Primary care presentations of Post Traumatic Stress Disorder PTSD: A case series analysis

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Primary care presentations of Post Traumatic
Stress Disorder (PTSD)A case series analysis

• Dr John M. Shephard

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Background

• Common in current op tempo
• Trauma exposure a major risk
• Shame, guilt sorrow important

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Background

• Clinical signs often delayed
• Co-morbid conditions
• Considerable barriers to treatment
• Huge psych-social impact

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Aim

• To examine
• Patterns of PTSD presentation
• Facilitators and barriers to case identification

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Study population

• ARA Infantry Bn
• RBG role
• High tempo
• Op Anode
• Op Catalyst
• Op Astute
• Op Deluge

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Study subjects

• Current PTSD cases Rx at RAP
• Oct 07 Sep 08
• Confirmed by Psychiatrist
• MEC downgrade

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Data collection

• Consent
• UMR review
• Interview

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Results

• 5 new cases
• lt 1 prevalence
• Rank PTE WO2
• Deployments
• Rwanda (1)
• INTERFET (1)
• IRAQ (2)
• TL (1)

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Traumatic exposure

• Civilian atrocities (3)
• Combat actions (1)
• Non-battle fatality (1)

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Presentation

• Time to diagnosis 5.2 yrs (mean)
• On deployment 3/5
• ETOH incidents 3/5
• Initial care giver
• MO 4/5
• Padre 1/5

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Barriers

• Poor psycho-education
• Trivialisation of exposure
• Pride
• Discrimination
• Career progression

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Outcome

• Medical discharge 3/5
• Remission 1/5
• Ongoing 1/5

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Limitations

• Small numbers
• Descriptive design

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Conclusions

• Prevalence rates appear lower than expected
• Considerable time delay to identification
• ETOH and deployment were common triggers for
  diagnosis

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Conclusions

• No cases were identified at RtAPS/POPS
• PTSD often led to discharge
• Numerous and sizeable barriers to help seeking
  exist

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QUESTIONS?

• Dr John M. SHEPHARD
• BMed, DTMH, FRACGP, MPH
• john.shephard_at_defence.gov.au