relax. She describes herself as easily startled with poor sleep and disturbed nightmares following
a house fire a year ago, while the family slept. What is the single best tx?
a. Rassurance
b. Relaxation therapy
c. Quetiapine
d. Lofepramine
e. Fluoxetine
answer: B
first line for PTSD: psychological therapy
NICE
Initial response to trauma
-
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.
-
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 people with post-traumatic stress disorder
(PTSD), should be considered. A follow-up contact should be arranged
within 1 month.
-
Trauma-focused cognitive behavioural therapy should be
offered to those with severe post-traumatic symptoms or with severe PTSD
in the first month after the traumatic event. These treatments should
normally be provided on an individual outpatient basis.
-
All people with PTSD should be offered a course of
trauma-focused psychological treatment (trauma-focused cognitive
behavioural therapy [CBT] or eye movement desensitisation and
reprocessing [EMDR]). These treatments should normally be provided on an
individual outpatient basis.
-
Trauma-focused CBT 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 with PTSD, including those
who have been sexually abused, should be offered a course of
trauma-focused CBT adapted appropriately to suit their age,
circumstances and level of development.
-
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 (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 who express a preference not to engage in trauma-focused
psychological treatment[1].
-
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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