In this the eleventh article of the SOCRATES series we present our synopses of reviews from the Cochrane Database of Systematic Reviews relating to counselling, psychology, and psychiatry that the working party felt were of particular relevance to emergency medicine practitioners. The methods of our review and the rationale for the forming the SOCRATES working party are as have previously been published.

BRIEF PSYCHOLOGICAL INTERVENTIONS (“DEBRIEFING”) FOR TRAUMA RELATED SYMPTOMS AND PREVENTION OF POST TRAUMATIC STRESS DISORDER

Background

Twenty five per cent of those involved in a road traffic accident have a defined psychiatric disorder one year later, with up to 11% displaying post-traumatic stress disorder (PTSD). Debriefing involves emotional processing by encouraging recollection of the traumatic event. The objective of this review was to assess the effectiveness of a single session of debriefing in the reduction and prevention of psychological morbidity after traumatic events.

Results

A total of 8 randomised trials were identified involving over 600 patients. The studies covered violent crime, burns, road traffic accidents, and spontaneous miscarriage. The populations were somewhat heterogeneous. Outcomes included PTSD, anxiety, and depression. Overall there was a tendency towards an adverse outcome with the intervention.

SOCRATES says

Brief psychological intervention for the prevention of trauma related psychological morbidity has not been shown to be beneficial and is potentially harmful.

PHYSICIAN ADVICE FOR SMOKING CESSATION

Background

There is evidence from some randomised trials to suggest that advice from motivated physicians can be effective in facilitating smoking cessation. From a public health perspective, even if effectiveness is small, large numbers of …