Management of posttraumatic stress disorder: diagnostic and therapeutic issues.

Although the hallmark symptoms of posttraumatic stress disorder (PTSD) are clear, this disorder is not always properly diagnosed. Reasons for misdiagnosis include a high rate of comorbidity, patient denial or minimization, overly high diagnostic thresholds set by clinicians, or failure to take a trauma history. There are a number of challenges associated with the treatment of PTSD. Patients with PTSD may not respond to pharmacotherapy in the same manner, and it is unclear whether this is related to gender, trauma type, or other factors. Antidepressants, particularly the selective serotonin reuptake inhibitors, are the most effective form of pharmacotherapy for patients with PTSD. Patients also may respond to therapy with monoamine oxidase inhibitors or tricyclic antidepressants. Psychosocial techniques, such as cognitive-behavioral therapy or stress inoculation training, are effective and may be considered as adjunctive therapy with medication. As awareness of PTSD increases, more patients should receive an accurate diagnosis and appropriate therapy.