FFinalistSouthampton · 2027
Psychiatry
AKT · Psychiatry/Anxiety & stress

Post traumatic stress disorder

Overview

Develops after exposure to actual/threatened death, serious injury or sexual violence, with four symptom clusters: re-experiencing, avoidance, negative cognitions/mood, and hyperarousal, persisting >1 month.

Recognise

  • Re-experiencing: flashbacks, nightmares, intrusive memories
  • Avoidance of reminders; emotional numbing
  • Negative mood/cognition; hypervigilance, exaggerated startle, poor sleep, irritability

Red flags

  • Acute risk of self-harm/suicide; dissociative flashbacks

Differentials & how to tell them apart

Acute stress reactionsame picture but within the first month
Adjustment disorderstressor not of catastrophic threat type
Depressionno trauma re-experiencing

Investigations

Clinical; symptoms >1 month (≤1 month = acute stress reaction). Screen comorbid depression and substance misuse.

Management

  1. 1Trauma-focused psychological therapy first-line: trauma-focused CBT or EMDR (≈8–12 sessions).
  2. 2Drug treatment (adults) if preference or no benefit from/declines psychology: venlafaxine or an SSRI.Gate: Do NOT offer drug treatment to under-18s — psychological therapy only
  3. 3Severe/refractory: specialist; risperidone may be added under specialist supervision.
Venlafaxine or SSRI (sertraline/paroxetine) — drug option in adults; NOT in under-18s
Risperidone — adjunct under specialist supervision in severe/refractory cases

Key points

Single-session psychological debriefing is NOT recommended (can harm). Under-18s: trauma-focused CBT, no drugs.

Monitor & prognosis

Symptom clusters; comorbid depression/substance misuse; SSRI under-30 suicidality.

Many recover with trauma-focused therapy; can become chronic.

Source: NICE CKS PTSD (2025) / NG116