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GPs should refer PTSD patients within month of trauma, NICE proposes

NICE has published new draft guidance on treating PTSD for consultation, marking the first update to the guideline since 2003.

The new draft guidance recommends that patients with 'clinically important' PTSD symptoms are referred for individual CBT within a month of experiencing a traumatic event.

The original 2005 guidance suggests a 'watch and wait' appraoch with follow up after a month in patients with milder symptoms, and referral for CBT in the first month for those with severe PTSD symptoms. 

The draft guideline acknowledges the diverse possible causes of PTSD, including homelessness, abuse, accidents and illegal immigration, and highlights the need for GPs to provide detailed information to patients about the treatment available to them.

It also updates the drug treatment options for PTSD in adults, suggesting that an SSRI or venlafaxine be considered if the patient has a preference for drug treatment, but that drug treatments should not be used to prevent PTSD.

The treatment recommendations for children and young people have also been updated, including the introduction of eye movement desensitisation and reprocessing therapy for children aged between seven and 17 who do not respond to or engage with CBT.

The guideline highlights the need to improve access to treatment services by providing multiple points of access and offering a choice of therapist to reflect the patient’s individual needs.

It also recommends that patients are involved in and fully understand decisions about transitioning their care between services.

Professor Mark Baker, director for the centre of guidelines at NICE, said: ‘PTSD is a treatable condition but the pain of revisiting past events can prevent people seeking the help they need.

'We have updated our guidance to make sure that PTSD is managed as early as possible and give advice on coordinating the complex needs that are often associated with this condition.’

The guideline will be available for consultation until 23 July 2018.

Readers' comments (17)

  • For them to be seen 17 months later by a nurse.

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  • PTSD is a treatable condition.Really??

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  • AlanAlmond

    As far as I was aware standard generic CBT for PTSD can be counter productive and actually harmful. Fine if there are specialist services avalibale but there aren’t. If this results in those with PTSD being routinely sent to the local CBT psychologist it’s bad news and unhelpful. If we are to refer to a specialist PTSD clinic perhaps they should actually exist in the number required - they don’t .
    NICE exists in a bubble. We are held to account for not following their advice but don’t have the resources to do what they suggest. I’ve not heard much from NICE in the last few years that hasn’t been mostly undeliverable. It it just me or is almost everything about primary care totally crap. Am I nuts? Am I missing something? Do I need CBT myself or am I actually correct in thinking leaving is/was the only sane option? That’s the conclusion I’ve come to and nothing I read anywhere persuades me any different.

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  • my crib for diagnostic criteria for ptsd-admittedly not from the Nice guideline - says 'can be diagnosed if th symptoms mean the patient cannot function normally in 1 month' -so referring sooner than r that with a firm diagnosisnot possible! quite apart from the patients having other priorities after a major trauma eg police interviews,funerals , than getting a gp appointment

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  • Nice. More guidelines drafted by people who are not aware of the availability of local CBT and the hoops GPs has to jump through to get their patient seen. The other question is will the patient present within 1 month? Unrealistic.

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  • Waiting list 6 month plus locally more NICE BS.Just what we need!!!!!!

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  • I see an opportunity for a new exclusion criteria from IAPT services - 'trigger event 1 month away - not eligible for treatment'!

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  • Young person gets "dissed" on social media. Self diagnoses ptsd from internet crib sheet. Her/ his GP although ideally placed dies nothing useful for patient. Daily Mail backs his/her version. Lawyer says Nice guideline not followed.

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  • Don't forget to signpost veterans to combat Stress ; a very useful source of help.

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  • what people experience as a trauma is very variable. are we to refer everyone who might have sufefred a trauma, before enough time has passed to see if they develop pTSD?
    Should we just block-refer the whole practice every time there is a potential local or national trauma? well, guidelines says so, so apparently we should.
    OK, I will. but where to? our local CMHT doesn't have any consultants at present, and the neighbouring one will not after august either.

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