Activity

Treatment of Post Traumatic Stress Disorder (PTSD)


Type: Consensus Study
Topics: Public Health, Substance Use and Mental Health
Board: Board on Population Health and Public Health Practice

Activity Description

I. The Department of Veterans Affairs asked the IOM to convene a new committee to review the literature on various treatment modalities (including pharmacotherapy and psychotherapy) and treatment goals for individuals with PTSD.

II. Specifically, the committee conducted an evidence-based review on best treatment practices, and types and timing of specific interventions, and commented on the prognosis of individuals diagnosed with PTSD (and existing co-morbidities). As part of its assessment, the IOM committee:

A) Developed descriptive evidence tables including: type of study and identify potential bias and generalizations of the study. The committee also searched for and classified systematic and narrative reviews on the topic of treatment and recovery of individuals with PTSD.

B) The committee examined and classified the existing studies on various treatment modalities for PTSD. The committee reported on the highest levels of evidence available. For each study the committee considered the quality of design and execution, and was guided by the following classification:
I - Randomized controlled trial
II-1 - Controlled trial without randomization
II-2 - Cohort or case-control study
II-3 - Time series or uncontrolled experiment
III - Opinion of respected authority, case report and expert committee

C) The committee considered the following framework to make conclusions about the strength of the available evidence for treatment modalities:
1) Evidence is sufficient to conclude the efficacy of X in the treatment of PTSD. (A qualifier of magnitude may be added if appropriate.)
2) Evidence is suggestive but not sufficient to conclude of efficacy X in the treatment of PTSD. (The committee may note inconsistencies in the data.)
3) Evidence is inadequate to determine the efficacy of X in the treatment of PTSD
4) Evidence is suggestive that X treatment is ineffective in treating PTSD
5) Evidence is suggestive that X treatment is harmful in the treatment of PTSD.

D) For each of the conclusions above, the restriction of the conclusion regarding the population, provider, setting intervention or comparator intervention was noted.

III. As part of its assessment, the IOM committee noted limitations in the evidence base and made suggestions for further research that could strengthen the evidence or address research gaps in the treatment of PTSD.

IV. In conducting its work, the committee considered the following questions in relation to treatment modalities (including pharmacotherapy and psychotherapy) and treatment goals for individuals diagnosed with PTSD.

A) What are the goals of PTSD treatment?
• What is the definition of “recovery”?
• For what proportion of patients is recovery possible?
• Besides recovery, what other outcomes would benefit patients?

B) Does evidence support the value of early intervention?

C) How long should treatment continue?
• What is the impact of a hiatus in treatment?
• What is the impact of periodic re-examination for asymptomatic patients?

V. The committee noted when the evidence base does not allow for responding to these questions due to insufficient research attention or poorly conducted studies.

There was a modification in the Statement of Task. Sections II.B.-II.D. were revised for greater clarity (7/6/07).


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