Mental Disorders: Posttraumatic Stress Disorder.

Posttraumatic stress disorder (PTSD) has a lifetime incidence of approximately 6.1% in the US population. However, studies of patients receiving regular primary care have shown a higher point prevalence, ranging from 11.1% to 24.5%. Multiple factors have been implicated in the etiology of PTSD, including genes, epigenetic regulation, neuroendocrine factors, inflammatory markers, autonomic risk and resilience, and sleep disturbances. There are many risk factors for PTSD, including exposure to trauma at a younger age, a high number of adverse childhood experiences, and a previous diagnosis of a mental disorder. Military personnel, police officers, and first responders who experience repeated or extreme exposure to traumatic events are at increased risk of PTSD. The National Institute for Health and Care Excellence (NICE) recommends that clinicians in the primary care setting consider screening for PTSD in patients with unexplained physical symptoms that may be associated with PTSD. Multiple evidence-based screening tools are available. If the patient is willing, psychotherapy is the treatment of choice, followed by combined psychotherapy and pharmacotherapy. PTSD is associated with many significant comorbidities and mortality.