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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

Special considerations

This guideline is concerned with the treatment of PTSD within the National Health Service. However, certain groups such as ex-military personnel, survivors of major disasters and many refugees and asylum seekers typically have some key aspects of their care delivered outside the NHS. In developing guidelines for the NHS it is therefore essential to give special consideration to the role and links with other organisations that play a key part in delivering care (particularly in the immediate aftermath of traumatic events) for those at risk of PTSD within specific populations of ex-military personnel, refugees and survivors of disasters.

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.

Experiences of PTSD sufferers and carers

This chapter describes the experiences of a number of PTSD sufferers and also those involved as family members or carers of PTSD sufferers. The testimonies set out below, which present both positive and negative experiences of services and treatment, were chosen because they illustrate a range of experience of sufferers and carers, and because they encompass both the initial trauma and the subsequent impact it had on people’s lives. Sufferers’ (and carers’) struggles to obtain appropriate treatment and the benefit derived from such treatments are also described.

Post-traumatic stress disorder

This guideline is concerned with the diagnosis, early identification and treatment of post-traumatic stress disorder (PTSD) as defined in ICD–10 (World Health Organization, 1992), code number F43.1. This disorder is one that people may develop in response to one or more traumatic events such as deliberate acts of interpersonal violence, severe accidents, disasters or military action. The guideline is concerned with the care of people for whom PTSD is the main problem after experiencing a traumatic event. The disorder can occur at any age, including childhood.

Children and young people with PTSD

When the diagnosis of PTSD was first formulated in 1980 (American Psychiatric Association, 1980) it was initially believed that it would not be relevant to children and young people. This was soon demonstrated to be false and it is now accepted that children and young people can develop PTSD following traumatic events. For the purposes of this guideline, ‘children’ refers to ages 2–12 years and ‘young people’ (adolescents) to ages 13–18 years.

Early interventions for PTSD in adults

The incentive to identify and develop effective early interventions for post-traumatic stress disorder comes from three sources. First, PTSD is a distressing and disabling condition from which a great number of sufferers do not spontaneously recover. Therefore, early and effective treatment might reduce the burden of PTSD on both the individual and society. Second, now that studies have identified the post-incident prevalence rates of PTSD from large-scale disasters and combat, there is concern to ameliorate the impact of PTSD by responding in the early days and weeks following such incidents. Third, occupational groups such as firefighters have campaigned to have the psychological impact of their work recognised and support services delivered as part of their conditions of employment. In addition, in military organisations, there exists a specific drive to early interventions – that of enabling traumatised combatants to return to front-line duties as soon as possible.

Predictors of PTSD and screening for the disorder

Various factors have been considered as potentially predictive of the development of PTSD and instruments have been developed to screen for it. The benefits of being able to predict accurately those who will develop or have PTSD include the opportunity to focus on individuals at high risk and to contribute to the development of specific interventions.

Psychological treatment of PTSD in adults

A range of psychological treatments is currently used in the NHS to treat PTSD sufferers. They vary from generic psychological treatments, such as supportive and psychodynamic therapy, to treatments that are specifically designed for PTSD, linked to specific theories or treatment techniques. The focus of these guidelines is on those approaches for which there is some evidence for efficacy from randomised controlled trials.

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