NET - primary care: Caring for patients with traumatic stress sequelae following intensive medical care

在德国，每年有200万例治疗病例在重症监护室（ICU）接受治疗。其中一半以上的人因此遭受长期的功能、心理或医疗后遗症。创伤后应激障碍（PTSD）是一种常见的后遗症，症状可能在ICU出院后持续数年。在等待专科精神病/心理治疗服务期间，全科医生是照顾病人的主要保健专业人员。创伤相关症状源于未能对创伤经历构建足够的记忆：在PTSD中，感觉，认知和情感表征与上下文和情景记忆系统失去了联系。创伤相关治疗的目标是重新连接记忆碎片。在“叙事暴露疗法”（NET）中，患者建立了一个专注于创伤经历情境化的叙事。咨询师和病人一起设计了一条“生命线”，由相关的传记事件组成。这特别依赖于全科医生的技能，采取全面的医疗和心理社会史。随后，患者重新叙述压力情况，以恢复创伤事件的背景细节，而不是侵入性记忆。我们申请了一项随机分组对照试验（N=340），以评估在基线后6个月使用创伤后应激诊断量表（PDS）评估的具有创伤后症状的ICU后患者的简短NET初级护理干预是否有效改善临床结局。

In Germany, two million treatment cases are treated at Intensive Care Units (ICUs) every year. More than half of them suffer from long-term functional, psychological or medical sequelae as a result. Posttraumatic stress disorder (PTSD) is a frequent sequela and symptoms may remain for years after ICU discharge. While waiting for specialist psychiatric/psychotherapeutic services, the General Practitioner (GP) is the main health professional attending to the patient. The trauma-related symptoms arise from a failure to construct adequate memories of the traumatic experiences: In PTSD, sensory, cognitive, and affective representations have lost association with the contextual and episodic memory system. The goal of trauma-related therapy is to reconnect the memory fragments. In "Narrative Exposure Therapy" (NET), the patient builds a narrative that focuses on the contextualization of traumatic experiences. Counsellor and patient together design a "lifeline", consisting of relevant biographical events. This specifically relies on the GP's skill at taking comprehensive medical and psycho-social histories. Subsequently, the patient recounts the stressful situations to recover contextual details of the traumatic event ¿ rather than intrusive memories. We apply for a cluster-randomized controlled trial (N=340) to evaluate whether a brief NET primary care-intervention for post-ICU-patients with posttraumatic symptoms effectively improves clinical outcomes as assessed using the Posttraumatic Stress Diagnostic Scale (PDS) 6 months after baseline.