Block 6: Post Traumatic Stress Disorder Management and Prevention - Treatment, Recovery and Implications for Industry

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TREATMENT:

Neuro-Physiology:

Persistent amygdala reactivity

Psycho-Education:

Information.
Correction of expectations.

Psychotherapy:

Cognitive-behavioural therapy (CBT).
Exposure therapy.
Eye Movement Desensitisation and Restructuring (EMDR).

Pharmacotherapy:

Symptom reduction only.
Fluoxetine.
Paroxetine.
Sertraline.

Normal recovery from trauma:

Three to four weeks.

Recovery from PTSD:

30% complete, 40% mild symptoms, 20% moderate, 10% unchanged or worse.

DETERMINANTS OF RECOVERY:

Factors of the person:

Age.
Psychiatric history.
Trauma history.
Personality.
Social supports.
Other stressors.

Factors of the traumatic incident:

Type of incident.
Injury or bereavement.
Unpredictability.
Likelihood of recurrence.
Subjective experience / cognitive attributions.

Factors of recovery environment:

Debriefing / counselling ?
Medication ?

danger of benzodiazepines,
danger of pathologising,
problem of delayed onset.

Social supports - the importance of validation.
Early identification and treatment.

IMPLICATIONS FOR INDUSTRY:

Decreased efficiency.
Absenteeism.
Staff turnover.
Disability claims.
Litigation, employer’s responsibility.

Compensation fund (circular instruction 172):

PTSD is an injury on duty.
Medical aid.
Disability.
Prevention.

Issues specific to work related trauma:

Social supports - management, colleagues.
Avoidance.
Medical attention.

Proposed model for management of work related trauma:

Typical reactions following trauma is defined as normal and functional.
Evaluation of risk factors.
Early treatment intervention.
Optimising recovery - guiding social supports, correcting expectations, correcting self-defeating cognitions.
Strategies for countering avoidance.
Training of managers.
Training of trauma vulnerable staff.
Training of other professionals.

NATIONAL TRAUMA LINE : 084 944 9444