately 25 to 30 percent of victims of significant trauma develop PTSD. The emotional and physical symptoms of PTSD occur in three clusters: re-experiencing the trauma, marked avoidance of usual activities, and increased symptoms of arousal. Before a diagnosis of PTSD can be made, the patient's symptoms must significantly disrupt normal activities and last for more than one month. Approximately 80 percent of patients with PTSD have at least one comorbid psychiatric disorder. The most common comorbid disorders include depression, alcohol and drug abuse, and other anxiety disorders. Treatment relies on a multidimensional approach, including supportive patient education, cognitive behavior therapy, and psychopharmacology. Selective serotonin reuptake inhibitors are the mainstay of pharmacologic treatment.
(Am Fam Physician 2003;68:2401-8,2409. Copyright© 2003 American Academy of Family Physicians)BRADLEY D. GRINAGE, M.D.

Posttraumatic stress disorder (PTSD) is an emotional illness that develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience. PTSD sufferers re-experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event (avoidance), and are exquisitely sensitive to normal life experiences (hyperarousal).

The guideline aims to:
* Evaluate the role of specific psychological interventions in the treatment and management of PTSD
* Evaluate the role of specific pharmacological interventions in the treatment and management of PTSD
* Evaluate the role of early psychological and pharmacological interventions shortly after traumatic event
* Address the issues of diagnosis, detection and the use of screening techniques in high-risk situations
* Provide key review criteria for audit, which will enable objective measurements to be made of the extent and nature of local implementation of this guidance, particularly its impact upon practice and outcomes for people with PTSD.

Mohit Bhandari, MD; Jason W. Busse, DC,MSc; Beate P. Hanson, MD,MPH; Pamela Leece, BSc; Olufemi R. Ayeni, MD; Emil H. Schemitsch, MD Can J Surg, Vol. 51, No. 1, February 2008
Conclusion: In a prospective study of 215 patients, 1 in 5 met the threshold for psychological distress. Only ongoing litigation and psychological symptoms were significantly associated with both SF-36 Physical Component and Mental Component summary scores. Future research is necessary to determine whether orthopedic trauma patients would benefit from early screening and intervention to address comorbid psychopathology.

These guidelines have been published by the Clinical Resource Efficiency Support Team (CREST), which is a small team of health care professionals established under the auspices of the Central Medical Advisory Committee in 1988. The aims of CREST are to promote clinical efficiency in the Health Service in Northern Ireland, while ensuring the highest possible standard of clinical practice is maintained. These guidelines have been produced by a small Sub-Group of Psychiatrists, Clinical Psychologists, Psychiatric Nurses and Social Workers. CREST wishes to thank them and all those who contributed in any way to the development of these guidelines.

These Trauma Pages focus primarily on emotional trauma and traumatic stress, including PTSD (Post-traumatic Stress Disorder) and dissociation, whether following individual traumatic experience(s) or a large-scale disaster.
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