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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2757

摘要内容如下：

描述

美国退伍军人事务部（VA）和国防部（DOD）合作修订了2017年VA/DOD创伤后应激障碍和急性应激障碍管理临床实践指南。本文总结了2023年临床实践指南（CpG）及其制定过程，重点关注证据足以支持或反对建议的评估和治疗。

方法

来自两个部门的学科专家提出了12个关键问题，并在使用PICOTS（人口、干预、比较、结果、结果测量的时间和设置）方法进行系统搜索后审查了已发表的文献。然后使用GRADE（建议评估、开发和评价的分级）方法对证据进行评估。在达成共识后提出了建议；它们基于证据的质量和强度，并考虑到其他因素，包括可行性和患者的观点。在外部专家组对草案进行同行审议并采纳其意见后，最后文件就完成了。

建议

修订后的CpG包括以下5个主题领域的34项建议：评估和诊断、预防、治疗、噩梦的治疗和创伤后应激障碍（PTSD）的治疗。六项关于PTSD治疗的建议被评为“强有力”。CpG建议使用特定的手工化心理疗法而不是药物疗法。延长暴露、认知加工疗法或眼动脱敏和再加工心理疗法；帕罗西汀、舍曲林或文拉法辛；以及安全视频电话会议，以在治疗已被验证可与视频电话会议一起使用时或在其他选项不可用时提供推荐的心理治疗。CpG还建议不要使用苯二氮卓类药物、大麻或大麻衍生产品。鼓励提供者使用本指南来支持循证、以患者为中心的护理和共同决策，以优化个人的健康结果和生活质量。

英文原文如下：

Abstracts

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.

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