Sep 18, 2019
R. Milner, MD, MEd, SpecEd, joins Lorenzo
Norris, MD, host of the MDedge Psychcast and editor in chief of
MDedge Psychiatry, to talk about steps psychiatrists can take to
address the mental health needs of people traumatized by a natural
disaster, such as Hurricane Dorian survivors.
In This Week in Psychiatry, Katherine Epstein, MD, and Helen M.
Farrell, MD, write about miracle cures in psychiatry. You can read
the article online by clicking
here or you can access the downloadable PDF by clicking here.
- This Week in Psychiatry (02:37)
- Interview with Dr. Milner (06:33)
- Dr. RK with Dr. Renee Kohanski (39:31)
Dr. Milner is a general and child and adolescent psychiatrist in
private practice in Everett, Wash. She has traveled across the
globe with various groups in an effort to alleviate some of the
suffering caused by war and natural disaster.
Don’t miss the “Dr. RK” segment by Renee Kohanski, MD, who discusses the
extent to which people choose what is important and meaningful. Dr.
Kohanski, a member of the MDedge Psychiatry Editorial Advisory
Board, is a psychiatrist in private practice in Mystic, Conn.
Show notes by Jacqueline Posada, MD, consultation-liaison
psychiatry fellow with the Inova Fairfax Hospital/George Washington
University program in Falls Church, Va.
STAGES OF NATURAL DISASTERS
- During the devastation stage, the primary objectives are giving
basic first aid and attending to the sick, searching for those who
are missing, and getting people safely into shelters.
- Psychological first aid (PFA) is the primary form of mental
health treatment. PFA addresses basic needs by helping people find
shelter, food, water; assisting with communication; reuniting
families; and conducting case management to address acute
- The normalization stage continues for several months after the
disaster and includes the honeymoon phase, in which people
are grateful to have survived and the community unites to rebuild;
and then the disillusionment phase, during which frustrations and
hopelessness arise as communities and individuals realize the
limits of disaster assistance.
- Psychiatric disorders are likely to develop during the
normalization stage. Acute stress disorder (ASD) typically occurs
3-30 days after the event with cardinal symptoms such as
hyperarousal, hypervigilance, and negative cognitions that affect
relationships. Medical professionals should monitor for development
of chronic disorders such as PTSD, major depressive disorder, and
anxiety disorders. Prolonged stressors, such as living in a damaged
home, increase the risk of depression and anxiety.
- Those with preexisting vulnerabilities – such as past traumatic
experiences from physical, sexual, or emotional abuse; previous
natural disasters; or other chronic stressors of poverty and
medical illness – are at greatest risk of developing a
trauma-related disorder after a natural disaster.
- The normalization stage is a critical period to use the
“training the trainer” model. Because many locations do not have a
surplus of mental health clinicians, psychiatrist volunteers can
train local individuals to provide services. For example, mental
health professionals can train the trainers to recognize symptoms
of common psychiatric conditions and to provide basic
- Manualized therapies are useful but require in-depth training.
Other simple modalities, such as deep breathing, visualization, and
relaxation techniques, can be useful.
- During the acceptance stage, rates of persistent PTSD range
from 25% to 40%.
- Ongoing therapy is helpful, especially group therapy, which is
an effective use of resources. Facilitation of group therapy can be
taught while training the trainers.
- If a mental health professional volunteers and participates in
the training the trainers’ model, there must be follow-up, which
should include providing intellectual support and refresher
courses, evaluating how training is being used, and checking up on
patients/clients who have received services.
Predisaster advice: Do not go it alone.
Affiliate with a group that has a plan, so that your presence on
the scene does not add to the chaos.
- Be aware of compassion fatigue and take time away from
volunteerism. Recognize signs of secondary
- Counsel volunteers upon their return from the disaster
Substance Abuse and Mental Health Services Administration.
of disaster. Last updated 2018 Oct 1.
Pfefferbaum B et al. Practice parameter on disaster
preparedness. J Am
Acad Child Adolesc Psychiatry. 2013 Nov;52(11):1224-38.
World Health Organization.
Psychological first aid: Guide for field workers. 2011.
National Child and Traumatic Stress Network. Psychological
first aid online.
International Institute for Psychosocial Trauma.
Clinical assessment of survivors of trauma.
U.S. Department of Veterans Affairs. PTSD: National Center on PTSD.
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