Munro Calum G, Freeman Chris P, Law Roslyn
Outpatient Psychotherapy Department,Maudsley Hospital, London, England.
Br J Gen Pract. 2004 Nov;54(508):843-7.
Post-traumatic stress disorder (PTSD) is common, is associated with substantial morbidity, and is often not recognised in primary care.
To explore whether general practitioners (GPs) have significant gaps in their knowledge of PTSD.
A controlled study.
Primary care in two Scottish regions.
A validated postal questionnaire consisting of clinical vignettes for PTSD, acute stress reaction, and depression was used to gather the data. The primary outcome measures were the proportion describing 'best practice' management of PTSD and the comparison of this with the control condition, the proportion describing 'best practice' management of depression. The secondary outcome measures were comparisons of PTSD and depression by recognition, drug treatment, and referral.
Two-thirds (67.5%) of GPs included PTSD in their differential diagnosis for the PTSD vignette, and 86.8% made a referral to secondary care for the PTSD case. A minority of GPs (42.9%) and only 54.1% of a comparison group of psychiatrists specified the drug treatment of choice for PTSD, a selective serotonin reuptake inhibitor. Only 28.3% of GPs had the knowledge to recognise PTSD and prescribe appropriately, compared with 89.8% for depression (P <0.001). Only 10.2% of GPs described best practice for PTSD, compared with 47.7% for depression (P <0.001).
Lack of knowledge is among the reasons for less than ideal recognition and management of PTSD in primary care. Further research should aim to explore the implementation of PTSD guidelines in primary care.
创伤后应激障碍（PTSD）很常见，与严重的发病率相关，且在初级保健中常常未被识别。
探讨全科医生（GPs）在创伤后应激障碍知识方面是否存在重大差距。
对照研究。
苏格兰两个地区的初级保健机构。
使用一份经过验证的邮寄问卷，其中包含创伤后应激障碍、急性应激反应和抑郁症的临床病例 vignettes 来收集数据。主要结局指标是描述创伤后应激障碍“最佳实践”管理的比例，并将其与对照情况（描述抑郁症“最佳实践”管理的比例）进行比较。次要结局指标是通过识别、药物治疗和转诊对创伤后应激障碍和抑郁症进行比较。
三分之二（67.5%）的全科医生在对创伤后应激障碍病例 vignette 的鉴别诊断中纳入了创伤后应激障碍，86.8%的医生将创伤后应激障碍病例转诊至二级保健机构。少数全科医生（42.9%），而在一组精神科医生对照组中只有54.1%指定了创伤后应激障碍的首选药物治疗，即选择性5-羟色胺再摄取抑制剂。只有28.3%的全科医生有识别创伤后应激障碍并进行适当开药的知识，而抑郁症的这一比例为89.8%（P<0.001）。只有10.2%的全科医生描述了创伤后应激障碍的最佳实践，而抑郁症的这一比例为47.7%（P<0.001）。
知识缺乏是初级保健中创伤后应激障碍识别和管理不理想的原因之一。进一步的研究应旨在探讨创伤后应激障碍指南在初级保健中的实施情况。
