Australian Guidelines for the Treatment of Adults with Acute Stress

192 Pages·2007·1.92 MB·English

AUSTRALIAN GUIDELINES FOR THE TREATMENT OF ADULTS WITH
Acute Stress Disorder and
Posttraumatic Stress Disorder
The development of these guidelines
has been generously supported by:
Emergency Management Australia
Department of Veterans’ Affairs
Department of Defence

© Australian Centre for Posttraumatic Mental Health, 2007
ISBN Print: 978-0-9752246-9-4 ISBN Online: 978-0-9752246-6-3
This work is copyright. Apart from any use as permitted under the Copyright
Act 1968, no part may be reproduced by any process without prior written
permission from the Australian Centre for Posttraumatic Mental Health
(ACPMH). Requests and inquiries concerning reproduction and rights should
be addressed to the Australian Centre for Posttraumatic Mental Health
([email protected]).
Copies of the full guidelines, and brief guides for practitioners and the public
are available online:
http://www.acpmh.unimelb.edu.au
http://www.nhmrc.gov.au
The suggested citation for this document is:
Australian Centre for Posttraumatic Mental Health (2007).
Australian Guidelines for the Treatment of Adults with
Acute Stress Disorder and Posttraumatic Stress Disorder.
ACPMH, Melbourne, Victoria.
Legal disclaimer
This document is a general guide to appropriate practice, to be followed
only subject to the practitioner’s judgement in each individual case.
The guidelines are designed to provide information to assist decision making
and are based on the best information available at the date of publication.
In recognition of the pace of advances in the field, it is recommended that
the guidelines be reviewed and updated in five years time.
These guidelines were approved by the Chief Executive
Officer of the National Health and Medical Research
Council on 8 February 2007 under Section 14A of the
National Health and Medical Research Council Act 1992.
AUSTRALIAN GUIDELINES FOR THE TREATMENT OF ADULTS WITH
Acute Stress Disorder and
Posttraumatic Stress Disorder
ASD and PTSD Treatment Guidelines
Australian Centre for Posttraumatic Mental Health
February 2007
Approved by the National Health and Medical Research Council
February 2007
Endorsed by the Royal Australian and New Zealand College of Psychiatrists
and the Australian Psychological Society
guidelineS developMent group
Steering group
Professor Mark Creamer
Director ACPMH, Department of Psychiatry,
University of Melbourne
Professor Beverley Raphael
Director Centre for Disasters and Terrorism,
University of Western Sydney
Working party
Chair
Associate Professor David Forbes
Clinical Director ACPMH,
Department of Psychiatry,
University of Melbourne
trauma experts
Professor Richard Bryant
School of Psychology,
University of New South Wales
Professor Mark Creamer
Director ACPMH,
Department of Psychiatry,
University of Melbourne
Professor Grant Devilly
Brain Sciences Institute,
Swinburne University of Technology
Professor Alexander McFarlane
Department of Psychiatry,
University of Adelaide
psychosocial rehabilitation expert
Dr Lynda Matthews
Behavioural and Community Health Sciences,
University of Sydney
Consultant Health economist
Associate Professor Chris Doran
School of Population Health,
University of Queensland
guideline assessment registrar
Dr Adele Weston
Director,
Health Technology Analysts
project Manager
Ms Andrea Phelps
Clinical Specialist ACPMH,
Department of Psychiatry,
University of Melbourne
IV Australian Guidelines for the Treatment of Adults with ASD and PTSD
aCknoWledgMentS
The Australian Centre for Posttraumatic Mental Health (ACPMH) and the working party gratefully
acknowledge the contribution of the following:
Multidisciplinary panel expert panel for aboriginal and torres Strait
Professor Beverley Raphael islander peoples
(Panel chair) Associate Professor Helen Milroy
(Panel convenor)
Dr Anne Arnott
(Psychologist) Mr Tom Brideson
(Office for Aboriginal & Torres Strait Islander
Dr David Barton
Health)
(Royal Australian and New Zealand College of
Psychiatrists) Dr Anne Harrison
(Psychiatrist, Winnunga Aboriginal
Ms Bronwen Browning
Community Controlled Health Organisation)
(Australian Association of Occupational Therapists)
Professor Ernest Hunter
Associate Professor David Crompton
(Department of Public Health, University of
(Psychiatry trauma specialist)
Queensland)
Dr Rob Gordon
Joylene Koolmatrie
(Psychology trauma specialist)
(Psychologist)
Ms Brenda Happell
Professor Beverley Raphael
(Mental health nurse)
(Director, Centre for Disasters and Terrorism,
Ms Vivian Jarrett University of Western Sydney)
(Consumer representative, Mental Health Council of
Australia)
expert panel for refugees and asylum seekers
Ms Charlene Micallef
Professor Derrick Silove
(Consumer representative)
(Panel convenor)
Associate Professor Helen Milroy
Mariano Coello
(Psychiatry, Indigenous mental health specialist)
(Clinical Director, Service for the Treatment
Mr Brian McKenzie and Rehabilitation of Torture and Trauma
(Consumer representative) Survivors)
Ms Julie Sharrock Ida Kaplan
(Australian and New Zealand College of Mental (Clinical Director, Victorian Foundation for
Health Nurses) Survivors of Torture)
Professor Derrick Silove Associate Professor Harry Minas
(Psychiatry refugee trauma specialist) (Director, Victorian Transcultural Psychiatry
Unit)
Ms Elizabeth Sommerville
(Australian Association of Social Work)
Mr David Stokes We also thank the Adelaide Health Technology
(Australian Psychological Society) Assessment Reviewers who conducted the
systematic review (see Appendix D), the
Dr Alex Tahmindjis ACPMH Project Support Team (see Appendix
(Rural and Remote General Practitioners) E) and the National Collaborating Centre
Dr Ian Wilson for Mental Health for granting permission to
(Royal Australian College of General Practitioners) reproduce the National Institute for Clinical
Excellence guideline recommendations for the
Ms Carolyn Worth recognition and management of posttraumatic
(Social work trauma specialist) stress disorder in children and young people.
Australian Guidelines for the Treatment of Adults with ASD and PTSD V

ContentS
GUIDELINE DEVELOPMENT GROUP IV
ACKNOWLEDGMENTS V
LIST OF ABBREVIATIONS XII
EXECUTIVE SUMMARY XIV
SUMMARY OF GUIDELINE RECOMMENDATIONS XVI
1 introduCtion 1
WHAT ARE CLINICAL PRACTICE GUIDELINES? 1
RATIONALE FOR DEVELOPING PRACTICE GUIDELINES ON THE TREATMENT
OF ACUTE STRESS DISORDER AND POSTTRAUMATIC STRESS DISORDER 1
OBJECTIVE OF THESE GUIDELINES 1
SCOPE OF THE GUIDELINES 1
GUIDELINE RECOMMENDATIONS 2
APPROACH TO GUIDELINE DEVELOPMENT 2
The development of clinical practice guidelines 2
Overview of methodology 4
Limitations of the review 8
2 aSd and ptSd 11
BACKGROUND TO ASD AND PTSD 11
Trauma, traumatic event and potentially traumatic event 11
Potentially traumatic events 11
Common responses to potentially traumatic events 11
Resilience in the face of potentially traumatic events 12
Traumatic stress syndromes 12
ACUTE STRESS DISORDER (ASD) 13
POSTTRAUMATIC STRESS DISORDER (PTSD) 14
Re-experiencing symptoms 14
Avoidance and numbing symptoms 14
Arousal symptoms 14
Associated features 16
Comorbid conditions 16
Prevalence and incidence of PTSD 16
The course of PTSD 17
Economic burden of PTSD 17
Posttraumatic mental health disorders: key differences between ASD and PTSD 18
SCREENING, ASSESSMENT AND DIAGNOSIS 18
Comprehensive assessment of PTSD 19
Diagnosis 19
Differential diagnosis 20
‘Recovered memories’ 20
Symptom exaggeration and malingering 20
Assessment instruments 21
INTERVENTION PLANNING 22
Factors influencing treatment outcome 22
Treatment goals 23
Cultural and linguistic diversity 23
The impact of PTSD on family 23
General professional issues 24
3 interventionS 27
PSYCHOLOGICAL INTERVENTIONS 27
Trauma-focussed CBT 27
Eye movement desensitization reprocessing (EMDR) 28
Brief psychodynamic psychotherapy 28
Stress management 28
Supportive counselling/therapy 28
Narrative exposure therapy (NET) 28
Hypnosis/hypnotherapy 28
Interapy 29
Imagery rehearsal 29
Group therapy 29
Debriefing 29
Psychological first aid 29
PHARMACOLOGICAL INTERVENTIONS 30
PHYSICAL THERAPIES 30
Medical 30
Exercise 30
Alternative therapies 30
PSYCHOSOCIAL REHABILITATION 31
4 evidenCe revieW and treatMent reCoMMendationS For
adultS WitH ptSd 33
INTERVENTIONS FOR ADULTS WITH PTSD 33
Psychological interventions 33
Single versus multiple psychological interventions 64
Individual and group psychological interventions 68
Self-delivered interventions 70
Pharmacological interventions 72
Combined pharmacological interventions 87
Initial psychological or pharmacological intervention 89
Combined psychological and pharmacological intervention 91
Psychosocial rehabilitation 95
Physical therapies and exercise 97
Comorbidities 100
5 evidenCe revieW and treatMent reCoMMendationS:
early intervention 103
INTERVENTIONS FOR ADULTS EXPOSED TO POTENTIALLY TRAUMATIC EVENTS 103
Psychological interventions 103
Pharmacological interventions 109
Combined psychological and pharmacological interventions 111
INTERVENTIONS FOR ADULTS WITH ASD 115
Psychological interventions 115
Pharmacological interventions 119
Combined interventions 121
6 eConoMiC ConSiderationS 127
SUMMARY OF LITERATURE COLLECTED 127
COMMENTARY ON ECONOMIC BURDEN 128
CURRENT FUNDING OF ASD/PTSD TREATMENT 129
POTENTIAL IMPLICATIONS 129
RECOMMENDATIONS 129
7 SpeCiFiC populationS and trauMa typeS: iSSueS For
ConSideration in tHe appliCation oF tHe guidelineS 133
ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES 134
REFUGEES AND ASYLUM SEEKERS 137
MILITARY AND EMERGENCY SERVICE PERSONNEL 141
MOTOR VEHICLE ACCIDENT AND OTHER INJURY SURVIVORS 144
VICTIMS OF CRIME 145
SEXUAL ASSAULT 147
NATURAL DISASTERS 149
TERRORISM 151
ADDENDUM TO THE SPECIAL POPULATIONS SECTION: NICE GUIDELINE
RECOMMENDATIONS FOR THE RECOGNITION AND MANAGEMENT OF
PTSD IN CHILDREN AND YOUNG PEOPLE 154
GLOSSARY OF TERMS 156
REFERENCES 158