Rethinking Disaster Mental Health Response in a Post-9/11 World

The Nancy and Ray L Hunt Chair in Crisis Psychiatry and Professor of Psychiatry and Surgery/Division of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 03/2013; 58(3):125-7.
Source: PubMed
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    ABSTRACT: Exposure to a disaster is common, and one-third or more of individuals severely exposed may develop posttraumatic stress disorder or other disorders. A systematic approach to the delivery of timely and appropriate disaster mental health services may facilitate their integration into the emergency medical response. To review and summarize the evidence for how best to identify individuals in need of disaster mental health services and triage them to appropriate care. Search of the peer-reviewed English-language literature on disaster mental health response in PsycINFO, PubMed, Cochrane Database of Systematic Reviews, Academic Search Complete, and Google Scholar (inception to September 2012) and PILOTS (inception to February 2013), using a combination of subject headings and text words (Disasters, Natural Disasters, Mental Health, Mental Health Programs, Public Health Services, Mental Disorders, Mental Health Services, Community Mental Health Services, Emergency Services Psychiatric, Emotional Trauma, Triage, and Response). Unlike physical injuries, adverse mental health outcomes of disasters may not be apparent, and therefore a systematic approach to case identification and triage to appropriate interventions is required. Symptomatic individuals in postdisaster settings may experience new-onset disaster-related psychiatric disorders, exacerbations of preexisting psychopathology, and/or psychological distress. Descriptive disaster mental health studies have found that many (11%-38%) distressed individuals presenting for evaluation at shelters and family assistance centers have stress-related and adjustment disorders; bereavement, major depression, and substance use disorders were also observed, and up to 40% of distressed individuals had preexisting disorders. Individuals with more intense reactions to disaster stress were more likely to accept referral to mental health services than those with less intense reactions. Evidence-based treatments are available for patients with active psychiatric disorders, but psychosocial interventions such as psychological first aid, psychological debriefing, crisis counseling, and psychoeducation for individuals with distress have not been sufficiently evaluated to establish their benefit or harm in disaster settings. In postdisaster settings, a systematic framework of case identification, triage, and mental health interventions should be integrated into emergency medicine and trauma care responses.
    Full-text · Article · Aug 2013 · JAMA The Journal of the American Medical Association
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    ABSTRACT: A large existing academic disaster mental health literature provides a foundation to help guide disaster mental health response. Recent studies, however, have indicated that reconceptualization of certain mental health aspects of disasters may be indicated to guide further research to inform the planning and implementation of disaster mental health interventions. In particular, there is need to more carefully measure specific postdisaster disorders and syndromes using full diagnostic assessments, differentiate pre-existing from incident (new) postdisaster psychopathology, appropriately consider disaster trauma exposure groups in assessing psychopathology, and conduct prospective follow-up assessments over time from the acute postdisaster period to the long term. Further descriptive and longitudinal research is needed to better characterize the occurrence and course of fully-assessed psychiatric disorders after different disasters, clarify the role of disaster trauma exposures in the development of postdisaster psychopathology, and deconstruct confounding effects in determination of causalities in mental health consequences of disasters.
    No preview · Article · Oct 2014 · Current Psychiatry Reports
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    ABSTRACT: Pharmacologic treatments intended to reduce neurotransmission through the dopamine D2 receptor have been the only proven therapeutic mechanism for schizophrenia and schizoaffective disorder (SZ/SA). However, in light of these psychoses' multifactorial geneses and pathogeneses, it is unlikely that the available antipsychotic drugs are equally effective at suppressing every symptom of these disorders. This has prompted the use of polypharmacy strategies, including multi-target pharmacotherapy, which is treatment incorporating one or more add-on medications and supplements. This review presents the current state of evidence underpinning the augmentation of antipsychotics with old (antidepressants, lithium, antiepileptic agents, and benzodiazepines) and new molecules and compounds in treating sufferers of SZ/SA.
    Full-text · Chapter · Jan 2015