The psychiatric differential diagnosis for military patients is broad and varies depending on several factors, including the type and severity of traumatic exposure and the time that has passed since the precipitating event.
7 Following exposure to severe trauma, mental disorders tend to occur in three sequential phases.
7 In the immediate phase—during or immediately after traumatic events—individuals may experience feelings of anxiety, confusion, disbelief, fear, and numbness. Such problems as acute stress disorder, adjustment disorders, brief psychotic disorder, substance abuse, and exacerbation of preexisting mental illness are considerations.
7 In the delayed phase (generally up to 2 weeks after trauma), individuals may experience apathy, autonomic arousal, grief, intrusive thoughts, social withdrawal, or somatic symptoms. Differential diagnoses at this point include anxiety disorders, depressive disorders, psychotic disorders, somatoform disorders, and substance abuse, as well as early PTSD.
7 Later, in the chronic phase (months to years after precipitating events), patients may report feelings of disappointment, resentment, sadness, and persistent intrusive symptoms. Diagnoses to consider in this phase include PTSD; depression, dysthymia, and other mood disorders; schizophrenia and other psychotic disorders; and substance abuse or dependence.
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