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Support for education and learning

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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Support for education and learning

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  1. Post-traumatic stress disorder (PTSD) Support for education and learning 2nd.edition - March 2012 NICE clinical guideline 26

  2. 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.

  3. What this presentation covers • Background • Epidemiology • Scope • Key priorities for implementation • Costs and savings • Discussion • NHS Evidence and NICE Pathways • Find out more

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. 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

  9. Key priorities for implementation • Initial response to trauma • Trauma-focused psychological treatment • Children and young people • Drug treatment for adults • Screening for PTSD

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

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

  22. 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?

  23. NICE pathway • The NICE pathway covers core interventions in the treatment of PTSD Click here to go to NICE Pathways website

  24. 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

  25. 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

  26. 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 implementation@nice.org.uk To open the links in this slide set right click over the link and choose ‘open link’

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