UNDERSTANDING COMPLEX PTSD Dr. in particular, our results reinforce the need for trauma-informed primary care practices including a more thorough exploration of complex trauma effects on patients presenting for treatment. Reliving trauma This includes unwelcome memories, nightmares, or vivid flashbacks. A mind-body workbook for healing and overcoming Complex PTSD. Understand the neurobiology of complex post-traumatic stress disorder; Understand the implicated regions of the brain in cPTSD; Understand how . He began postgraduate psychiatric training at the Middlesex Hospital where he. (PTSS) form classes consistent with the diagnostic criteria of complex PTSD (CPTSD) as proposed for the ICD-11, and to relate the emerging classes with treatment outcome of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Bisson JI, Cosgrove S, Lewis C, Robert NP (November 2015). NICE recommends that you are offered 812 regular sessions of around 6090 minutes, seeing the same therapist at least once a week. London SE1 1SD. The most successful treatment for PTSD is usually psychotherapy (psychological or talking therapy) that is specifically focused on identifying and treating the symptoms of the trauma. Post-Traumatic Stress Disorder (PTSD) Post-Traumatic Stress Disorder (PTSD) is an anxiety related mental health condition. ca Read the full text PDF Tools Share Abstract Lanius RA, Bluhm RL, Frewen PA. About us. uk or call Complex PTSD Pathway clinicians Livia or Ghiselle on 0203 317 6820. In April 2018, an executive order affecting undocumented immigrants led to the forced separation of over 2,000. Bisson JI, Cosgrove S, Lewis C, Robert NP (November 2015). Consultant, counselling and clinical psychologists. Source www. Rachel Hillers JCPP open access paper first published 20 March 2020. Alcohol misuse. It can also affect you if you witnessed something terrible happening, such as a serious accident. the content of the weekend includes an overview of the neuroscience of trauma and complex trauma, also known as attachment and developmental trauma, how it develops and how it can be healed (including polyvagal theory updated - and how all trauma-informed modalities can be integrated seamlessly how to recognise and work with c-ptsd and ego. Only one-third of individuals with bipolar disorder (BD) and posttraumatic stress disorder (PTSD) receive specialty mental health care during the course of a year. This book provides the readers with a series of complex cases that are organized by psychiatric disorder. Leave a reply. Consultant Perinatal Psychotherapist and Psychiatrist, South London and Maudsley NHS Foundation Trust. Find the best Psychiatrists covered by AVIVA specialised in complex ptsd in East London. Results The prevalence of either PTSD or C-PTSD was 36. Although BPD doesn't always have its roots in trauma, this is often the case. I am a practising psychiatrist and Clinical Professor in Psychiatry at Cardiff University. & McCrory, E. (2020) 216129-31. 71 &163;130. University of London and an MBA from Babson College. Were open 9am to 6pm, Monday to Friday (except for bank. This is caused by experiencing an event or series of events that are extremely threatening or horrifying. Such events can leave us feeling shocked, disorientated, and distressed. Complex post-traumatic stress disorder (Complex PTSD) has been recently added as a separate diagnosis in the WHO International Classification of Diseases. Mental health nurses. Complex PTSD, also known as CPTSD, can result if a person experiences prolonged or repeated trauma over months or years. It can develop at any time but is often associated with at-risk populations such as children, veterans, and others who have experienced repeated. Chronic Fatigue Syndrome. Dr Chris Corcos has worked as a consultant general adult psychiatrist for over 20 years in a variety of settings including public, private, forensic, inpatient and community. Complex PTSD is a more complicated version of PTSD, at times confused for a . Without awareness, someone could believe that. Corporate and Institutional Clients; Businesses; Charities and 3rd Sector. Compare patient reviews and book online instantly. MAKE AN ENQUIRY Home Mental Health Post-Traumatic Stress Disorder (PTSD) Treatment Page medically reviewed by Dr Leon Rozewicz (MBBS, FRCPsych, MRCGP, MRCPsych), Consultant Psychiatrist and Medical Director of Priory Hospital North London in September 2021. Psychiatric Clinics of North America, 17(2) 425-437. Call 0800 860 6267. If you have complex PTSD, you may be offered therapies used to treat PTSD, such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR). The chapter takes up the campaign to recognize complex PTSD (CPTSD) and representations of traumatized antisocial veterans in Hollywood films and shows how PTSD is invoked in institutional settings where psychiatric taxonomies serve as an institutional defense, particularly in splitting images of virtuous and villainous inmates. For example torture. You don&39;t have to struggle with PTSD - help is available. Complex post-traumatic stress disorder or abbreviated as C-PTSD, on the other hand, usually occurs due to exposure to long-term exposure to traumatic stress rather than any one single event. In 2020, researchers in London conducted a study that sought to examine the relationship between emotional dysregulation, impairment, and . Social Psychiatry and Psychiatric Epidemiology, 52(6. She has a specific interest in assessing psychiatric injuries including complex Post-Traumatic Stress Disorders. One novel approach is MDMA-assisted psychotherapy for people diagnosed with treatment-resistant PTSD, where MDMA is used as a catalyst to facilitate trauma processing during psychotherapy. He began postgraduate psychiatric training at the Middlesex Hospital where he. Journal of Child Psychology and Psychiatry, 58 (2), 160-168. Posted Apr 06, 2021 Reviewed by Abigail Fagan Summary The ICD-11 includes the diagnosis of CPTSD, which involves. Josh Dickson- EMDR Consultant, Clinical Director. For BPD treatment is aimed at alleviating the emotional dysregulation and tendency to self-harm and to work on establishing a more consistent sense of self and of others. In the NHS, she works as a Consultant at the South London and Maudsley NHS Foundation Trust for TREAT (Treatment REview and Assessment Team). Dr Gen-Cos is the lead Consultant Psychiatrist for the Trauma and. The city leans into its travel-savvy background, with sites like Big Ben, Westminster Abbey, and Hyde Park drawing in countless international. General Medical Council - Full registration with licence to practice 6136566. that offer specialized treatment for C-PTSD. Trauma PTSD. If you would like to speak with our medical secretaries, call us now on 02071180407 or click the button below. Complex Depression, Anxiety and Trauma Service (CDAT) Service managers Allison Arekion and Stuart Linke Address. Such events can leave us feeling shocked, disorientated, and distressed. I have been supported and encouraged during times when I doubted myself. Complex PTSD is simply a type of PTSD. To put it in simple terms an isolated perhaps a one-off severe trauma can lead to PTSD, but if the traumatic experience is chronic and not just a one-off, it can lead to Complex PTSD. uk or call Complex PTSD Pathway clinicians Livia or Ghiselle on 0203 317 6820. Symptoms of PTSD and C-PTSD can look similar to other diagnoses. Consultant Psychiatrist. The lines are open 9am to 6pm, Monday to Friday (except for bank holidays) 0300 123 3393. For the last 16 years, she has specialised in the diagnosis and treatment of PTSD, complex trauma and dissociative disorders. PTSD shares most of its symptoms (fear reactions, avoidance, hypervigilance) with Complex PTSD, but the latter also shows emotional dysregulation, poor self- . Friday, September 23, 2022. disorder (PTSD) is a central task for psychotraumatol- ogy. The failing treatment of complex PTSD An autoethnography of trauma and secondary trauma 28 th International Conference on Psychiatry & Psychology Health May 06-07, 2019 Amsterdam, Netherlands. If you would like to talk to someone about Post Traumatic Stress Disorder, Complex Post Traumatic Stress Disorder, or trauma, please get in touch with the Private Therapy Clinic on Whatsapp message at 447434585472 email, chat bot or book online to arrange an appointment. Dr Ana-Maria Ilea is an experienced General Adult Consultant Psychiatrist with a special interest in Eating Disorders, having spent more than 5 years working in highly specialist ED units in London. Trauma Therapy & PTSD Therapy in London (Post-Traumatic Stress Disorder). 5 Division of. Post-traumatic stress disorder (PTSD) - Psychiatrists - AXA PPP - London in Central London · Payments for pre-paid services · Dr Stefania Bonaccorso · Dr Leon . Complex post-traumatic stress disorder (complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e. It can also affect you if you witnessed something terrible happening, such as a serious accident. Dr Martin Baggaley is a former Medical Director of the South London and Maudsley NHS Trust and Chief Medical Officer of Maudsley Health in Dubai. May 24, 2022 COMPLEX POST TRAUMATIC STRESS DISORDER (CPTSD) TREATING PTSD, CPTSD AND TRAUMA HOW CAN I GET PTSD, CPTSD, AND TRAUMA TREATMENT IN LONDON REFERENCES THERAPISTS WHO Treat Post Traumatic Stress Disorder (PTSD) and Trauma AT PRIVATE THERAPY CLINIC Post Traumatic Stress Disorder (PTSD) and Trauma free consultation Book online As Seen On. Find event and ticket information. Search for other works by this author on Oxford Academic. A mind-body workbook for healing and overcoming Complex PTSD. London Hogarth Press. Complex post-traumatic stress disorder (Complex PTSD) has been recently added as a separate diagnosis in the WHO International Classification of Diseases. 30 January 2022 at Regent's University London, London, England. She is employed as the clinical lead for the female service line within Health & Justice services,. 17 18 in our. Complex post-traumatic stress disorder (complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e. Complex PTSD is simply a type of PTSD. United Kingdom Phone 020 3317 7358 Email CDAT. Private psychotherapy work with various forms of gaslighting, narcissistic abuse, emotional abuse and C-PTSD. It is easy to recognize when a child is explicitly, physically or sexually abused, but the impact of having inadequate or deficient parents can be elusive and escape our collective awareness. vi Adults Surviving Child Abuse (ASCA) www. Whenever available, use screening. This might include Trauma-focused Cognitive Behavioural Therapy (CBT) Eye Movement Desensitisation and Reprocessing (EMDR) Narrative exposure therapy. Eventbrite - MindBody Breakthrough presents London LiveWorkshop Understanding & Treating Complex PTSD - Sunday, 31 January 2021 Sunday, 12 March 2023 at Regent's University London, London, England. Conclusion The treatment resistant PTSD is very a complex condition that requires various ways to make real contact with, endeavour congruent, emphatic and. Complex PTSD is also conceptually similar to disorder of extreme stress not otherwise specified, which in addition to PTSD symptoms is often described as having alterations in self-identity, self-directed harm, and chaotic relationships (7). World Psychiatry, 18, 236-237. 05), where 80 of adolescents had reached diagnostic remission of PTSD. Background Recent research has identified a number of pre-traumatic, peri-traumatic and post-traumatic psychological and ecological factors that put an individual at increased risk for developing PTSD following a life-threatening event. Many of the people she sees for therapy have complex mental health problems with multiple diagnoses that require specialized interventions including input from psychiatrist colleagues and other health professionals. Psychiatry London. Gupta obtained her medical degree from the University of Toronto. Information · Copyright The Royal College of Psychiatrists 2019 · Published online by Cambridge University Press 08 August 2019. Were open 9am to 6pm, Monday to Friday (except for bank holidays). Pradhan is an NHS Adult Consultant Psychiatrist covering the inner city of Birmingham since 2003 where she assesses and treats a diverse patient population, many with complex mental health problems precipitated by social factors. Most people take time to get over a traumatic event, but with PTSD, you can't move past. ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in treatment seeking veterans risk factors and comorbidity. bpd (or eupd) can look very similar to complex ptsd, but has a few extra symptoms frantic attempts to avoid being abandoned, unstable relationships, unstable sense of self (the person. 1007s00127-021-02028-6 PMID 33464398. Examples of experiences that may lead to PTSD include sexual assault, a serious accident, or a devastating natural disaster. If you would like to discuss a referral, please email keepingwellNCL. Trauma Therapy & PTSD Therapy in London (Post-Traumatic Stress Disorder). IAPT - IAPT Clinical Skills Working with Complexity in PTSD Leverage a leading global provider of evidence-based digital mental and behavioural healthcare solutions. We believe in the importance of multidisciplinary working that is collaborative, respectful, and integrative, with a particular focus on therapeutic. If you have mild symptoms of PTSD, or you&x27;ve had symptoms for less than 4 weeks, an approach called active monitoring may be. At LPC, we understand that traumatic events can be extremely difficult to come to terms. Trauma Clinic London. Bloom, S. I have been supported and encouraged during times when I doubted myself. Compare patient reviews and book online instantly. "The only journey is the journey within. Trained in Oxford and London General Adult Psychiatrist with over 21 years of experience in PTSD, psychosis, mood and anxiety disorders, Court Diversion, LGBT and transcultural issues and personality disorders As a medico-legal psychiatrist and expert witness, I have extensive experience in providing opinions to the Home Office, courts. Chronic trauma refers to Post-traumatic Stress Disorder, while complex trauma refers to a more severe form of PTSD, known as Complex PTSD, or C-PTSD. The lines are open 9am to 6pm, Monday to Friday (except for bank holidays) 0300 123 3393 Mind Legal line 0300 466 6463 The Mind Legal line provides legal information and general advice on mental health related law. London sees the UKs highest levels of tourism, boasting 21 million travelers yearly pre-pandemic. One novel approach is MDMA-assisted psychotherapy for people diagnosed with treatment-resistant PTSD, where MDMA is used as a catalyst to facilitate trauma processing during psychotherapy. Emma is a registered mental health nurse, psychotherapist, EMDR therapist and TCTSY yoga facilitator. 6 Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, United Kingdom; 7 Department of Psychosomatic Medicine and Psychotherapy,. We have recently welcomed Dr. This guideline covers recognising, assessing and treating post-traumatic stress disorder (PTSD) in children, young people and adults. If you would like to discuss a referral, please email keepingwellNCL. Apr 24, 2019 &183; The complex mixture of symptoms experienced by women with PTSD after birth can often lead to delays and even misdiagnosis. The American Psychiatric Association, in the third edition of its Diagnostic and Statistical Manual, recognizes PTSD as a disorder, replacing disorders related to specific traumas. London Harcourt Brace & Company. As a complex trauma patient, who has had a long involvement with the Australian mental health system,. Gupta obtained her medical degree from the University of Toronto. Get an assessment and diagnosis appointment with a specialist psychiatrist or psychologist. 5 Treatment and management of PTSD in the NHS 17 2. Trauma-focused phase-based approaches and multicomponent interventions that include cognitive restructuring and imaging exposure seem to be particularly effective in this regard. Bisson JI, Cosgrove S, Lewis C, Robert NP (November 2015). 07717 989 022 (textline) lifecentre. Discover how you can transform harmful patterns to reduce your symptoms and give yourself a new, positive outlook on life. If you have complex PTSD, you may be offered therapies used to treat PTSD, such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR). About us. something that puts our life in danger, either real or perceived), our nervous system reacts by entering survival mode. National Institute for Health and Care Excellence. The treatment options commonly adopted for the care of post-traumatic stress disorder include trauma-focused psychotherapies, including cognitive processing therapy (CPT) and prolonged exposure (PE). psychological effects Working together from trauma to recovery We are offering virtual sessions at reduced rates for Key Workers during the COVID-19 pandemic If you feel you would benefit from supporttherapy, please contact our team on adminassisttraumacare. 02071180407 Meet our CAMHS specialists Isabelle Rassaerts Paediatrician Dr Aaron Lovelle Psychiatrist Dr Omar Choudhry Psychiatrist. An initial group of five UK military veterans with experience of severe and complex PTSD have been recruited to take part in the Phase Two trial, with each participant receiving a combination of MDMA (a psychoactive drug that can produce feelings of euphoria in users) and established talking therapies. Facing ones PTSD is a brave, courageous actand with the right guidance, recovery is possible. Integrated Psychological Therapies Team, IPTT, Lewisham, South London and Maudsley NHS Foundation Trust, London, UK (Received 12 June 2016; accepted 22 October 2016). Reviews, prices, referral letter. In a study of exposure therapy conducted with adults who had experienced complex trauma,. You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this leaflet. uk or call Complex PTSD Pathway clinicians Livia or Ghiselle on 0203 317 6820. You&39;ll also be offered treatment for other problems you may have, such as depression or alcohol addiction. They will look for details of help and support in your own area. it is important first to understand PTSD. One novel approach is MDMA-assisted psychotherapy for people diagnosed with treatment-resistant PTSD, where MDMA is used as a catalyst to facilitate trauma processing during psychotherapy. 145 - 152. I am a practising psychiatrist and Clinical Professor in Psychiatry at Cardiff University. Gupta has enjoyed working with complex psychiatric patients, mainly with PTSD, who often present with varied and multiple medical co-morbidities. Am J Psychiatry 1678, August 2010 ajp. Find the best WPA psychiatrist expert in complex ptsd located in London. , torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or. Find the best Psychiatrists covered by AVIVA specialised in complex ptsd in East London. IAPT - IAPT Clinical Skills Working with Complexity in PTSD Leverage a leading global provider of evidence-based digital mental and behavioural healthcare solutions. Results The prevalence of either PTSD or C- PTSD was 36. 00pm (doors open from 9. However, preliminary evidence indicates that PTSD tends to be under-reported in Brazilian health services, despite the high prevalence of trauma. Rawle Ragoobar, Deputy Lead Staff Support. These include depression. 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Expert Assessments. Zenith Psychology is a leading London psychological therapy and consultation service. Share this article Share with. The Clinic is an affiliation between a number of researchers, organisations and clinical psychologists, and is directed by Professor Richard Bryant. Clinic for Child and Adolescent PsychiatryPsychotherapy, University of Ulm, Ulm, Germany. Belfast Workshop Understanding & Treating Complex PTSD Tickets, Multiple Dates Eventbrite &163;51. Google Calendar ICS. Find the best WPA psychiatrist expert in complex ptsd located in London. Examples of experiences that may lead to PTSD include sexual assault, a serious accident, or a devastating natural disaster. The newly released ICD11 includes two related diagnoses within the section on Disorders Specifically Associated with Stress posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) 1. MAKE AN ENQUIRY Home Mental Health Post-Traumatic Stress Disorder (PTSD) Treatment Page medically reviewed by Dr Leon Rozewicz (MBBS, FRCPsych, MRCGP, MRCPsych), Consultant Psychiatrist and Medical Director of Priory Hospital North London in September 2021. They will look for details of help and support in your own area. We aim to become a trusted partner of NHS medical professionals and support patients in using medicinal cannabis where other treatments have failed. Although PTSD occurs as a response to a single traumatic event. If these persistent traumatic experiences occur when someone is young, their maturing personality gets damaged and that leads to BPD. In this book, American psychiatrist Dr Conti discusses the devastating effect that trauma can have on an individual&x27;s life, as well as on the society as a whole. Repeated trauma that causes harm by an intimate caregiver and situations wherein the individual is helpless, trapped, and can leave the individual with severe health disorders. In the proposed criteria by ICD-11,17 PTSD will be diagnosed according to six criteria (table). 1 thg 3, 2022. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Dr Deirdre MacManus - Consultant Psychiatrist and Clinical Lead. She primarily works therapeutically using Cognitive Behaviour Therapy (CBT), but draws on a range of models to meet clients&x27; unique needs, such as Compassion Focussed Therapy, Acceptance and. She has over forty-three years of experience in the psychiatry field. Appropriate problems Depression, Anxiety, Stress, OCD,. Over the years Dr. Were open 9am to 6pm, Monday to Friday (except for bank. - Glenn Close. ICD-11 PTSD and Complex PTSD Structural validation using exploratory graph analysis. 00 - 11. To put it in simple terms an isolated perhaps a one-off severe trauma can lead to PTSD, but if the traumatic experience is chronic and not just a one-off, it can lead to Complex PTSD. The diagram. Learn about treatments for PTSD, including medication, talking therapy and other. Introduction Complex post-traumatic stress disorder (C-PTSD) is characterized by the typical symptoms of PTSD, in addition to affective dysregulation, negative self-concept, and disturbances in interpersonal relationships. Dr Claudia Herbert, founder and Clinical Director of The Oxford Development Centre, is an internationally recognised expert in the field of Trauma Psychology, Post Traumatic Stress Disorder (PTSD), Complex Trauma, Personality Disorders including Dissociative Personality Disorder (DID) and Post-Trauma Growth. Complex ptsd psychiatrist london. A new case study from Smart TMS shares a patients experience of recovery from complex PTSD after having transcranial magnetic stimulation treatment at the companys Manchester clinic. Posttraumatic stress disorder (PTSD) is highly prevalent within prison settings, yet is often unidentified and undertreated. Stress 2022 is the leading meeting dedicated to Psychiatrists and. hb zl lg. learn more Conditions we Treat. Chronic Fatigue Syndrome. Sometimes the trauma. Guptas research has focused on various aspects of psychosomatic medicine including somatic symptoms in PTSD, psychosomatic dermatology and sleep disorders. If you would like to discuss a referral, please email keepingwellNCL. Find the best WPA psychiatrist expert in complex ptsd located in London. We are offering virtual sessions at reduced rates for Key Workers during the COVID-19 pandemic. You Become Dissociated and Feel Dead Inside 2. MRCPsych , CCT Sec 12 (2) Approved. Symptoms of PTSD include re-experiencing the traumatic event, avoiding triggers related to the event, negative changes in mood and thinking, and hyperarousal and reactivity (DSM-5, APA, 2013). Anxiety, racing heart, nightmares, and flashbacks making you relive the worst moments of your life, over and over again. If these persistent traumatic experiences occur when someone is young, their maturing personality gets damaged and that leads to BPD. org Phone 07850 732303. Wetterneck, PhD, is a licensed clinical psychologist who serves as the clinical director of Trauma Recovery services at Rogers Behavioral Health, where he developed the adult trauma recovery programs at the residential, partial hospital, and intensive outpatient levels of care, and helped incorporate a. Complex ptsd psychiatrist london. Medical & Legal Admin Services Nationwide Medico Legal Experts. Compare patient reviews and book instantly. Complex PTSD is simply a type of PTSD. ca Read the full text PDF Tools Share Abstract Lanius RA, Bluhm RL, Frewen PA. We can offer supervision on work with trauma, dissociation and PTSD. 5878). Vaccines might have raised hopes for 2021, but our most-read articles about Harvard Business School faculty research. These events can happen during childhood or as an adult. It is much more common than primary tokophobia. learn more Conditions we Treat. Burnout and Secondary Traumatic Stress (1. I made a recovery from Complex PTSD but I also suffered a fugue (amnesia) and suffer memory problems etc. Complex post-traumatic stress disorder (complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e. how your brain regulates hormones and. City of London. Who we are. 0203 326 9160. Background Recent research has identified a number of pre-traumatic, peri-traumatic and post-traumatic psychological and ecological factors that put an individual at increased risk for developing PTSD following a life-threatening event. . Ciconia Recovery London (CRL) is a private outpatient clinic treating mental health disorders and addiction, we aim to serve the needs of our clients who are looking for discretion, professionalism and ultimately success when they have made the decision to address their concerns. The American Psychiatric Association, in the third edition of its Diagnostic and Statistical Manual, recognizes PTSD as a disorder, replacing disorders related to specific traumas. Clinical Psychologists at London Trauma Specialists are highly trained and experienced in working with Complex presentations of PTSD. As a complex trauma patient, who has had a long involvement with the Australian mental health system,. , Murphy, S. You don&39;t have to struggle with PTSD - help is available. Nearly half of intensive care staff reported symptoms of post-traumatic stress disorder, severe depression or anxiety, according to research that led. Mental health nurses. Br J Psychiatry. such as a psychological therapist, psychologist, community psychiatric nurse or psychiatrist. MRCPsych , CCT Sec 12 (2) Approved. Another issue standing in the way of diagnosis is the stigma attached to. Over the years Dr. McElroy, E. Combat Stressdmscombatstress. PTSD has been known by many names in the past. We aim to become a trusted partner of NHS medical professionals and support patients in using medicinal cannabis where other treatments have failed. . dewalt refurbished tools website