Post-traumatic stress disorder. The management of PTSD in adults and children in primary and secondary care.

• National Collaborating Centre for Mental Health. Post-traumatic stress disorder: the management of PTSD in adults and children in primary and secondary care. London (UK): National Institute for Clinical Excellence (NICE); 2005. 167 p. [69 references]

This is the current release of the guideline.

Post-traumatic stress disorder (PTSD)

Diagnosis
Evaluation
Management
Prevention
Screening
Treatment

Family Practice
Internal Medicine
Pediatrics
Psychiatry
Psychology

Advanced Practice Nurses
Allied Health Personnel
Emergency Medical Technicians/Paramedics
Hospitals
Nurses
Occupational Therapists
Patients
Physicians
Psychologists/Non-physician Behavioral Health Clinicians
Social Workers

To make recommendations and suggest good practice points for the treatment and management of post-traumatic stress disorder (PTSD). Specifically, the guideline aims to:

• Evaluate the role of specific psychological interventions in the treatment and management of PTSD
• Evaluate the role of specific pharmacological interventions in the treatment and management of PTSD
• Evaluate the role of early psychological and pharmacological interventions shortly after traumatic event
• Address the issues of diagnosis, detection and the use of screening techniques in high-risk situations
• Provide key review criteria for audit, which will enable objective measurements to be made of the extent and nature of local implementation of this guidance, particularly its impact upon practice and outcomes for people with PTSD.

Adults and children of all ages, who meet the diagnostic criteria for, or are at risk for, post-traumatic stress disorder (PTSD)

Screening and Diagnosis of Post-Traumatic Stress Disorder (PTSD)

1. Symptom assessment and coordination of care (including determination of need for emergency or psychiatric assessment)
2. Screening of individuals involved in major disasters, refugees, and asylum seekers
3. Assessment of comorbid conditions
4. Familiarisation with ethnic and cultural background of patient
5. Special considerations for assessing PTSD symptoms in children

Psychological Interventions

1. Trauma-focused cognitive behavioural therapy
2. Eye movement desensitisation and reprocessing (EMDR)

Pharmacologic Therapy

1. Antidepressants
   • Mirtazapine
2. Selective serotonin reuptake inhibitors
   • Paroxetine
3. Tricyclic antidepressants
   • Amitriptyline
4. Monoamine oxidase inhibitors
   • Phenelzine
5. Hypnotic medication
6. Antipsychotic agents
   • Olanzapine
7. Management of side effects of therapy and discontinuation/withdrawal symptoms

Other Practices

1. Watchful waiting

Supportive Measures

1. Family and carer support
2. Disaster planning (organization of social and psychological support)

Interventions Considered But Not Recommended

Sertraline, fluoxetine, imipramine, venlafaxine, risperidone relaxation therapy, hypnotherapy, supportive therapy, non-directive therapy, systemic psychotherapy and psychodynamic therapy, debriefing, repetitive transcranial magnetic stimulation (rTMS).

• Incidence and prevalence of post-traumatic stress disorder (PTSD)
• Symptom improvement (as measured by independent assessors or self-report)
• Side effects of pharmacologic therapy
• Relapse rate
• Impact on patient carers