Treating adults with acute stress disorder and post-traumatic stress disorder in general practice: a clinical update.
General practitioners have an important role to play in helping patients after exposure to severe psychological trauma. In the immediate aftermath of trauma, GPs should offer "psychological first aid", which includes monitoring of the patient's mental state, providing general emotional support and information, and encouraging the active use of social support networks, and self-care strategies. Drug treatments should be avoided as a preventive intervention after traumatic exposure; they may be used cautiously in cases of extreme distress that persists. Adults with acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) should be provided with trauma-focused cognitive behaviour therapy (CBT). Eye movement desensitisation and reprocessing (EMDR) in addition to in-vivo exposure (confronting avoided situations, people or places in a graded and systematic manner) may also be provided for PTSD. Drug treatments should not normally replace trauma-focused psychological therapy as a first-line treatment for adults with PTSD. If medication is considered for treating PTSD in adults, selective serotonin reuptake inhibitor antidepressants are the first choice. Other new generation antidepressants and older tricyclic antidepressants should be considered as second-line pharmacological options. Monoamine oxidase inhibitors may be considered by mental health specialists for use in people with treatment-resistant symptoms.
Forbes
David
D
Australian Centre for Posttraumatic Mental Health, University of Melbourne, Melbourne, VIC, Australia. dforbes@unimelb.edu.au
Creamer
Mark C
MC
Phelps
Andrea J
AJ
Couineau
Anne-Laure
AL
Cooper
John A
JA
Bryant
Richard A
RA
McFarlane
Alexander C
AC
Devilly
Grant J
GJ
Matthews
Lynda R
LR
Raphael
Beverley
B
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003887:Desensitization, Psychologic / Q000379:methods; D005194:Family Practice / Q000379:methods*; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D040701:Stress Disorders, Traumatic, Acute / Q000523:psychology / Q000628:therapy*
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors