While psychotropic medications have been used in the treatment of PTSD, antidepressant medications are the most commonly

prescribed. The more recently developed SSRIs are showing promise as effective medications with lower side-effect profiles. Depending on the clinical presentation, other drugs may be useful in targeting specific symptoms. When prescribing antidepressants in PTSD, it is important to ensure that the dose is sufficiently high to optimise the therapeutic effect. Also, patients should be advised that they may have to remain on the medication for some time. Experience has shown that patients are highly vulnerable to relapse for months, even years in some cases, post-trauma.

services (such as sexual assault centres and torture foundations) are available in most states. Each state has a Vietnam Veterans Counselling Service (VVCS); they may be able to provide advice even if the patient is not a veteran.The Australian Centre may be able to help with a suitable referral. Regardless of the particular approach to treatment, it should be remembered that each individual will have a unique response to their experience and to any intervention that might be applied. It is important to adapt these general guidelines to the specific needs of the individual concerned.

Posttraumatic Stress Disorder

The Treatment of PTSD
No 4 in the PTSD series of Australian Centre brochures

Referral for Specialist Help
If the patient is not showing signs of recovery, referral to a specialist mental health practitioner may be indicated. Intensive treatment is likely to cover many of the domains discussed above. Several techniques may be employed including cognitive-behavioural and brief psychodynamic approaches, hypnosis and EMDR. Each requires specialist training and should occur in the context of a multi-component approach. WHERE CAN I REFER? You may wish to refer straight to a psychiatrist, clinical psychologist or other mental health professional specialising in traumatic stress. Depending on the nature of the trauma, specialist

To find out more about PTSD, other veteran and military mental health issues or the Australian Centre, please contact us at: AUSTRALIAN CENTRE FOR POSTTRAUMATIC MENTAL HEALTH (INC.) A&RMC, 300 Waterdale Road, Heidelberg Heights 3081 AUSTRALIA. Telephone: (03) 9496 2922 Facsimile: (03) 9496 2830 Email: acpmh-info@unimelb.edu.au WebSite: www.acpmh.unimelb.edu.au

What is PTSD?

Phases of Treatment
In assisting survivors of trauma, it is common to work through several phases of treatment in a specific order.These phases may be summarised as:
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STRESS DISORDER (PTSD) is a psychological reaction to experience of overwhelming traumatic events. It can affect people of any age, culture or gender.

The symptoms of PTSD include intrusive memories, avoidance, numbing and hyperarousal. The disorder can be associated with great distress and interfere with relationships and work performance.

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Support and stabilisation Education Stress management Trauma focus: confronting the memories Relapse prevention Follow-up and maintenance

STRESS MANAGEMENT Provide advice on simple stress management strategies such as aerobic exercise and distraction techniques.You may wish to try more specific techniques such as deep muscle relaxation and breathing retraining. Practical advice around issues such as sleep and diet - especially reducing stimulants like caffeine and nicotine - will often be useful here. TRAUMA FOCUS WORK If you have sufficient time, provide opportunities to discuss the traumatic experience.This enables the person to confront the painful memories and their associated feelings in a safe environment and to reflect on the meaning of the event.The goal is to remember what happened without being overwhelmed by distress. Equally, be aware that not everyone will be ready to talk about the trauma at the same time. RELAPSE PREVENTION & MAINTENANCE Recognise that recovery from trauma is a long process that may, for some people, take several years.The survivor may require your support from time to time, especially during periods of crisis.

How Can I Help? Psychological Interventions
Not all people who experience trauma require treatment and many are able to deal with their experience(s) with the support of family and friends. Severe traumatic events rarely leave the individual untouched and many people benefit from professional help in recovering from the effects of trauma. As a general rule, the sooner people receive treatment, the more likely they are to recover. Cases of chronic PTSD (more than 3 months duration) should be referred to mental health professionals experienced in the treatment of PTSD. However, there is much that other health professionals can do to help, particularly in the early stages. SUPPORT AND STABILISATION Provide advice on practical issues.This may involve establishing realistic short and medium-term goals and assisting with problem solving. A key focus should be to encourage individuals to return to their normal activities or routine.This should occur at a gentle pace as soon as possible. Attention should be paid to minimising alcohol and drug use at this stage, with a referral for specialist treatment if required. EDUCATION Provide information about typical traumatic stress symptoms and reassurance that reactions are normal (see other brochures in this series). Try to promote expectations of recovery.

Pharmacological Interventions
Medication can be an important adjunct of treatment for PTSD. It also has an important role in the management of comorbid conditions associated with PTSD. As a general rule however, it may be best to avoid medication in the first few weeks (especially benzodiazepines).