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Post-traumatic stress disorder (PTSD). Support for education and learning. 2 nd .edition - March 2012. NICE clinical guideline 26. Guideline review . Issue date: 2005 First review year: 2007 Second review year: 2011 2011 review recommendation:

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Post-traumatic stress disorder (PTSD)

Support for education and learning

2nd.edition - March 2012

NICE clinical guideline 26


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Guideline review

  • Issue date: 2005

  • First review year: 2007

  • Second review year: 2011

  • 2011 review recommendation:

  • the guideline should not be updated at this time

  • the guideline should be reviewed again in due course.


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What this presentation covers

  • Background

  • Epidemiology

  • Scope

  • Key priorities for implementation

  • Costs and savings

  • Discussion

  • NHS Evidence and NICE Pathways

  • Find out more


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Background: what is PTSD?

  • PTSD is a disorder that develops in response to a stressful event or situation of exceptionally threatening or catastrophic nature (for example, assault, road accident, disaster, rape)

  • Symptoms include:

    • re-experiencing symptoms (for example, flashbacks, nightmares)

    • avoidance of people or situations associated with the event

    • emotional numbing

    • hyperarousal.


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Epidemiology

  • Probability of developing PTSD after a traumatic event:

    • men 8–13%

    • women 20–30%.

  • Annual prevalence:

    • 1.5–3%.

  • Prevalence in primary care trust population of 170,000:

    • 2500–5000 people.

  • Prevalence in GP practice of 5000:

    • 75–150 people.


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What is the natural course of PTSD?

Usual onset of symptoms a few days after the event

Many recover without treatment within months/years of event (50% natural remission by 2 years), but some may have significant impairment of social and occupational functioning

Treatment means that about 20% more people with PTSD recover

Generally 33% remain symptomatic for 3 years or longer with greater risk of secondary problems


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Scope

  • The guideline covers:

  • adults and children of all ages, who have, or are at risk of PTSD

  • diagnosis and detection of PTSD

  • therapeutic interventions – pharmacological and psychological

  • information needs of people with PTSD.


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Scope – what is not covered?

  • Adjustment disorders: symptoms of significant trauma that do not meet criteria for PTSD

  • Disorders such as:

    • dissociative disorders

    • enduring personality changes following trauma.

  • Note: many symptoms of these can be managed with interventions used in PTSD


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Key priorities for implementation

  • Initial response to trauma

  • Trauma-focused psychological treatment

  • Children and young people

  • Drug treatment for adults

  • Screening for PTSD


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Initial response to trauma: 1

  • 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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Initial response to trauma: 2

  • Where symptoms are mild and have been present for less than 4 weeks after the trauma, watchful waiting, as a way of managing the difficulties presented by individual sufferers, should be considered by healthcare professionals. A follow-up contact should be arranged within 1 month.


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Trauma-focused psychological treatment :1

  • Trauma-focused cognitive behavioural therapy should be offered to those with severe post-traumatic symptoms or with severe post-traumatic stress disorder in the first month after the traumatic event. These treatments should normally be provided on an individual outpatient basis.


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Trauma-focused psychological treatment: 2

  • All PTSD sufferers should be offered a course of trauma-focused psychological treatment (trauma-focused cognitive behavioural therapy or eye movement desensitisation and reprocessing). These treatments should normally be provided on an individual outpatient basis.


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Recognition of PTSD in children

  • Directly question thechild or young person. Do not rely solely on information from the parent or guardian in any assessment.

  • Advise parents of children involved in traumatic events of the possibility of PTSD developing and describe thesigns and symptoms.


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Children and young people: 1

  • Trauma-focused cognitive behavioural therapy should be offered to older children with severe post-traumatic symptoms or with severe PTSD in the first month after the traumatic event.


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Children and young people: 2

  • Children and young people with PTSD, including those who have been sexually abused, should be offered a course of trauma-focused cognitive behavioural therapy adapted appropriately to suit their age, circumstances and level of development.


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Drug treatments for adults: 1

  • Drug treatments for PTSD should not be used as a routine first-line treatment for adults (in general use or by specialist mental health professionals) in preference to a trauma-focused psychological therapy.


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Drug treatments for adults: 2

  • Drug treatments (paroxetine* or mirtazapine for general use, and amitriptyline or phenelzine for initiation only by mental health specialists) should be considered for the treatment of PTSD in adults where a sufferer expressesa preference not to engage in trauma-focused psychological treatment.


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General recommendations about drug treatment

  • Inform people prescribed antidepressants of side effects and discontinuation/withdrawal symptoms.

  • Review after 1 week and frequently thereafter in adults with increased suicide risk or aged 18–29 years.

  • Monitor for increased suicide risk and other adverse effects.


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Screening for PTSD

  • For individuals at high risk of developing PTSD following a major disaster, consideration should be given (by those responsible for coordination of the disaster plan) to the routine use of a brief screening instrument for PTSD at 1 month after the disaster.


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Costs and savings

Costs correct at July 2005 (not updated for 2nd. Edition)


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Discussion

  • How do local services meet the guideline recommendations?

  • What are the implementation actions for managers?

  • What services are provided locally?

  • How do social services provide support locally?


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NICE pathway

  • The NICE pathway covers core interventions in the treatment of PTSD

Click here to go to NICE Pathways website


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NHS Evidence

To be added- the latest NHS evidence image

Visit NHS Evidence for evidence on all aspects of PTSD

Click here to go to the NHS Evidence website


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Find out more

  • Visit www.nice.org.uk/guidance/CG26 for:

    • the guideline

    • the quick reference guide

    • ‘Understanding NICE guidance’

    • costing report and template

    • commissioning guide


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What do you think?

  • Did the implementation tool you accessed today meet your requirements, and will it help you to put the NICE guidance into practice?

  • We value your opinion and are looking for ways to improve our tools. Please complete this short evaluation form.

  • If you are experiencing problems accessing or using this tool, please email [email protected]

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