Post Traumatic Stress Disorder

A quick reference is available at http://www.nice.org.uk/pdf/CG026quickrefguide.pdf.

Summarising treatment:

• Don't do debriefing
• In mild symptoms less than 4 weeks after an event review in a month
• Trauma focussed CBT(individual outpatient basis) for individuals with severe symptoms in the first month after a traumatic event
• All individuals with PTSD should be offered (on an individual outpatient basis) trauma focussed CBT or eye movement desensitisation and reprocessing
• Children should be able to access treatment
• Drug treatments should not be first line treatments
• Paroxetine or mirtazepine can be used where psychological treatments are declined

PTSD can occur in any individual who has experienced or witnessed a severely traumatising event.
Consider the diagnosis in people experiencing depression, substance use, episodes of re-experience of an event (e.g. flashbacks, nightmares), hyperarousal, numbing (difficulty in experiencing feelings), avoidance (of situations or people), anger and unexplained physical symptoms. Clearly with some of these situations the trauma may not be part of the presentation and may be revealed by direct enquiry.

The above information is appropriate for me as a generic GP but the guidance goes on to dicuss screening after major disaster - let's hope I don't have to do that and screening asylum seekers (who I do come into contact with).