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News Aid industry, your employers foreign voluntary workers compensation insurance and removing subjectiv

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eloc

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OK here is the bad news 30 % of international aid workers get PTSD and 70% of national ones get it - and of those 30% will have symptoms that persist beyond three years. I have found out about the neuro endocrinology of PTSD last mainly because the insurer wanted to downgrade me to MDD. Pysch give you the business about a disconnected brain and that your automatic/lizard brain is deciding that things that are not life threatening are and setting off your body reactions which in turn set off your emotions and by focusing on your body symptoms with your thinking briain you can then do a scan and realize nothing is going on and your brain supposedly reintegrates . According to neuroendocrinology a whole lot more might be going on.

In the research I found that there is a HPA ( Hypothalmus Pituitary Adrenal) axis dysfunction in both Major depressive order and in PTSD and that they are not the same - so a easy disprove the differential misdiagnosis and confirm PTSD with two simple tests 1) 24hour urinary cortisol ( basically collect pee for 24 hrs - preserved with some chemical) and count the daily out put of cortisol 2) overnight suppression test- take a dexamethasone tablet at 11 pm at night and have a blood test at 8 am ish for your blood cortisol level. In PTSD cortisol levels are low and suppressed in both tests. This is not used for diagnosis yet but maybe in future - this is mostly from combat vets and I suspect aid workers is same - anyway my dysfunction is like this .There is also a HPT dysfunction which affects T3 T4 ratio but I have an Implanon implant so have not been able to assess myself for that while I have the implant/

Currently PTSD diagnosis and treatment in Australia is as per this
http://phoenixaustralia.org/wp-content/uploads/2015/03/Phoenix-ASD-PTSD-Guidelines.pdf new guidelines are coming out in 2018.

I had CBT and EMDR which I think helped a lot in first year of treatment and had a go at acupuncture which helped relieve symptoms and bought a think slim MP4 player for hypnosis for weight loss- eating less moving more drinking less water - but the thing has heaps for other trauma and emotional issues and people who suffer from PTSD are usually highly susceptible to hypnosis - soit also helped me a lot with emotional regulation and sleep

Anyway here are the links for the neuroendocrinology stuff on PTSD:
Biological Studies of Posttraumatic Stress Disorder

This is the MDD vs PTSD one
Comorbidity between post-traumatic stress disorder and major depressive disorder: alternative explanations and treatment considerations

This link Endocrine aspects of post-traumatic stress disorder and implications for diagnosis and treatment. - PubMed - NCBI is a description of a chapter from a 1700 USD text of the latest research in PTSD that was released in June 2016. You can get it for free from one of the links.

This is my favorite as it explains what the chemical imbalance/HPA axis dyssfunction has on your emotions and behaviour
Posttraumatic Stress Disorder and Neurochemical Processes - Posttraumatic Stress
and this one is a little cautionary as people who have PTSD have 60% higher risk of heart disease and stroke due to inflammation - and may not be usual warning signs.

I went as far as getting an angiogram and found I have almost no risk of cardiac A. Disease but I still worry about my peripheral arteries and my weight and diabetes risk Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease

The employers insurer tried to push SSRIs which if you scan the first doc are not really warranted for PTSD and only if comorbid condition prevents CBT and EMDR. The success of SSRIs is really hit and miss and is as successful as a placebo - but with side-effects and 6-8 weeks trying different ones to see if you are in the 30% helped by them. My psych suggested unless depression predated PTSD it is situational and best dealt with through regular exercise. Short term use of SSRIs can apparently make situational depression into chronic depression - so I avoided them baed on my research.I had to be hypnotized to take up regular exercise - PTSD sufferers are highly susceptible to hypnosis - so give it a go- I did it with a recorded hypnosis because I did not want to make myself vulnerable in one on one session – super-cautious hyper-vigilant that's me.

So here are my suggestions if you have PTSD from your overseas work or are at risk of it.

1 get 24 hour urinary cortisol tested and overnight suppression test done - GP should be able to arrange or endocrinologist
2. Get a health care plan and have ten sessions of CBT and EMDR
3. If you think it is work related get a psych/psychiatrist to diagnose you and share it with your HR department- you may be entitled to paid leave/income support and treatment
4. Don't have high expectations of your employers insurers ethics beyond one/two years no matter how easy they make it in those years.
5. Have a workers compensation lawyer working on no win no fee basis before any IME and assessment of MMI and before the income support cuts out - make sure a truly independent IME is organised by your Lawyer to coincide with or before the cessation of income support - you need them to protect you from further harm.
6 swim or exercise.
7. Involve your employers ethics oversight mechanism and engage with the insurance director and insurance represeentative - simultaneously so that value for money the employer is not getting is exposed - encourage your employer to make policy practices changes ie 30% of people with PTSD will have symptoms beyond 3 years - so income support for at least 3 years should be possible - MMI evaluation must coincide with income support cessation as the situation of being unable to turn to work and having no income will prevent improvement and possibly cause further illness and activation - system abuse
8. Whenever you are employed abroad- ask about the companies foreign workers compensation insurance - conditions/ jurisdiction ( where a workers compensation case can be lodged if needed) in case of claim- ask that these things be placed in the employee manual before signing your contract
9. Do not sign away your right to pursue a personal injury and damages claim in case of employee fault
10. Keep watching the research if you are at risk of being exposed to trauma as there is some indication if you already have low cortisol then a one off injection of hydrocortisone within 6 hours of a major trauma helps with fear processing and prevents onset of PTSD.

Of course this is from research and my personal experience and new research and your own experience may be different - but its what 2 years of fighting system abuse has taught me
 
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Thanks, @eloc - that's a lot of interesting info.

One thing jumped out to me as really not proven:
Short term use of SSRIs can apparently make situational depression into chronic depression...
I'm not a big believer in the efficacy of SSRIs for anything other than mild depression - but mild depression is often part of the PTSD symptom profile. And SSRIs are specifically designed for short-term use (12-24 weeks).

So - while they are certainly not right for everyone, and aggressively treating the PTSD can often shift the depression fairly quickly...some people, esp those who have experienced prolonged early trauma, may only be able to process down their trauma slowly. Various forms of psychotropic drugs, including SSRIs, can help with that.

I'd just not spread misinformation that short term use of SSRIs can create a more intractable depression problem.

And: any psychotropic for mood symptoms should always be accompanied by one of the cognitive therapies. Otherwise, there's really no chance of actually becoming better.
 
Ok I will try and find the reference for it - and make sure it is a credible source and put it here -otherwise sure disputed - thats why I said my experience and research I recognize people have their own sources and information and nobody has the answers - or this would be easier right?. I am sure the guidelines for their use are different in different countries. It it is worth searching SSRI using CRT F and seeing what are the different guidelines saying.
 
Link Removed This page has two videos on Australian recommendations and phamocology PTSD - experts not me. I will still look for where I read about situation depression and SSRIs

Link Removed This is not the article I read re short term use and chronic - but I will keep looking

Selective serotonin reuptake inhibitors (SSRIs) - NHS Choices This NHS referenced link suggests A course of SSRI treatment usually lasts for at least six months, although longer courses are sometimes recommended and some people with recurrent problems may be advised to take them indefinitely. As I said different countries have different guidelines - and I am sure many people swap SSRis when one is not working -but still have not found the link suggesting a confirmed link between short term use for situation depression and onset of chronic.
 
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