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Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder

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Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder 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
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