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Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care

Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK)

Version: 2005

Pharmacological and physical interventions for PTSD in adults

Drug treatments currently have an important place in the management of PTSD. This is supported by reviews, which suggest that they are effective (e.g. Van Etten & Taylor, 1998; Friedman et al, 2000). Drug treatments have been shown to achieve statistically significant (positive) effects on each of the three main elements of PTSD (re-experiencing, avoidance and hyperarousal). However, other reviews, for example Stein et al (2004), have suggested that the efficacy of drug treatments may be less strong (they estimated an SMD for drug treatments against placebo of −0.46 (k=4; n=327; 95% CI −0.71 to −0.2). This more modest view was based on a rigorous systematic review of relevant studies, including only randomised controlled trials and applying more strenuous inclusion criteria (in particular those for trial quality). As with this review, Stein et al (2004) used between-group rather than within-group effect sizes, thereby reducing the likelihood of artificially inflating the effect size (as is acknowledged by Van Etten & Taylor, 1998).

Summary of recommendations

For individuals who have experienced a traumatic event, the systematic provision to that individual alone of brief, single-session interventions (often referred to as debriefing) that focus on the traumatic incident should not be routine practice when delivering services.

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