Post-Traumatic Stress Disorder

This guideline has been developed to advise on the treatment and management of post-traumatic stress disorder (PTSD). The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, PTSD sufferers and guideline methodologists after careful consideration of the best available evidence. (The term ‘PTSD sufferer’ was chosen for use in the guideline on the basis of a survey conducted by sufferer members of the Guideline Development Group. People with the disorder were presented with a range of options such as ‘people with PTSD’, ‘patients with PTSD’ and ‘PTSD sufferer’ and asked to indicate which term they preferred; ‘PTSD sufferer’ was the term favoured by the majority.) It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for those with PTSD while also emphasising the importance of the experience of care for patients and their families.

Contents

• Guideline Development Group membership
• Acknowledgements
• List of abbreviations
• 1. Introduction
  • 1.1. National guidelines
  • 1.2. The national PTSD guideline
• 2. Post-traumatic stress disorder
  • 2.1. The disorder
  • 2.2. Incidence and prevalence
  • 2.3. Diagnosis and differential diagnosis
  • 2.4. Aetiology of PTSD
  • 2.5. Treatment and management of PTSD in the NHS
  • 2.6. Primary care
  • 2.7. Economic burden of PTSD
• 3. Experiences of PTSD sufferers and carers
  • 3.1. Personal testimonies from PTSD sufferers
  • 3.2. Understanding PTSD from the sufferer’s perspective
  • 3.3. Summary of PTSD sufferer concerns
  • 3.4. Carers’ testimonies
  • 3.5. Understanding the impact of PTSD on carers
  • 3.6. Summary of carer needs
  • 3.7. Clinical practice recommendations
• 4. Methods used to develop this guideline
  • 4.1. Overview
  • 4.2. The Guideline Development Group
  • 4.3. Clinical questions
  • 4.4. Systematic clinical literature review
  • 4.5. Health economics review strategies
  • 4.6. Stakeholder contributions
  • 4.7. Validation of this guideline
• 5. Psychological treatment of PTSD in adults
  • 5.1. Introduction
  • 5.2. Definitions
  • 5.3. Previous systematic reviews
  • 5.4. Studies considered for review
  • 5.5. Evidence statements
  • 5.6. Clinical summary for psychological treatments
  • 5.7. Recommendations for psychological treatments for chronic PTSD
  • 5.8. Research recommendations
• 6. Pharmacological and physical interventions for PTSD in adults
  • 6.1. Introduction
  • 6.2. Current clinical practice
  • 6.3. Limitations of the literature: comparing RCTs of pharmacological and psychological treatment
  • 6.4. Issues and topics covered by this review
  • 6.5. Studies included
  • 6.6. Study characteristics
  • 6.7. General issues arising in the management of antidepressant medication
  • 6.8. Repetitive transcranial magnetic stimulation
  • 6.9. Clinical summary
  • 6.10. Clinical practice recommendations
  • 6.11. Research recommendations
• 7. Early interventions for PTSD in adults
  • 7.1. Introduction
  • 7.2. Current practice
  • 7.3. Studies included
  • 7.4. Treatment for all
  • 7.5. Treatment for all – clinical summary
  • 7.6. Early psychological interventions for acute PTSD and acute stress disorder
  • 7.7. Clinical summary of early psychological interventions
  • 7.8. Early intervention drug treatments for PTSD
  • 7.9. Clinical summary of early intervention drug treatments
  • 7.10. Economic evaluation of early versus later delivery of psychological treatment
  • 7.11. Clinical practice recommendations
• 8. Predictors of PTSD and screening for the disorder
  • 8.1. Introduction
  • 8.2. Risk factors
  • 8.3. Screening
  • 8.4. Clinical practice recommendations
  • 8.5. Research recommendations
• 9. Children and young people with PTSD
  • 9.1. Introduction
  • 9.2. Developmental differences
  • 9.3. Incidence, prevalence and natural history
  • 9.4. Diagnostic and assessment measures
  • 9.5. Psychological interventions
  • 9.6. Clinical summary of psychological interventions
  • 9.7. Pharmacological interventions
  • 9.8. Clinical summary of pharmacological interventions
  • 9.9. Clinical practice recommendations
  • 9.10. Research recommendations
• 10. Special considerations
  • 10.1. Introduction
  • 10.2. Disaster planning
  • 10.3. Ex-military personnel
  • 10.4. Phased interventions in settings of continuing threat
  • 10.5. Working with refugees and asylum seekers
  • 10.6. Role of the non-statutory sector
  • 10.7. Recommendations
• 11. Summary of recommendations
  • 11.1. Key recommendations for implementation
  • 11.2. Guidance
  • 11.3. Recognition of PTSD
  • 11.4. Assessment and coordination of care
  • 11.5. Support for families and carers
  • 11.6. Practical support and social factors
  • 11.7. Language and culture
  • 11.8. Care for all people with PTSD
  • 11.9. Treatment of PTSD
  • 11.10. Disaster planning
  • 11.11. Research recommendations
• Appendices
  • Appendix 1. Scope for the development of a clinical guideline on the management of post-traumatic stress disorder
  • Appendix 2. Stakeholders who responded to early requests for evidence
  • Appendix 3. Stakeholders and experts who responded to the first consultation draft of the guideline
  • Appendix 4. Researchers contacted to request information about unpublished or soon-to-be published studies
  • Appendix 5. Clinical questions
  • Appendix 6. Search strategies for the identification of clinical studies
  • Appendix 7. Systematic review quality checklist
  • Appendix 8. Randomised controlled trial methodological quality checklist
  • Appendix 9. Clinical study data extraction form
  • Appendix 10. Methods for calculating means and standard deviations for pooled treatment groups
  • Appendix 11. Search strategies for the identification of health economics studies
  • Appendix 12. Quality checklists for economic studies
  • Appendix 13. Diagnostic criteria
  • Appendix 14. Evidence tables for clinical studies
  • Appendix 15. Forest plots
  • Appendix 16. Evidence statements
• References

Gaskell is an imprint of the Royal College of Psychiatrists. The views presented in this book do not necessarily reflect those of the Royal College of Psychiatrists, and the publishers are not responsible for any error of omission or fact. The Royal College of Psychiatrists is a registered charity (no. 228636).