**7.2 Immediate treatment**

Immediate intervention is contemplated during the acute phase or shortly after exposure to a traumatic event. Immediate intervention is provided based on the principles of crisis intervention.

a. *Assessing risk factors for post-traumatic stress disorder:* Several risk factors for posttraumatic stress disorder have been documented including criminal assault, political detention and torture, rape, childhood physical abuse (Kaimer et al, 2009); acute posttraumatic stress disorder and the presence of premorbid and comorbid psychopathology (Koren et al, 1999); age at first experience of traumatic experience, severity of traumatic experience and availability of social support after traumatic

Post Traumatic Stress Disorder – A Northern Uganda Clinical Perspective 205

Psychotherapy involves talk therapies popularly termed "counselling" in the Ugandan context. Various types psychotherapy have been used by trained counsellors and members of humanitarian agencies in PTSD in Uganda including individual counselling of a supportive nature, group counselling such as Interpersonal Psychotherapy, Cognitive Behaviour Therapy, Narrative Exposure Therapy, Play therapy for children, and Art therapy for both children and adults. Specific issues are dealt with during psychotherapy e.g. helping clients overcome the problems of memory loss and denial related to the traumatic stress experience, exploring social resources available to the client, strategies the client might have used in coping with symptoms of PTSD before seeking professional help, how to come to terms with a shameful trauma such as rape, imprisonment, and how to deal with perpetrators who may be in the victims environment such as police officers, prison guards or rebel abductors in the victim's community, and how the client can reconstruct his/her life so as to continue living positively. For psychotherapy to be successful, the environment for psychotherapy should be neutral so that the client can feel safe to share or receive support in coping with his/her traumatic experiences. The role of the therapist/counsellor is to facilitate the validation of the client's traumatic experience and

PTSD in northern Uganda tends to be associated with other specific psychiatric illnesses and physical complications (Ovuga, Oyok and Moro, 2008), which need treatment. Co-morbid psychiatric disorders include Depression, Anxiety and Panic disorder, social phobia, sexual disorders and alcohol dependence. Often, these occur in multiple combinations. Specific interventions are directed to these disorders as appropriate e.g. treatment of depression, addictions, and counselling or family interventions for unwanted babies of rape etc. Often there's a need for, or age and gender specific intervention as well as spiritual atonement in line with cultural traditional practice, and the individual needs of specific clients. Specialised surgical interventions include removal of foreign bodies, correction of contractures and deformities and surgery for osteomyelitis to prevent prolonged effects of

The aim of rehabilitation in PTSD in northern Uganda is to integrate the victim back into his/her society as a fully functioning individual with dignity. Many of these victims were abducted as young children and missed the opportunity for formal education. Other individuals got institutionalized to camp life in internally displaced persons' camps and require adaptation to life outside camp life. The various types of rehabilitation that are tailored to the individual needs of victims include job acquisition or vocational skills re/training; training for social functioning in the family and community with integrity as a leader; and traditional or social remedies to redress financial losses, material supplies e.g. to repossess one's land upon return from camp life; reconciliation rituals and ceremonies aimed to facilitate the acts of forgiveness for acts committed in the course of the northern

Some forms of PTSD as in landslides, or earthquakes may not be preventable but their longterm impacts on the lives of victims can be mitigated through emergency medical and

**7.5 Psychotherapy** 

foster recovery.

physical disability.

**7.7 Rehabilitation** 

Uganda war.

**7.8 Prevention** 

**7.6 Management of co morbidities** 

exposure (Engdahl et al, 1997), sex, previous experience of trauma and the subjective appraisal of threat to life (Stallard, Velleman & Baldwin, 1998). Assessment and identification of predictive risk factors for posttraumatic stress disorder and addressing these at the earliest opportunity after exposure to traumatic experience is a vital first step in trauma management.


#### **7.3 Short-term treatment**

This involves those treatments necessary to mitigate the effects of the trauma or limit the progression of the psychological sequel into chronic or complicated phase. Intervention follows a thorough psychiatric assessment and then treatment planning involving the individual in which the interventions are individualized depending on the needs of each patient. These interventions include (as deemed necessary):


#### **7.4 Medications**

The use of medications in PTSD is for the control of symptoms that include insomnia, agitation, anxiety, panic, depression or those specific to the organs injured e.g. epilepsy, . Anxiety, panic and agitation are especially common and will respond to minor tranquillisers such as alprazolam, diazepam, and clorazepam. Depression, panic disorder and phobias will respond to antidepressants such as fluoxetine, paroxetine, amitryptiline. Specific medications for other health problems may be indicated such as Anticonvulsants for Seizures due to brain injury, such as Phenytoin or carbamazepine or antipsychotics such as haloperidol or chlorpromazine.
