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Early Intervention in PTSD — MRCPsych Paper B MCQ

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HardAnxiety & Stress-Related DisordersEarly Intervention in PTSDMRCPsych Paper B

A 22-year-old woman is assessed 2 weeks after a sexual assault. Her symptoms began several days after the event and include intrusive memories, avoidance, hypervigilance, dissociation and persistent negative mood. Formal assessment identifies 10 acute stress symptoms causing marked occupational and social impairment. She is physically safe, has no immediate risk requiring crisis intervention and wishes to receive treatment. According to NICE NG116, which is the most appropriate management?

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Correct answer: B — Offer individual trauma-focused cognitive behavioural therapy now

The correct answer is B. She has clinically significant acute post-traumatic symptoms within 1 month of the assault, with sufficient symptoms and impairment to indicate acute stress disorder. NICE NG116 recommends offering adults in this group individual trauma-focused CBT, such as cognitive processing therapy, cognitive therapy for PTSD, narrative exposure therapy or prolonged exposure therapy. Treatment does not have to be postponed until the 1-month PTSD diagnostic threshold. Active monitoring is appropriate for subthreshold symptoms, not as the sole mandatory response to acute stress disorder. EMDR is considered for adults presenting 1–3 months after non-combat trauma when preferred, rather than being the recommended intervention during the first month. Medication, including sertraline, should not be offered to prevent PTSD.

Reference: NICE. Post-traumatic stress disorder (NG116), recommendations 1.6.4 and 1.6.15, 2018 (minor presentational update 2024). https://www.nice.org.uk/guidance/ng116/chapter/recommendations