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Addressing the Psychiatric Sequelae of Catastrophic Trauma
the 9/11 terrorist attacks.
6,7,73
Such responses, described by the majority of The timing of psychopathology after disasters is an important factor in
disaster-exposed groups,
3
must be considered normative and not necessarily determining the most appropriate intervention. In the early hours and days
pathological. In the absence of avoidance and numbing symptoms, these post-disaster, before psychiatric disorders such as PTSD and new episodes of
responses have been described as ‘normal responses to abnormal events’ major depression can be diagnosed, supportive interventions and providing
and termed ‘subdiagnostic distress’ in people who do not fulfill criteria for psychological first aid are useful. As time progresses, assessment for
a psychiatric diagnosis.
48
Members of the larger population who are psychiatric disorders will direct clinicians to the most appropriate treatment
distressed but not psychiatrically ill, while not requiring the intensity of tailored to the individual’s identified problems.
mental health services of those with psychiatric disorders, represent an
important majority with psychosocial needs also deserving interventions. Conclusion
Post-disaster mental health interventions must be tailored to individuals and The above principles, derived from empirical research in disaster settings, will
their needs if they are to be effective.
74
This requires, as a first step, guide the psychiatric professional through the management of mental health
distinguishing distress from PTSD or other psychiatric illness. Those with sequelae of disasters. These principles will help the clinician consider
distress, but not psychiatric illness, may benefit from interventions involving individual risk for psychiatric sequelae, conceptualize the range of
information, reassurance, and social support. For those with psychiatric psychopathology, assess it systematically, and apply interventions appropriate
illness, well-established treatments, especially psychotropic medications and to the individual’s needs and the time-frame. In addition to having a
psychotherapy, are appropriate tools for the clinician.
75–77
Competing tasks knowledge of this information, members of the psychiatric community can
in the post-disaster setting are to avoid pathologizing the distress of be further prepared by networking with other mental health professionals
individuals affected by disasters, while recognizing and managing post- and making plans for an organized response, ideally co-ordinated with the
disaster psychiatric illness effectively. larger medical and emergency response teams, before the disaster strikes. ■
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