Chronicity in Posttraumatic Stress Disorder and Predictors of the Course of Posttraumatic Stress Disorder Among Primary Care Patients

Abstract

The present study examined the course of posttraumatic stress disorder (PTSD) in a sample of 84 primary care patients. More specifically, this study investigated the role of Axis I comorbidity, psychosocial impairment, and treatment participation in the maintenance of an episode of chronic PTSD and whether patients at follow-up met criteria for PTSD (full remission) or continued to exhibit residual PTSD symptoms and impairment (partial PTSD). Diagnostic structured interviews established all clinical diagnoses and information on the course of anxiety disorder symptoms, psychosocial functioning, and treatment status. Using a prospective, longitudinal design, this study found that during the first 2 years of follow-up, the probability of no longer meeting full DSM-IV criteria for PTSD was .69, and .18 for full remission from PTSD. The number of comorbid anxiety disorders and degree of psychosocial impairment at intake were significantly related to remission status (i.e., full and partial PTSD). This study suggests that, in a primary care setting, PTSD is a persistent illness, and that many subjects who have recovered from PTSD continue to suffer from subthreshold symptoms of PTSD.

Dissociative symptoms mediate the relation between PTSD symptoms and functional impairment in a sample of military members, veterans, and first responders with PTSD

“…Furthermore, the current study assessed PTSD symptoms over the past month, but did not assess chronic or persistent PTSD symptomatology. Previous work indicates that lower levels of psychosocial functioning is associated with maintenance of chronic PTSD (Zlotnick et al, 2004). Given the inpatient status of the current sample, it is likely that they have experienced a persistent and severe course of illness, consistent with a chronic presentation.…”

Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions

“…First, unlike MDD, which is characterized by a cyclical course, PTSD is more persistent and unremitting. Because many patients treated for PTSD demonstrate lingering psychiatric symptomatology, 28 MDD-PTSD comorbid patients treated using depression clinical practice guidelines might be less likely than those with depression alone to experience full remission. As illustrated in a recently published report, 41 relative to patients with depression alone, depressed patients with PTSD experienced a delayed response to an effective primary care-based depression intervention.…”

“…Given the frequency of MDD-PTSD co-occurrence, however, it is shortsighted to treat MDD without consideration of the possibility that PTSD might also be present. Indeed, the persistent course of PTSD and the fact that some PTSD symptoms appear to be treatment-resistant 28 have the potential to increase complexity among depressed patients. At a minimum, it is important for general medicine providers to be aware of depressed primary care patients with PTSD.…”

Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury

“…The detrimental effect of comorbid disorders on recovery from PTSD has been suggested. For example, studies of PTSD in samples of patients with other anxiety disorders found low rates of remission of the PTSD (18%) over 2.5 years of follow-up [91][92]. The high rates of comorbid conditions that occur with PTSD contribute to the chronicity of this disorder [93].…”