Disaster psychiatry

The role of the psychiatrist generally changes in a disaster, at least in the initial response (Norwood, et al., 2007). Most psychiatrists deal with treatment of persons with mental illness, but in a disaster the major initial effort is dealing with people who experience normal psychological and behavioral symptoms that would be expected after the disaster. The initial responses that indicate "normal" psychological and behavioral response include anger, sadness, fear, irritability, sleep disturbances, and increased use of alcohol, caffeine, and tobacco. There are some caveats that are important to remember in the psychiatric evaluation of patients with possible psychiatric complications from a disaster, including evaluation for the possibility of an authentic mental disorder due to head injury, exposure to toxins, illness such as a CNS infection, and dehydration. There also may be the loss of standard medications for the individual.

The major psychiatric diagnosis following a disaster is post-traumatic stress disorder (PTSD) (Neuner et al., 2006; Thienkrua et al., 2006). This is a result of a serious threat to life or injury to self or others that is followed by terror, helplessness or abnormal fear lasting over one month. It may also occur acutely and is then referred to "acute stress disorder" (ASD), described as symptoms similar to those of PTSV that occur within one month of the event and persist for at least two days with a maximum of four weeks. Other disaster-associated responses that are relatively common include adjustment disorders, substance abuse, major depression, generalized anxiety disorders, and complicated bereavement (van Griensven et al., 2006).

The psychological impact of disasters on children may be quite different, and is age-associated. As with adults, the risk is greater in children with prior psychiatric difficulties, and the range of conditions include PTSD, depression, and separation anxiety. For pre-school children through grade 2, the common reactions are fear, confusion, sleep disturbance, separation anxiety, and regressive symptoms. Older children, aged 8-11 years, often have difficulty in concentrating, somatization, concerns for safety, and sleep disturbances. For adolescents the responses are more like those of adults, and are often characterized by increased risk-taking.

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