Schnurr PP, Hamblen JL, Wolf J, et al. The Management of Posttraumatic Stress Disorder and Acute Stress Disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med. 2024 Mar;177(3):363-374. doi: 10.7326/M23-2757. Epub 2024 Feb 27. (Evidence-based guideline)

DESCRIPTION: The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) worked together to revise the 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. This article summarizes the 2023 clinical practice guideline (CPG) and its development process, focusing on assessments and treatments for which evidence was sufficient to support a recommendation for or against.

METHODS: Subject experts from both departments developed 12 key questions and reviewed the published literature after a systematic search using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) method. The evidence was then evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Recommendations were made after consensus was reached; they were based on quality and strength of evidence and informed by other factors, including feasibility and patient perspectives. Once the draft was peer reviewed by an external group of experts and their inputs were incorporated, the final document was completed.

RECOMMENDATIONS: The revised CPG includes 34 recommendations in the following 5 topic areas: assessment and diagnosis, prevention, treatment, treatment of nightmares, and treatment of posttraumatic stress disorder (PTSD) with co-occurring conditions. Six recommendations on PTSD treatment were rated as strong. The CPG recommends use of specific manualized psychotherapies over pharmacotherapy; prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy; paroxetine, sertraline, or venlafaxine; and secure video teleconferencing to deliver recommended psychotherapy when that therapy has been validated for use with video teleconferencing or when other options are unavailable. The CPG also recommends against use of benzodiazepines, cannabis, or cannabis-derived products. Providers are encouraged to use this guideline to support evidence-based, patient-centered care and shared decision making to optimize individuals' health outcomes and quality of life.

Discipline Area Score
FM/GP/Mental Health 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Psychiatry 6 / 7
Family Medicine (FM)/General Practice (GP) 6 / 7
Comments from MORE raters

FM/GP/Mental Health rater

A very long article with many details that may not be known to practitioners.

General Internal Medicine-Primary Care(US) rater

Very interesting and welcomed approach to treat patients with PTSD as opposed to using medication, many of which are probably not helpful and are possibly harmful.

General Internal Medicine-Primary Care(US) rater

This synopsis is based on the review of clinical guidelines in various areas about post-traumatic stress disorder (PTSD). They clarify the definition and evidence-based treatments, which makes this highly valuable in the PTSD field.

Psychiatry rater

An important article that deserves wide dissemination.
Comments from EvidenceAlerts subscribers

Mr. Eduard Bokan (3/5/2024 11:58 AM)

I like the recommendations: physio and psycho therapies play a more important role than pharma therapy.