Recent articles in this bulletin have discussed how to identify and treat post-traumatic stress disorder (PTSD) in combat personnel returning from the Persian Gulf. In the aftermath of Hurricane Katrina—which damaged the Keesler Air Force Base in Biloxi and several military facilities in the New Orleans area—and Hurricanes Rita and Wilma, TRICARE providers also need to be vigilant about spotting PTSD symptoms in these survivors. PTSD is a behavioral health problem that develops after exposure to extreme psychological trauma—events that produce fear or helplessness, such as a threat to life. Seeing another person in a life-threatening situation also can trigger PTSD. The trauma is persistently re-experienced as intrusive recollections, images, thoughts, dreams, dissociative flashbacks or intense reactions to situations that resemble an aspect of the traumatic event.

“Left untreated, PTSD frequently gets worse,” explains Dr. Gary Proctor, chief medical officer for ValueOptions, the South Region’s behavioral health care subcontractor. “Patients may experience guilt, depression and panic disorder, and many develop substance abuse problems.”

Asking the Right Questions

Proctor recommends asking the following questions of individuals who have been affected by the hurricanes:

• How did you experience trauma? (There will likely be a significant difference in the severity of symptoms between a patient who evacuated early and someone who suffered prolonged exposure to flooding, hunger, crime and the like.)
• Are you having intrusive memories, dreams or trouble sleeping?
• Are you feeling unusually anxious or irritable/numb?
• Have you lost interest in activities that you once enjoyed?
• Do rain or storms elicit an extreme response?
• Are you more easily startled than before?
• Are you experiencing depression or general anxiety?
• Are you drinking or taking drugs in an attempt to feel better?

Some people are at increased risk for PTSD, including patients who lack an adequate support system, those with a history of psychiatric disorders, and low-income individuals who tend to have fewer support systems. Females carry a slightly higher risk, and children are especially vulnerable. In fact, it is sometimes difficult to diagnose PTSD in children because they are not adept at voicing their symptoms. Providers should look for signs of behavior problems, aggression, nightmares, violent play and unexplained physical symptoms, such as stomach pain. For PTSD to be diagnosed, the symptoms must be present for at least one month and be accompanied by significant impairment in functioning. PTSD is considered acute if the symptoms last fewer than three months and chronic if they last longer. In addition, onset can occur more than six months after the trauma.

Medications used to treat PTSD include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, monoamine oxidase inhibitors, clonidine, lithium, carbamazepine, valproic acid, lamotrigine, buspirone and trazodone.

Proctor says the most effective treatment usually involves a combination of psychotherapy and medication. Patients diagnosed with PTSD are eligible for such outpatient services as individual or group psychotherapy, crisis intervention, collateral visits and family therapy. Other benefits may include psychological testing, medication management, substance abuse treatment and more.

Active duty service members must get a referral from their primary care manager (PCM) so care can be coordinated. All other beneficiaries can access coverage for PTSD or other behavioral health problems without a referral through their eight unmanaged outpatient behavioral health care visits.

VA/DoD Clinical Practice Guideline for Management of PTSD
National Center for PTSD
National Institute of Mental Health
PTSD Alliance
Veterans Administration
Military OneSource
Hooah 4 Health
Courage to Care
Lifeline Services Network

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Last Reviewed:  February 13, 2007