Forbes David, Creamer Mark, Phelps Andrea, Bryant Richard, McFarlane Alexander, Devilly Grant J, Matthews Lynda, Raphael Beverley, Doran Chris, Merlin Tracy, Newton Skye
Australian Centre for Posttraumatic Mental Health, West Heidelberg, Vic, Australia.
Aust N Z J Psychiatry. 2007 Aug;41(8):637-48. doi: 10.1080/00048670701449161.
Over the past 2-3 years, clinical practice guidelines (CPGs) for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) have been developed in the USA and UK. There remained a need, however, for the development of Australian CPGs for the treatment of ASD and PTSD tailored to the national health-care context. Therefore, the Australian Centre for Posttraumatic Mental Health in collaboration with national trauma experts, has recently developed Australian CPGs for adults with ASD and PTSD, which have been endorsed by the National Health and Medical Research Council (NHMRC). In consultation with a multidisciplinary reference panel (MDP), research questions were determined and a systematic review of the evidence was then conducted to answer these questions (consistent with NHMRC procedures). On the basis of the evidence reviewed and in consultation with the MDP, a series of practice recommendations were developed. The practice recommendations that have been developed address a broad range of clinical questions. Key recommendations indicate the use of trauma-focused psychological therapy (cognitive behavioural therapy or eye movement desensitization and reprocessing in addition to in vivo exposure) as the most effective treatment for ASD and PTSD. Where medication is required for the treatment of PTSD in adults, selective serotonin re-uptake inhibitor antidepressants should be the first choice. Medication should not be used in preference to trauma-focused psychological therapy. In the immediate aftermath of trauma, practitioners should adopt a position of watchful waiting and provide psychological first aid. Structured interventions such as psychological debriefing, with a focus on recounting the traumatic event and ventilation of feelings, should not be offered on a routine basis.
在过去两到三年间，美国和英国已制定了创伤后应激障碍（PTSD）和急性应激障碍（ASD）的临床实践指南（CPG）。然而，仍需要针对澳大利亚的医疗保健背景制定治疗ASD和PTSD的澳大利亚CPG。因此，澳大利亚创伤后心理健康中心与全国创伤专家合作，最近为患有ASD和PTSD的成年人制定了澳大利亚CPG，这些指南已得到国家卫生与医学研究委员会（NHMRC）的认可。通过与多学科参考小组（MDP）协商，确定了研究问题，随后对证据进行了系统综述以回答这些问题（符合NHMRC程序）。在审查证据并与MDP协商的基础上，制定了一系列实践建议。已制定的实践建议涉及广泛的临床问题。关键建议指出，使用以创伤为重点的心理治疗（认知行为疗法或眼动脱敏再处理以及现场暴露）是治疗ASD和PTSD最有效的方法。对于成年PTSD患者需要药物治疗时，选择性5-羟色胺再摄取抑制剂类抗抑郁药应作为首选。药物治疗不应优先于以创伤为重点的心理治疗。在创伤发生后不久，从业者应采取观察等待的立场并提供心理急救。不应常规提供诸如心理疏导之类的结构化干预措施，这种干预措施侧重于讲述创伤事件和宣泄情绪。
