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Subthreshold post-traumatic stress symptoms after a recent traumatic event — MRCEM SBA MCQ

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EasyMental health and behavioural emergenciesSubthreshold post-traumatic stress symptoms after a recent traumatic eventMRCEM SBA

A 34-year-old man attends the emergency department five days after witnessing a fatal road traffic collision. He reports occasional intrusive images, has avoided the road where it happened and is sleeping less well. He finds this unsettling but continues to work and manage his usual activities. He is alert, has no physical illness requiring treatment and reports no thoughts of harming himself or others. He asks whether treatment now could prevent his symptoms becoming persistent. What is the most appropriate management plan?

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Correct answer: E — Provide practical support and arrange active monitoring within one month.

His intrusive images, avoidance and sleep disturbance follow a traumatic event, but are currently mild, with preserved functioning and no identified immediate safety concern. Because he presents within the first month with subthreshold symptoms, the best plan is practical support and **active monitoring with follow-up contact arranged within one month**. This provides an opportunity to identify symptoms that persist or become clinically important. ([nice.org.uk](https://www.nice.org.uk/guidance/ng116/chapter/recommendations)) A is tempting because early trauma-focused cognitive behavioural therapy is recommended for adults with acute stress disorder or clinically important post-traumatic symptoms; those features are not present here. B may appear supportive, but psychologically focused debriefing is not recommended to prevent or treat PTSD. C might suit an adult with established PTSD who prefers drug treatment, but medication, including benzodiazepines or antidepressants, should not be offered to prevent PTSD after this recent event. D offers reasonable initial advice but omits the *planned* follow-up that distinguishes active monitoring from leaving the patient to re-present if symptoms persist. ([nice.org.uk](https://www.nice.org.uk/guidance/ng116/chapter/recommendations))

Reference: NICE NG116, Post-traumatic stress disorder: recommendations (5 December 2018) — https://www.nice.org.uk/guidance/ng116/chapter/recommendations NICE, April 2025 surveillance of post-traumatic stress disorder (NG116) (8 April 2025) — https://www.nice.org.uk/guidance/ng116/evidence/april-2025-surveillance-of-post-traumatic-stress-disorder-nice-guideline-ng116-15313065517