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Mental Health in a Time of Terror

Mental Health in a Time of Terror. Robert K. Schneider, MD Assistant Professor Departments of Psychiatry, Internal Medicine and Family Practice Virginia Commonwealth University The Medical College of Virginia Campus. Outline. Review Studies of Terror Disease Model Health Model

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Mental Health in a Time of Terror

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  1. Mental Health in a Time of Terror Robert K. Schneider, MD Assistant Professor Departments of Psychiatry, Internal Medicine and Family Practice Virginia Commonwealth University The Medical College of Virginia Campus

  2. Outline • Review Studies of Terror • Disease Model • Health Model • What can we do?

  3. Models of Coping Disease Model Trauma/Stressor + Person = Disease Health Model: Trauma/Stressor + Person = Health

  4. PTSD: Posttraumatic Stress Disorder Reexperiences Hyperarousability Avoidance Major Depression Depression Anhedonia Disease Model

  5. Oklahoma City BombingNorth et. al.JAMA 1999 April 19, 1995 167 dead 684 injured “the most severe incident of terrorism ever experienced on American soil”

  6. Oklahoma City BombingNorth et. al.JAMA 1999 • 45% postdisaster psychiatric disorder 34.5% PTSD 22.5% Major Depression 9.4% Alcohol Use Disorder

  7. Oklahoma City BombingNorth et. al.JAMA 1999 • Predictors • Any predisaster diagnosis: 66% • Female sex: 55% vs. 34% • 94% of PTSD had early avoidance and numbing symptoms

  8. SCUD Missile Attacks Israel, 1991 Gulf WarLaor et. al. Am J Psychiatry 2001 • 107 families exposed • Half of the families displaced • Mother’s functioning and Children’s Symptoms • 3 studies: 6 and 30 months and 5 years

  9. SCUD Missile Attacks • Over time symptoms decrease in residentially stable children • Mothers’ reaction correlated with young children’s symptoms most • Family cohesion highly correlated with children’s well being

  10. SCUD Missile Attacks • Mother’s functioning: • Ability to relate to child • Coping skills • Symptoms • Children’s symptoms • PTSD symptoms • Avoidance

  11. SCUD Missile Attacks • Younger children highly correlated with mother’s symptoms • Displaced families had more symptoms (longer time: more problems) • Family functioning impacted displaced more than residentially stable children • Mothers coping with adaptive defenses correlated with resolution of children’s symptoms

  12. PTSD in the CommunityBreslau et. al. Arch Gen Psychiatry 1998 • 90%: one or more traumas • Most prevalent trauma: unexpected death of a loved one

  13. Categories: traumatic events • Personally experienced assaultive violence • 37.7% • Other personally experienced injury or shocking experience • 59.8% • Learning about traumas to others • 62.4% • Sudden unexpected death of a loved one • 60.0%

  14. Conditional Risk • Rape 40-60% • Combat 35% • Violent Assault 20% • Sudden death of a loved one 14% • Witnessing a traumatic event 7% • Learning about trauma to others 1-2%

  15. Rick Factors for PTSDBrewin et al J Consult Clinical Psych 2000 Meta analysis Civilian and Military (Weighted averages) • Lack of Social Support: 0.40 • Post trauma life stresses: 0.32 • Trauma Severity: 0.23

  16. Health Model • No predisaster disorder (OCB) • 70% remained without disorder • Stability and High Functioning (SMA) • No children had symptoms at five years

  17. Anticipation Affiliation Altruism Humor Self-assertion Self-observation Sublimation Suppression Health Model – DefensesAdaptive Coping

  18. Adaptive CopingSCUD Missile Attacks • “Mother’s capacity to control mental images had a direct effect on her symptoms”

  19. Devaluation Denial Dissociation Displacement Acting Out Omnipotence Apathy Complaining Health Model – DefensesMaladaptive Coping

  20. What can we do? Self Family Community

  21. What can we do?SELF • We are in a time of stress and transition • Use our adaptive defenses • Avoid our maladaptive defenses • Regulate our exposure to potentially traumatic information: • Television, Internet, Newspaper • Be where you need to be

  22. What can we do?FAMILY • Model adaptive behavior • Be present and available • Maintain Boundaries • Clarity • Rules • Monitor

  23. What can we do?Community • Model adaptive behavior • Be present and available • Maintain Boundaries • Clarity • Rules • Monitor

  24. Conclusions • We are living in a time of stress and transition • Diseases to prevent include PTSD and Major Depression • Young children are particularly vulnerable • Coping is an active, conscious process that occurs on multiple levels

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