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Issue date: March 2005
Quick reference guide
Post-traumatic stress disorder
The management of PTSD in adults and
children in primary and secondary care
Clinical Guideline 26
Developed by the National Collaborating Centre for Mental Health

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Ordering information
Copies of this quick reference guide can be obtained from the NICE website at or from the NHS Response Line by telephoning
0870 1555 455 and quoting reference number N0848.
Information for the public on the guideline (`Post-traumatic stress disorder (PTSD): the
treatment of PTSD in adults and children') is also available from the NICE website at or from the NHS Response Line (quote reference
number N0849 for a version in English and N0850 for a version in English and Welsh).…read more

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Patient-centred care 2
Grading of the recommendations 2
Key priorities for implementation 3
Post-traumatic stress disorder (PTSD) 5
Recognition 6
Recognition in primary care and general hospital settings 6
Specific recognition issues for children and young people 7
Screening 8
Screening after a major disaster 8
Screening refugees and asylum seekers 8
Assessment and coordination of care 8
Support to families and carers 9
Practical and social support 9
Language and culture 10
Care across all conditions 10
Comorbidities 11
Depression 11
High…read more

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Grading of the recommendations/Patient-centred care
Patient-centred care
Treatment and care should take into account patients' individual needs and
preferences. Good communication is essential, supported by evidence-based
information, to allow patients to reach informed decisions about their care.
Carers and relatives should have the chance to be involved in discussions
unless the patient considers it inappropriate.…read more

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Key priorities for implementation
Key priorities for implementation
The following recommendations have been identified as priorities for
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.…read more

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Key priorities for implementation
Children and young people
· 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 as needed to suit their age, circumstances and level of
development.…read more

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Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD)
PTSD can develop in people of any age following a stressful
event or situation of an exceptionally threatening or catastrophic nature.
PTSD does not usually develop following generally upsetting situations such
as divorce, loss of job, or failing an exam.
Up to
Effective treatment of PTSD can only take place if the 30% of people
disorder is recognised.…read more

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Recognition in primary care and general hospital settings
Symptoms typically associated with PTSD are as follows:
· re-experiencing ­ flashbacks, nightmares, repetitive and distressing intrusive
images or sensory impressions; in children, these symptoms may include: re-
enacting the experience, repetitive play or frightening dreams without
recognisable content
· avoidance ­ avoiding people, situations or circumstances resembling or
associated with the event
· hyperarousal ­ hypervigilance for threat, exaggerated startle response, sleep
problems, irritability and difficulty concentrating
· emotional numbing ­ lack of ability…read more

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Specific recognition issues for children and young people
· Do not rely solely on information from the parent/guardian in any
assessment for PTSD ­ ask the child or young person separately and directly
about PTSD symptoms. GPP
· Consider asking children and/or their parents/guardians about sleep
disturbance or significant changes in sleeping patterns. G
Children in emergency departments
· Inform the parents/guardians that PTSD may develop in children who have
been involved in traumatic events.…read more

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Screening after a major disaster
· Those coordinating the disaster plan should consider using a brief screening
instrument for PTSD 1 month after the event for individuals at high risk of
developing PTSD following a major disaster.…read more


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