Post-Traumatic Stress Disorder

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is the name given to the psychological and physical problems that can sometimes follow threatening or distressing events, where a real physical threat or severe disempowerment (intense fear, hopelessness or horror) was experienced.

These events could include a major disaster, war, rape or sexual, physical or emotional abuse, witnessing a violent death or a serious accident, traumatic childbirth or other situations in which a person felt afraid, horrified, helpless, or that his/her life was in danger. The trauma can be a single event or a series of events taking place over many months or even years.

PTSD is a normal response to these types of incidents and is quite common. It may affect the person directly involved in a traumatic event or situation and may also develop in the families of those involved in a traumatic event. It could develop in people of all ages, including children. Some people start to use recreational drugs or alcohol as a coping mechanism, especially if they have had PTSD or experienced trauma for a long time.

Treatment of PTSD 

If you have experienced a trauma and have distressing symptoms, your general practitioner (GP) is the best person to see immediately. If you see your GP about distressing symptoms in the first four weeks after a traumatic event, you may be told it is very common to feel like this and not to be alarmed. You may not be offered any treatment at this stage, although your GP should offer you another appointment within one month. If you do not have a further appointment, you should go back to your doctor if you do not feel better.

If your symptoms are severe, your GP should offer you treatment straight away. If your GP thinks that you need further treatment, you may be referred to someone who is trained and skilled in providing treatment for PTSD sufferers. This may be a counsellor, community psychiatric nurse, psychologist or psychiatrist. You may be offered an assessment where you will be asked about your physical and psychological health, your social needs, and whether you have thoughts about harming yourself.

Ideally you should receive all your treatment from one healthcare professional, who should be appropriately trained in giving the treatment. All healthcare professionals should treat you with respect, sensitivity and understanding, and explain PTSD and its treatment to you simply and clearly.

What treatments are available for PTSD?

Psychological treatment is available and medication could also be helpful for adults. Many PTSD sufferers have had the symptoms for many months and sometimes years, but treatment can still be helpful. You should be offered treatment regardless of when the traumatic event happened. If you have developed symptoms recently you may get better with little or no treatment. Your healthcare professional should give you enough information about the effective treatments for PTSD and which treatment you might prefer. Your own preference for a particular treatment is important and your healthcare professional should support your choice, where possible.

1. Psychological treatment

Depending on what your symptoms are and when you developed PTSD, you may be offered psychological treatments that are specific to PTSD sufferers, such as trauma-focused cognitive behavioural therapy (CBT). This is a psychological treatment for PTSD based on CBT. CBT focuses on a person's distressing feelings, thoughts and behaviour and helps to bring about a positive change. In trauma-focused CBT, the treatment concentrates specifically on the memories, thoughts and feelings that a person has about the traumatic event. You will be given help to cope with any emotional distress and behavioural problems that may arise during treatment.

Psychological treatments designed for PTSD sufferers have been shown to be effective in helping most people feel better, but this depends on when the traumatic event occurred, when you developed PTSD and how you are feeling. If you do not feel better after a specific treatment, your healthcare professional may suggest you try a different psychological treatment, or offer you a course of medication while you are receiving therapy.

2. Medication

Medication may help to treat adults with PTSD, but for most people it is not as helpful as trauma-focused psychological treatment. Healthcare professionals should usually offer you psychological treatment before medication, but you may also be offered medication in the following instances:

• you prefer not to have psychological treatment, or it would be very difficult for you to start (it may not be available in your area);
• beta-blockers (a type of medication that relaxes blood vessels) may be offered early after the incident as it may prevent future complications;
• psychological treatment, because of threat of further trauma (for example, violence at home), has not had an impact; and
• if psychological treatment is not having an impact, or if you suffer from depression, medication may be combined with your treatment.

What should I know about the medication?

All medication have potential side effects and the relevant information is included on the package insert, of the specific prescribed medication. Should there be any uncertainty, please ask your treating doctor, pharmacist or medical scheme call centre to provide you with extra information.

How long should I take the medication?

If the medication is effective, you are encouraged to continue with the treatment for at least 12 months. After this period, an assessment by your treating doctor will determine whether treatment is still required. Your treating doctor will also assist you to discontinue the use of the medication.

Suicidal thoughts

If are receiving treatment, yet still experience thoughts about suicide, you should contact your treating doctor, irrespective of your age.

Will other conditions affect my PTSD treatment?

• If you have PTSD and also suffer from depression, you should be offered treatment for both. Usually the PTSD will be treated first. Depression symptoms often improve as a result of PTSD treatment. However, if you have severe depression, the depression will usually be treated first. If your treating doctor thinks that you may be at risk of harming yourself or others, they should try and deal with this problem first.

• If you take recreational drugs and/or alcohol, this may affect your treatment for PTSD. Healthcare professionals should therefore treat any drug or alcohol problem first.

• If you have lost a family member or friend due to an unnatural or sudden death, your emotions may be overwhelming and you may have what is known as ‘traumatic grief'. Your GP should be able to refer you to professionals who have training and experience in this area to confirm whether this is indeed the correct diagnosis.

How can I support someone with PTSD?

You have an important role in providing practical and emotional support to someone with PTSD. If appropriate and the person with PTSD consents, healthcare professionals should give you full information about common reactions to traumatic events, including the symptoms of PTSD, its course and treatment.

References

1. 2004. In: Document to Psychiatric Commission. South African Society of Psychiatrists.

2. GORE, TA & RICHARDS-REID, GM. December 2006. Cochrane review article. Emedicine.

3. GREEN, B. 2004. Post-traumatic stress disorder in UK police officers. Current Medical Research and Opinion. 20(1).

4. GRINAGE, BD. 15 December 2004. Diagnosis and management of post-traumatic stress disorder. American Family Physician. Website: http://www.aafp.org/afp/20031215/2401.html

5. http://www.mental-health-today.com/ptsd/dsm.htm

6. LUBIT, R. 7 October 2007. Post-traumatic stress disorder in children. Emedicine.

7. MERCK MANUAL OF DIAGNOSIS AND THERAPY. 17th Edition. 2004. Post-traumatic stress disorder. Section 15, Chapter 178.

8. National Institute for Health and Clinical Excellence (NICE) guidelines.

9. SWINGLER, D Dr. Chief Psychiatrist. 1 Military Hospital, Wynberg, Cape Town.