Posttraumatic Stress Disorder Workup

  • Author: T Allen Gore, MD, MBA, CMCM, DFAPA; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: Apr 25, 2012
 

Approach Considerations

Laboratory and imaging tests have limited use in the assessment of patients with PTSD.

One study found that nearly half (48%) of the patients in general medical practices with PTSD were receiving no mental health treatment at the time they entered the study. The most common reason patients gave for not receiving medication was the failure of physicians to recommend such treatment.[25]

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Lab Studies

Cortisol levels may be decreased, norepinephrine and epinephrine levels may be elevated, and hypothalamic-pituitary-adrenal axis activity may be abnormal in patients with PTSD; however, these findings are still only used for research.

Natural opiates, which are produced by the body to mask pain in the face of danger, may be found in higher levels in people with PTSD, even after the danger has passed. This may lead to the blunted emotions seen in persons with this condition.

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Imaging Studies

Magnetic resonance imaging (MRI) studies of the brain suggest that the amount of hippocampal atrophy correlates with the intensity of PTSD symptoms, but MRI is still not a recommended diagnostic test.[24] Some studies in monozygotic twins show that a small hippocampus may be a predisposing factor to the later development of PTSD in the face of a stressor.[26]

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Other Tests

Although increased arousal is not a required criterion for diagnosis, it might be measurable through studies of autonomic functioning (eg, heart rate monitoring, electromyography, sweat gland activity).

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Contributor Information and Disclosures
Author

T Allen Gore, MD, MBA, CMCM, DFAPA  Assistant Professor, Department of Psychiatry, Howard University School of Medicine; Senior Psychiatrist and Director, Medical Education, Comprehensive Psychiatric Emergency Program, District of Columbia Department of Mental Health

T Allen Gore, MD, MBA, CMCM, DFAPA is a member of the following medical societies: American College of Managed Care Medicine, American Psychiatric Association, and National Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Joel Z Lucas, MD  Senior Medical Writer, Reckitt Benckiser Pharmaceuticals, Inc

Joel Z Lucas, MD is a member of the following medical societies: American College of Physicians, American Medical Student Association/Foundation, and Student National Medical Association

Disclosure: Johnson & Johnson Salary Employment

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of Health Sciences: Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

Additional Contributors

The authors would like to thank all colleagues and students who contributed to this article. We are especially grateful to the following individuals:

Georgianna M Richards-Reid, MD, Staff Physician, Department of Neurology, Howard University Hospital, Howard University College of Medicine

Zachary Osborne, MD; Ross University School of Medicine

Bobbi Adams, BS; University of Alabama

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Brain structures involved in dealing with fear and stress.
 
 
 
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