American College of Physicians Internal Medicine Meeting
American College of Physicians Internal Medicine Meeting
April 25, 2018
1 min read

How to recognize the subtle signs of PTSD

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact

Heidi Combs
Heidi Combs

NEW ORLEANS — Primary care physicians and internists need to ask pointed questions to determine if their patient is suffering from PTSD, according to a presenter here at the American College of Physicians Internal Medicine Meeting.

Patients with PTSD are often reluctant to talk about the precipitating incident, Heidi Combs, MD, an associate professor at the University of Washington, told Healio Family Medicine.

“PTSD is caused by trauma. A patient may not always offer that information. They’re going to come in with these somatic experiences or pain and sleep disturbances,” she said.

Combs offered some ways PCPs and internists can query their patients to distinguish PTSD.

“Ask the patient, ‘Have you had an experience of some sort that is still haunting you in some way? Are you having bad dreams at night, flashbacks, are you thinking about this event that happened to you a lot and it’s upsetting to you?’”

The condition can also be diagnosed by administering the GAD 7 Anxiety Test Questionnaire, she said.

Combs discussed what to tell patients who finally reveal the source of their PTSD.

“Tell the patient: ‘We need to talk about this, because this is something you need some help with and I want to be able to provide that or help you figure out how to get that help,’

Pharmacological treatment for PTSD has come from a source that is only starting to become more discussed in the public domain — the antihypertensive medication prazosin, Combs said.

“This helps with the patients’ trauma-related nightmares and flashbacks, as well as with anger issues, hypervigilance, and aggression, but don’t give PTSD patients benzodiazepines because those will likely only make things worse,” she said.

She added that nonpharmaceutical approaches include cognitive behavioral therapy, which will “identify the maladaptive thoughts and behaviors and restructure them.”

PTSD affects approximately 7.5% of men, and 10% of women, which Combs said is higher than the 5% to 10% of patients from both sexes with panic disorder. – by Janel Miller


Combs H. Psychiatry for the Nonpsychiatrist: depression, anxiety, PTSD, and ADHD. Presented at: American College of Physicians Internal Medicine Meeting; April 17-21, 2018; New Orleans.

Disclosure: Combs reports no relevant financial disclosures.