Biomedical Engineering Reference
In-Depth Information
tary numbing of emotions and detachment from
relationships, and (c)“marked” arousal (American
Psychiatric Association, 1994).
Incidence data from several studies including
motor vehicle accidents, assaults, burns, and indus-
trial accidents suggest that as many as 20% of
adults who experience a traumatic accident or
assault develop ASD [13]. Several prospective
studies reviewed by Bryant [9] indicate that ASD is
a risk for
but not an automatic predictor
of PTSD.
As many as eight in ten persons who develop
ASD go on to develop PTSD between 6 months
and two years following trauma exposure. Yet, the
proportion of individuals with ASD who develop
PTSD differs substantially, from as high as 78% to
as low as 30% (O'Donnell et al., 2001; Schnyder
et al., 2001). Ehlers and Clark [23] and Brewin
[13] conclude that ASD should be considered a
sign of potential long-term psychiatric risk and
treated immediately if it causes clinically signifi-
cant impairment, but in most cases providing brief
education about the effects of stress on the body
[14] and the importance of healthy self-care (e.g.,
nutrition, sleep) and social support,
terrorism, and some (5%) patients show decreases
in utilization. Help-seekers more often turn to
medical than psychiatric or social (mental health)
providers, as is the case generally in healthcare.
For example, adults surveyed in the United States
and Canada reported contacting their physician
for antidepressant, sleep, or anxiolytic medications
shortly after September 11th, but there appeared to
be no increase in the use of specialty mental health
services (see Adams et al., 2004 for a summary of
these studies).
Addressing the needs of people suffering from
pre-existing mental and physical health problems
or bereavement, particularly if they have increased
their substance use, is a first priority in order
to engage survivors and emergency workers on
their own terms and with a focus on supporting
natural recovery processes and preventing long-
term risks. Disaster survivors tend to both receive
and provide a great deal of emotional/social and
practical support—but only for a relatively limited
time (i.e., most relief efforts end within 3 months)
and unevenly, so that many with the greatest needs
(e.g., stigmatized racial or ethnic groups; people
with less education) suffer the greatest relative loss
in resources and receive the least assistance [1,2].
Symptoms of unwanted memories (“intru-
sive re-experiencing”), extreme attempts to avoid
unwanted memories (e.g., increased substance use,
unwillingness or inability to travel to places or
engage in activities that are reminders of trauma),
“marked” arousal (e.g., jumpiness, tension,
anxiety, irritability, inability to sleep, excessive
vigilance due to fear of re-traumatization), and at
least three symptoms of dissociation (i.e., numbing,
feeling in a daze, depersonalization, derealiza-
tion, and amnesia) (which may occur only during
the traumatic exposure) constitute an
Acute Stress
Disorder
(ASD) if they persist between 2 days
and one month, and impair the individual's func-
tioning (American Psychiatric Association, 1994).
Post-Traumatic Stress Disorder
(PTSD) involves
similar symptoms which must persist for at least
one month and significantly interfere with sociovo-
cational functioning, specifically: (a) unwanted
trauma memories, (b) purposeful attempts to avoid
trauma memories and reminders or an involun-
is the best
immediate plan of action.
Based on evidence that extreme immediate
mental and physical stress reactions is an indi-
cator a survival-based (as opposed to ordinary)
biological adaptation [14], and that survival adap-
tations may be functional in crises but can inter-
fere with normal memory [14] and self-regulation
[24] processes, Brewin [13] developed a Trauma
Screening Questionnaire that asks affected persons
to simply say “yes” or “no” to PTSD's five symp-
toms of intrusive re-experiencing and five symp-
toms of hyperarousal. In studies with train crash
survivors and victims of violent assaults, Brewin
[13] found that endorsing six or more of these 10
items within the first few days following trauma
accurately (>90% overall efficiency) identified
persons who developed PTSD.
11.2.4 Triage and Acute Psychosocial
and Psychopharmacological Treatment
The first systematic approaches to early psycho-
social intervention in the wake of trauma were
