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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

guideline review
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.
what this presentation covers
What this presentation covers
  • Background
  • Epidemiology
  • Scope
  • Key priorities for implementation
  • Costs and savings
  • Discussion
  • NHS Evidence and NICE Pathways
  • Find out more
background what is ptsd
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.
  • 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.
what is the natural course of ptsd
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

  • 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.
scope what is not covered
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
key priorities for implementation
Key priorities for implementation
  • Initial response to trauma
  • Trauma-focused psychological treatment
  • Children and young people
  • Drug treatment for adults
  • Screening for PTSD
initial response to trauma 1
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.
initial response to trauma 2
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.
trauma focused psychological treatment 1
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.
trauma focused psychological treatment 2
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.
recognition of ptsd in children
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.
children and young people 1
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.
children and young people 2
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.
drug treatments for adults 1
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.
drug treatments for adults 2
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.
general recommendations about drug treatment
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.
screening for ptsd
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.
costs and savings
Costs and savings

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

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

Click here to go to NICE Pathways website

nhs evidence
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

find out more
Find out more
  • Visit for:
    • the guideline
    • the quick reference guide
    • ‘Understanding NICE guidance’
    • costing report and template
    • commissioning guide
what do you think
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

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