PSYCHIATRIST Russell Hinton says post-traumatic stress disorder is not well understood by most people, including those who are at a high risk of getting it.

He treats about 25 patients with the illness at his Belmont practice, including former police officers, paramedics, and military personnel, and he has spoken out about the way sufferers are being re-traumatised by the workers’ compensation process, the very system designed to support them.

“Post-traumatic stress disorder (PTSD) is not particularly well understood by the general population and there does not appear to be much in the way of education of emergency service workers that this can happen to them,” Dr. Hinton said.

“There is little in the way of meaningful screening and these guys are often genuinely surprised when they are informed by me that they have the condition.”

It is estimated the illness will affect between five and 10 per cent of Australians at some point, Dr. Hinton said.

It presents in many ways, which can make recognizing the symptoms difficult for sufferers.

“PTSD usually presents with intrusive recollections in the form of flashbacks and nightmares, avoidance of reminders (people, places, thoughts) of the trauma, hypervigilance which often includes marked anxiety, irritability, poor sleep, and difficulty concentrating, feelings of guilt and shame, and this often presents with depression and substance abuse as an unwelcome package,” Dr. Hinton said.

“The emergency service workers tend to gradually become unwell over time,” he said.

“They are exposed to multiple and often daily traumas and while one particular trauma might have pushed them over the edge, it is usually a cumulative effect of many years of dealing with trauma.

“They often do not recognize that they are becoming unwell and it is often family or friends who first noticed something was not right.”

Jack*, who served as a paramedic for 31 years before leaving the service suffering PTSD, said he was battling symptoms of the illness long before he knew what was wrong.

“Take it back five, maybe six, even seven years,” he said. “I was tired, thrashing in my sleep. I mean fighting in my sleep where I’d wake up and there’d be no bedsheets or I’d be out of bed, on the ground with pillows all over the place.

“I’d wake up absolutely crying and trying to figure it out: ‘oh I’ve got something wrong with my eyes’.

“So I went to see an optometrist and found out there was nothing wrong with my eyes.”

Tom*, a paramedic of 25 years who was medically retired in 2013 and survives week to week on workers’ compensation payments, said his PTSD presented as unpredictable rage.

“You just explode at your children,” he said.

“My son, he asked ‘why are you always so angry all the time?’ and you’re going, ‘I don’t mean to be’.

“But you just explode and you don’t mean to and for years you’ve been doing that to your wife.”

The treatments available to PTSD sufferers included individual and group psychotherapy, which includes desensitizing to the trauma as well as emotional support, Dr. Hinton said.

“Group psychotherapy tends to aim at providing education about the illness and allowing patients to see that there are other people out there with the same condition as them and getting support and a sense of camaraderie from this,” Dr. Hinton said.

Medications include anti-anxiety drugs and antidepressants but there were also emerging treatments including methylphenidate, or Ritalin and rivastigmine, or Exelon, which is normally used to slow down the progress of dementia.

Experimentally, the use of MDMA (ecstasy) is “showing promise”  in psychotherapy, Dr. Hinton said.

“An example of how it would be used is that the patient may take it once a month for three months and would have several hours of psychotherapy with two therapists on those three occasions,” he said.

“It is thought that using the drug during imaginal exposure allows the patient to feel much less anxious than they normally would and so they are better able to access thoughts, feelings, and memories of the abuse and therefore be able to process it more thoroughly.”

Another treatment showing promise for PTSD is yoga, which Dr. Hinton incorporated into his practice in August, with impressive results.

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