Post Traumatic Stress Disorder – Aftermath of Disasters

The sinking of the MV Rabaul Queen was the worse maritime disaster in PNG history.  The late Philip Batari had been a passenger aboard this ship on its and his last journey.  Moments before the ship went down Philip posted this picture and comments on his facebook page.

“bloody rough time” he posted and later his last post on facebook read: “experiencing the worse moment of my life”

It is likely that the ship had been overloaded and that proper saftey procedures were not followed.  Hopefully those responsible for this disaster are brought to justice and that the saftey issues are tightened up.  Over 100 people are feared to have died, while about 250 people were luckily rescued, thanks a big part due to the Australian Maritime authorities and the Australian Defence force who responded quickly to lend a hand to the PNG authorities.

Only weeks before this ocean tragedy, a landslide in the Southern Highlands buried a whole village, killing about 40 people.

 

 

 

 

 

 

 

Photo From AP – From Sydney Morning Herald http://www.smh.com.au/world/massive-png-landslide-wipes-out-sleeping-village-20120125-1qhps.html

For those who experienced these events and survived it’s going to be a tough few months to years ahead as they come to terms with what happened and try to rebuild their lives.  Many will have suffered great disabling physical injuries; all will be grieving the loss of loved ones while trying to cope with their own shock.  It is likely that many will go on to develop PTSD, which will have a great impact on their quality of life.  They all will need support and counselling and treatment to minimise the impact of their trauma.

Post Traumatic Stress Disorder (PTSD) occurs after a person has experienced a highly stressful event which is outside the range of ordinary human experience that would upset almost anybody. Examples include natural and manmade disasters, serious accidents, and witnessing violent deaths, such as those occurring in the context of war or terrorist activity.  The person may be themselves directly involve in the event or they may have witnessed the event.

The main diagnostic features of PTSD include:

1)      Experience an extraordinary traumatic event.

2)      Re-experiencing of the traumatic event through nightmare and intrusive thoughts.

3)      Showing emotional numbing such as feeling detached from others.

4)      Having symptoms of autonomic hyperarousal such as irritability and exaggerated startled response.

5)      Symptoms (2-4) more than 1 month

6)      The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

PTSD can be further specified as:

Acute: if duration of symptoms is less than three months

Chronic: if duration of symptoms is three months or more

And:

With or Without delay onset: Onset of symptoms at least six months after the stressor

For a more detail description refer to the DSM-IV-TR classification.  I have avoided to include this criteria here in order to be brief.  The survivors of the MV Rabaul Queen disaster and the Southern Highlands Landslide have already met the 1st of the 6 criteria and it is very likely that many will develop the other symptoms and PTSD.  They need to be supported to minimise the detrimental physical, psychological and social effects of their trauma and ideally this support should be initiated immediately.

TREATMENT   

The two selective serotonin reuptake inhibitors (SSRI) paroxetine (20-50mg/day) and sertraline (50-200mg/day) have been shown to be effective in decreasing depressive symptoms, to reduce symptoms such as nightmares and flashbacks, and to normalise sleep.

Benzodizepines  (e.g. – diazepam 5-10mg twice daily) may help reduce anxiety but should be used with caution because of their abuse potential.

Preliminary evidence suggest the use of beta-blockers immediately after the traumatic event may reduce some later symptoms of PTSD.

Establishing a sense of safety and separation from the trauma is an important 1st step in the treatment of PTSD.  Cultivating a therapeutic working relationship requires time for the patient to develop trust.  Research show the Cognitive behavioural therapy (CBT) is effective in reducing PTSD symptoms.  With CBT patients are provided with skills to control anxiety and to counter dysfunctional thoughts (eg “I deserved to be rape”)

Group therapy and family therapy are also useful.

About Dr. Poyap J Rooney

Dr. Rooney is a medical doctor who has gained both his undergraduate medical degree and more recently his post graduate masters degree in clinical biochemistry at the University of Papua New Guinea.
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One Response to Post Traumatic Stress Disorder – Aftermath of Disasters

  1. Pingback: Post-Traumatic Stress Disorder – The silent sufferers | Papua New Guinea – Health

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