Psychiatrists have taken one of the greatest natural disasters in Japan’s recent history as an opportunity to help doctors as well as patients better understand post-traumatic stress disorder (PTSD).
Psychiatrists have taken one of the greatest natural disasters in Japan’s recent history as an opportunity to help doctors as well as patients better understand post-traumatic stress disorder (PTSD).
Taking lessons learned from the March 2011 earthquake and tsunami, PTSD guidelines for primary care physicians were published for the first time online Sept. 6 by the Japanese Society for Traumatic Stress Studies. The guidelines, as well as an available summary version, explain how to initially respond to patients with PTSD and medicinal treatment for the disorder.
PTSD symptoms can be triggered from witnessing horrible devastation or natural disasters, crimes and other accidents. They can also be brought about through feelings of guilt for not being able to do more to help. An individual is judged to have PTSD if symptoms, such as insomnia and lethargy, last for one month or longer.
According to a 2005 survey by the World Health Organization, the ratio of lifetime PTSD prevalence in Japan is between 1.1 and 1.6 percent of the total population. The ratio increased to between 3 and 4.1 percent for those in their 20s and early 30s.
Furthermore, many people in areas of northeastern Japan devastated by the Great East Japan Earthquake and tsunami, followed by the resulting Fukushima nuclear accident, have been suffering from PTSD.
For example, the survey released in June by the civil group “Shinsai Shien Network Saitama” (Disaster support network Saitama) showed that more than half of over 500 evacuees in Fukushima Prefecture who were forced to relocate in the prefecture due to the nuclear accident were likely to have the disorder.
Moreover, the survey results released in May 2012 by the National Police Agency showed that 4.1 percent of police department workers had signs of PTSD in Iwate, Miyagi and Fukushima prefectures, the three prefectures hardest hit by the disaster.
However, many patients do not appear to receive appropriate treatment due to the lack of medical specialists.
The guidelines explain to doctors the importance of listening very carefully to what their patients have experienced.
Doctors are also instructed to take sufficient time for the patients’ first few visits, allowing them to talk at their own pace.
In addition, in light of the fact that many patients tend to blame themselves for their symptoms, the guidelines say that doctors should explain to the patients that PTSD can occur in anyone, and it is not their fault.
For patients who are suffering from flashbacks and feelings of suffocation, relaxation and breathing methods are also taught as an effective way to reduce the symptoms.
Careful advice is also given to medicinal treatment.
According to the guidelines, medicinal treatment should be taken as a last means. Antidepressants called SSRIs (selective serotonin reuptake inhibitors) are recommended, as opposed to the long-term use of benzodiazepines, which have been widely used as anti-anxiety agents.
Benzodiazepines are not effective for the main symptoms of PTSD, and the drugs tend to cause dependency, the medical specialists said.
They also advise that administering SSRIs for at least one or two weeks and then continuing for a year after the signs have disappeared as a maintenance treatment will be useful in preventing a recurrence of the disorder.
Jun Shigemura, a lecturer of mental science studies at National Defense Medical College, has worked to prepare the guidelines as a committee member.
Shigemura said that with appropriate treatment, many people suffering from PTSD will be able to find relief.