Lecrubier Yves
Hôpital la Salpêtrière, INSERM, Paris, France.
J Clin Psychiatry. 2004;65 Suppl 1:49-54.
Posttraumatic stress disorder (PTSD) is common worldwide, with prevalence rates ranging from 1% to nearly 40%, depending on the population studied. The disability and natural course of PTSD in psychiatric patients have been well characterized. However, even though the primary care setting has been described as the "de facto mental health care system," surprisingly little is known about PTSD in primary care. Available data from primary care clinics in the United States and Israel suggest that PTSD may be as prevalent in this setting as has been reported in large epidemiologic studies. Patients may be unlikely to endorse traumatic experiences or may not consider them related to their current psychological problems. The prevalence of PTSD in primary care may indeed be higher than expected because of underreporting of domestic violence and other histories of trauma. Recognition of PTSD in primary care could be greatly improved if simple trauma histories were integrated into routine medical examinations. Primary care clinicians who maintain a high index of suspicion for PTSD in their patients with positive histories of trauma plus symptoms of depression or anxiety or other signs of psychological distress, suicidal thoughts or actions, alcohol or substance abuse, or excessive health care service utilization may increase the recognition rate of this disorder in their practices.
创伤后应激障碍（PTSD）在全球范围内都很常见，患病率从1%到近40%不等，具体取决于所研究的人群。精神病患者中PTSD的残疾情况和自然病程已得到充分描述。然而，尽管初级保健机构被描述为“事实上的精神卫生保健系统”，但令人惊讶的是，人们对初级保健中的PTSD知之甚少。来自美国和以色列初级保健诊所的现有数据表明，PTSD在这种环境中的患病率可能与大型流行病学研究报告的患病率一样高。患者可能不太愿意承认有创伤经历，或者可能不认为这些经历与他们当前的心理问题有关。由于家庭暴力和其他创伤史报告不足，初级保健中PTSD的患病率可能确实高于预期。如果将简单的创伤史纳入常规医学检查，对初级保健中PTSD的识别可能会大大改善。对于有创伤阳性史且伴有抑郁或焦虑症状或其他心理困扰迹象、自杀念头或行为、酒精或药物滥用或过度利用医疗服务的患者，保持高度怀疑PTSD的初级保健临床医生可能会提高其在实践中对这种疾病的识别率。
