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Treatment Guidelines for PTSD: A Systematic Review.

Alicia Martin1, Mark Naunton1, Sam Kosari1

  • 1Discipline of Pharmacy, Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia.

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Summary

International post-traumatic stress disorder (PTSD) guidelines often lack specific recommendations for nightmare treatment, despite their clinical importance. Updates are needed to improve guideline quality and address this gap.

Keywords:
PTSDguidelinesnightmarespost-traumatic stress disordertreatment

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • International treatment guidelines for post-traumatic stress disorder (PTSD) were reviewed.
  • The focus was on assessing guideline quality and identifying variations in recommendations, particularly for nightmare treatment.

Purpose of the Study:

  • To evaluate the quality of international PTSD treatment guidelines.
  • To identify discrepancies in recommendations, with an emphasis on nightmare management.

Main Methods:

  • A systematic search of multiple databases (MEDLINE, CINAHL, PubMed, Embase, Science Direct) and online repositories was conducted.
  • The AGREE II criteria were used to assess the quality of fourteen identified PTSD guidelines published between 2004 and 2020.
  • Extracted data focused on treatment recommendations, especially for nightmares.

Main Results:

  • Fourteen guidelines were reviewed; only five were less than five years old.
  • Most guidelines recommend cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) as first-line treatments for PTSD.
  • Nightmare treatment is inadequately addressed in most guidelines, with varied recommendations for prazosin.

Conclusions:

  • Current guidelines require updating to enhance clinical utility, particularly in applicability, rigor of development, and stakeholder involvement.
  • Guideline developers should create more detailed recommendations for targeted nightmare treatment in PTSD.
  • Further high-quality research is necessary to support evidence-based recommendations for managing nightmares in PTSD.