Post-Traumatic Stress Disorder (PTSD)
NICE guideline [NG116] Post-traumatic stress disorder. Published: Dec 2018.
Background Information
Causes
PTSD could develop after experiencing or witnessing:
- Serious accidents
- Physical and sexual assault
- Abuse, including childhood or domestic abuse
- Work-related exposure to trauma, including remote exposure
- Trauma related to serious health problems or childbirth experiences (for example, intensive care admission or neonatal death)
- War and conflict
- Torture
Guidelines
Recognition
Some common symptoms:
- Re-experiencing
- Avoidance
- Hyperarousal (including hypervigilance, anger and irritability)
- Negative alterations in mood and thinking
- Emotional numbing
- Dissociation
- Emotional dysregulation
- Interpersonal difficulties or problems in relationships
- Negative self-perception (including feeling diminished, defeated or worthless)
Management
Consider active monitoring for those with subthreshold PTSD symptoms within 1 month of a traumatic event.
Do not offer psychologically-focused debriefing for the prevention or treatment of PTSD
Children and Young People
Psychological Therapy
- 1st line: individual trauma-focused CBT
- Consider group trauma-focused CBT if the event led to large-scale shared trauma
- 2nd line: eye movement desensitisation and reprocessing (EMDR)
- Indicated >3 months of traumatic event AND a lack of enagement/response to CBT
Pharmacological Management
Do not offer drug treatments for the prevention or treatment of PTSD in children and young people aged under 18 years
Adults
Psychological Therapy
1st line: individual trauma-focused CBT interventions:
- Cognitive processing therapy
- Cognitive therapy for PTSD
- Narrative exposure therapy
- Prolonged exposure therapy
Eye movement desensitisation and reprocessing (EMDR) can be considered/offered in non-combat related trauma in the following scenarios:
- Consider if 1-3 months post-traumatic event AND preference for EMDR
- Offer if >3 months post-traumatic event
EMDR is not excluded from use in combat trauma-related PTSD, but its research base and clinical implementation is less extensive compared to civilian/non-combat trauma.
Pharmacological Management
1st line: SSRI (e.g. sertraline) or venlafaxine
Consider antipsychotics (e.g. risperidone) in addition to psychological therapies to manage symptoms if:
- Disabling symptoms and behaviours (e.g. severe hyperarousal or psychotic symptoms) and
- Failed to respond to other drug or psychological treatments
References
Original Guideline