Blank A S
Readjustment Counseling Service, Department of Veterans Affairs, Washington, D.C.
Psychiatr Clin North Am. 1994 Jun;17(2):351-83.
This article has reviewed the detection, diagnosis, and differential diagnosis of PTSD. Recognition of particular effects of traumatic stress on patients' communications and adjustments in interviewing technique facilitate the expression and detection of PTSD when it is present. The phenomenologic boundaries between PTSD and a number of clinical syndromes and disorders are explored in detail. Delineation of PTSD from other disorders even when they co-occur with PTSD is almost always possible with effective rapport and knowledge from clinical research. An understanding of the role of traumatic stress in the origin of several disorders aside from PTSD assists in differential diagnosis, particularly when PTSD is present along with another trauma disorder. To avoid an undue, misleading proliferation of diagnoses (illusory comorbidity), the clinician should move beyond simply a cross-sectional enumeration of symptoms, to conduct a careful exploration of the patient's longitudinal history and thus understand fully which features are secondary to traumatic stress.
本文回顾了创伤后应激障碍（PTSD）的检测、诊断及鉴别诊断。认识到创伤应激对患者沟通的特殊影响以及在访谈技巧方面进行调整，有助于在PTSD存在时将其表达出来并进行检测。本文详细探讨了PTSD与多种临床综合征及疾病之间的现象学界限。即使创伤后应激障碍与其他疾病同时出现，通过有效的医患关系以及临床研究知识，几乎总能将PTSD与其他疾病区分开来。了解创伤应激在除PTSD之外的多种疾病起源中的作用有助于鉴别诊断，特别是当PTSD与另一种创伤性疾病同时存在时。为避免诊断过度、产生误导性的增加（虚假共病），临床医生不应仅仅简单地列举症状，而应仔细探究患者的纵向病史，从而充分了解哪些特征是创伤应激的继发表现。
