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PTSD Disorder Is Complex; Symptoms Can Be Long-Lasting

Dear Dr. Roach: Have you ever heard of PTS disorder? What is it? What are its symptoms? — N.R.

Answer: Post-traumatic stress disorder, or PTSD, is a complex condition that occurs in some people after major psychological trauma. The causes of PTSD are many. Some traumas typically associated with PTSD include military combat, violent personal assault, natural disasters, sexual abuse and motor vehicle accidents. Even a hospitalization in the intensive care unit is a cause of PTSD. PTSD is more common in women, especially after assault.

To make the diagnosis, the symptoms need to be present for more than one month after the trauma, and symptoms may last for years.

Symptoms of PTSD include dreams or flashbacks, often uncontrollable, about the event. Many people try to avoid thinking about the trauma and will no longer go to places that remind them of the event. A sense of numbness is common. Sleep disturbances are nearly universal. Many people find that they are hyperaware in public places. The severity of these symptoms ranges from only occasionally noticeable to disabling.

On the one hand, many of these symptoms are normal after a severe psychological trauma, so PTSD is sometimes overdiagnosed. The symptoms need to be severe and ongoing, and diagnosis should be made by an expert, usually a psychiatrist or psychologist experienced in the area, especially since depression and anxiety often complicate PTSD.

On the other hand, many people are reluctant to talk about PTSD, and the symptoms can vary widely from one person to another, so PTSD is often overlooked and consequently not treated.

Both psychotherapy and medication therapy can be effective for PTSD, and a combination is more effective than either.

Dear Dr. Roach: I had tuberculosis and was released from the sanatorium with a chronic TB scar. Whenever I have extensive activity, I feel pain in my chest. Could this be due to the pulmonary scar? — M.V.

Answer: This must have been a while ago, since almost all sanitoria (medical facilities for long-term illness, especially tuberculosis) closed in the 1950s, after the discovery of effective drug treatment for tuberculosis, although some continue to serve as hospitals or research centers.

There are two kinds of infection with tuberculosis, active and latent. In active tuberculosis, people are infectious, coughing out large amounts of bacteria, and only one is needed to cause infection. Active tuberculosis is treated with multiple antibiotics, usually four at a time. A chest X-ray will diagnose active tuberculosis.

Most people, however, only become latently infected, and are not infectious. This latent infection is discovered by a skin test or a new blood test called QuantiFERON Gold. The chest X-ray is normal in latent tuberculosis, and most people are advised to have treatment with one or two drugs to kill any tuberculosis bacteria and prevent active disease.

Everyone with active disease gets scarring in the lungs, and the scars usually are visible on chest X-ray. In most cases, the scar doesn’t cause any symptoms. However, the scar sometimes affects the lining of the lungs, and when this happens, many people do complain of chest discomfort. The lungs themselves don’t have nerves, but the lining, called the pleura, does.

Having had tuberculosis doesn’t prevent you from having other, serious causes of chest pain, and since yours occurs with activity, you should get evaluated for other lung or heart problems — especially angina, which is caused by blockages in the arteries in the heart.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.