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Textbook of Disaster Psychiatry
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Book description

Originally published in 2007, this was the first textbook to focus specifically on disaster psychiatry. It brings together the views of international experts to provide a comprehensive review of the psychological, biological, and social responses to disaster, describing evidence-based clinical and service-led interventions to meet mental health needs and foster resilience and recovery. Chapters address the epidemiology of disaster response, the neurobiology of disaster exposure, socio-cultural issues, early intervention and consultation-liaison care, the role of non-governmental organizations, workplace policies, and implications for public health planning at the level of the individual and the community. This book is essential reading for all those involved in preparing for traumatic events and their clinical and social outcomes for public health planning.

Reviews

Review of the hardback:'… by virtue of its comprehensive content, lucid and attractive style of presentation and its contemporary evidence base, the Textbook of Disaster Psychiatry represents an excellent purchase for a wide range of interested professionals.'

Source: British Journal of Psychiatry

Review of the hardback:'… there is no doubt that the editors, distinguished scholars themselves, have assembled an impressive line-up of contributors to consider a range of issues, from epidemiology, assessment and diagnosis to pandemics, terrorism, bereavement, service planning and interventions. … The volume contains well argued contributions on possible mechanisms for psychological responses from various fields, including from psychology and neurobiology and … sociology.'

Source: British Medical Journal

Review of the hardback:'The book covers a very important topic in psychiatry, which is dealing with people suffering from disasters and how the psychiatric services can help in such events. The quality of the coverage if very scientific and well written. This book is important for psychiatrists, psychologists, social workers and governmental and non-governmental organisations who work with people after disasters such as the Red Cross and Red Crescent. The book is an excellent buy.'

Source: Saudi Medical Journal

Review of the hardback:'This is a timely and welcome first textbook on disaster psychiatry. Timely, because the 1980 introduction of the diagnosis of post traumatic stress disorder (PTSD) in DSM-III … focused attention on the effect of disasters on vulnerable individuals rather than populations. Welcome, because in the excellent and diverse choice of contributors the editors have firmly established that significant advances in our understanding and treatment of post traumatic stress disorders will require the engagement of a much wider ranger of health care professionals, and allied disciplines, than in recent years. … The Textbook of Disaster Psychiatry offers a 'not to be missed' current state-of -the-art review of this important area of research. It also raises the hope that as well as treating the vulnerable few, we should be able to develop psychological interventions that strengthen the mental resilience of many.'

Source: Journal of Psychosomatic Research

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Contents

  • 1 - Individual and community responses to disasters
    pp 3-26
    • By J. Robert Ursano, Professor University of the Health Sciences, Bethesda, Maryland, S. Carol Fullerton, Research Professor University of the Health Sciences School of Medicine, Bethesda, Maryland, Lars Weisaeth, Professor University of Oslo, Norway, Beverley Raphael, Professor University of Western, Sydney, Australia
  • View abstract

    Summary

    Disasters are grouped into two major types: natural and human-made. Disasters overwhelm local resources and threaten the function and safety of the community. The majority of people exposed to disasters do well; however, some individuals develop psychiatric disorders, distress, or health risk behaviors such as an increase in alcohol or tobacco use. Exposure to a traumatic event, the essential element for development of acute stress disorder (ASD) or post-traumatic stress disorder (PTSD), is a relatively common experience. Increasingly, traumatic loss and the bereavement and grief associated with the traumatic loss are recognized as posing special challenges to survivors of disasters and other traumatic events. There is substantial evidence that the perceived availability of social support buffers the effect of stress on distress and psychological symptoms including depression and anxiety. Community leadership is critical to fostering recovery, providing treatment and maximizing community restoration.
  • 2 - Epidemiology of disaster mental health
    pp 29-47
    • By Carol S. North, Professor of Psychiatry UT Southwestern Medical Center Department of Psychiatry USA
  • View abstract

    Summary

    This chapter provides an overview of epidemiologic research on the mental health effects of major disasters. It begins by examining disaster typology and then proceeds to examine various outcomes of disasters, and predictors such as preexisting characteristics, exposure status, and time frame. The chapter also critically reviews other predictors of potential relevance for post disaster settings. Predicting mental health outcomes of disasters is vital to directing mental health resources that may be scarce in postdisaster settings. Community response to disaster may affect mental health problems that may be reduced by an outpouring of community support. The first task in responding to mental health effects following disasters is to differentiate psychiatric illness from distress, because these two entities generally require different approaches and interventions tailored to their needs. Post-traumatic stress disorder (PTSD) and other disorders need psychiatric evaluation and treatment, because effective treatments are available.
  • 3 - Children and disasters: public mental health approaches
    pp 48-68
    • By Robert S. Pynoos, Center Director National Center for Child Traumatic Stress, Alan M. Steinberg, Associate Director University of California, Melissa J. Brymer, Director Terrorism and Disaster Programs National Center for Child Traumatic Stress USA
  • View abstract

    Summary

    This chapter reviews the importance of maintaining a child and adolescent developmental perspective. Studies of the biological, psychological, and behavioral impact of natural disasters on children and adolescents have been growing steadily, with earthquakes and hurricanes being the most widely investigated disasters. A modern public mental health approach to the postdisaster recovery of children, adolescents, adults, and families recognizes the importance of conceptualizing stages of disaster response. A three-tier model for providing postdisaster mental health interventions for children and families includes general psychosocial support to a broad population, specialized interventions for those with severe, persistent distress and impairment, and specialized treatment for high-risk cases that need more intensive psychiatric care. Clinical evaluation and intervention outcome data involve the rigorous clinical evaluation of affected individuals, and are used to examine the contribution of interventions to the course of recovery.
  • 4 - Disaster ecology: implications for disaster psychiatry
    pp 69-96
    • By James M. Shultz, Director, Center for Disaster and Extreme Event University of Miami Miller School of Medicine, Zelde Espinel, Center for Disaster and Extreme Event University of Miami Miller School of Medicine, Sandro Galea, Associate Professor The University of Michigan, Dori B. Reissman, Senior Medical Advisor National Institute for Occupational Safety
  • View abstract

    Summary

    This chapter describes the evolution of a disaster ecological framework for portraying the impact of disasters on human populations. It begins with a detailed look at exposure to hazards-categorized by type, intensity, time, and place factors. Globally, the cumulative impact of disasters can be estimated using multiple measures. Directly relevant to the field of disaster psychiatry, the degree of psychosocial impact varies by disaster type and generally increases with increasing magnitude and frequency of disaster occurrence. The public health consequences of disasters can be assessed in terms of mortality, morbidity and disruption of health care infrastructure. Disaster impact on citizens and whole populations varies by individual and family characteristics such as age, gender, race/ethnicity, education, occupation, employment status and income. The scope and magnitude of disasters are associated with the extent of disruption of health and social services.
  • 5 - Neurobiology of disaster exposure: fear, anxiety, trauma, and resilience
    pp 97-118
    • By Rebecca P. Smith, Assistant Clinical Professor World Trade Center Worker and Volunteer Mental Health Screening, Monitoring and Interventions Programs, Craig L. Katz, Assistant Clinical Professor Psychiatry Mount Sinai School of Medicine, Dennis S. Charney, Professor Psychiatry Mount Sinai School of Medicine, Steven M. Southwick, Professor Section of Child Study Center Yale University
  • View abstract

    Summary

    This chapter reviews the findings of human and animal studies which have characterized normal function in the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis, and then briefly describes post-traumatic stress disorder (PTSD)-associated abnormalities seen in each system. Neurobiological models of the structure, function and neurochemistry of the brain have evolved significantly as a result of recent input from findings of neuroimaging studies. In recent years several neurochemicals have been associated with resilience. In humans, neuroimaging studies of PTSD have primarily focused on the amygdala, the hippocampus, medial prefrontal cortex, and anterior cingulate cortex. Multidisciplinary studies that use neurochemical, neuroimaging, genetic, and psychosocial approaches may in the future clarify the complex relationships between genotype, phenotype, and psychobiological responses to stress. Pharmacological intervention aimed at treating early severe symptoms which are known to be predictive of later PTSD, such as excessive arousal, is one possible avenue of study.
  • 6 - Early intervention for trauma-related problems following mass trauma
    pp 121-139
  • View abstract

    Summary

    This chapter addresses public mental health interventions in the immediate phase following disasters and mass violence. Studies on the relative contribution of early arousal to subsequent post-traumatic stress disorder (PTSD), and the possible pharmacological strategies to reduce expressed adrenergic activity, suggest that the initial stress response is a necessary but insufficient cause of traumatic stress disorders. Social resources, such as social support, socioeconomic status, and access to services, have shown strong effects on mental health and played a variety of roles in the stress process. While offering cognitive-behavioral therapy (CBT)-based trauma-focused interventions may be helpful for some disaster survivors in the first month after the trauma, it may be lower on the hierarchy of needs for survivors faced with complex and chronic stressors. Further research into the needs of disaster-affected populations will help guide the timing of interventions, of both early and later-stage interventions after disasters.
  • 7 - Acute stress disorder and post-traumatic stress disorder in the disaster environment
    pp 140-163
    • By David M. Benedek, Associate Professor Center for the Study of Traumatic Stress
  • View abstract

    Summary

    The chapter highlights the idea that many individuals exposed to significant trauma do not develop acute stress disorder (ASD) or post-traumatic stress disorder (PTSD) and describes subgroups that may be at greater risk for these conditions in the aftermath of disaster. It reviews neurobiological mechanisms in normal and pathological traumatic stress responses. Traumatic experience results in both immediate and long-term endocrine changes that affect metabolism and neurophysiology. Some evidence exists to support the effectiveness of psychotherapeutic approaches immediately after trauma in preventing the development of ASD or PTSD. Cognitive-behavioral therapy (CBT) attempts to correct cognitive distortions and reduce the frequency and symptomatology associated with traumatic memories. Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line medication treatment for PTSD. The clinical interview remains the gold standard for the assessment of ASD or PTSD for several reasons. Future research should help to identify individual and group-specific risk factors or vulnerabilities.
  • 8 - Assessment and management of medical-surgical disaster casualties
    pp 164-189
    • By R. James Rundell, Professor of Psychiatry Mayo Clinic College of Medicine 200 First Street, SW, West 11 Rochester, MN 55905, USA
  • View abstract

    Summary

    This chapter identifies how postdisaster patient triage and management can incorporate behavioral/psychiatric assessment and treatment, merging behavioral and medical approaches in the differential diagnosis and early management of common psychiatric syndromes among medical-surgical disaster or terrorism casualties. A postdisaster screening examination to triage and identify early psychiatric casualties can be thought of as a tertiary survey that focuses on the most common psychiatric sequelae. Government and organizational responses play an important role in limiting psychological contagion and may help to lessen overburdening of the healthcare system after a terrorist event or disaster. In a postdisaster hospital or hospice setting, depression is common. The utility of antidepressant medications is limited by the several weeks needed for the agents to be effective. Careful management of the public education and risk communication aspects of disaster and terrorism has multiplier effects in terms of preventing inappropriate and costly utilization of healthcare resources.
  • 9 - Interventions for acutely injured survivors of individual and mass trauma
    pp 190-205
    • By Douglas Zatzick, Department of Psychiatry University of Washington School of Medicine
  • View abstract

    Summary

    For acutely injured patients multiple physical, financial, social, medical, and legal post-trauma concerns exist that may limit the ability to focus exclusively on the psychological sequelae of the trauma. Injured patients treated within trauma care systems are at high risk for developing post-traumatic stress disorder (PTSD). Acute care mental health services research programs aim to address the mental health needs of populations of injured patients presenting for treatment in the acute care medical setting. Recent investigation suggests that emergency department heart rate alone has only modest specificity and sensitivity for the prediction of chronic PTSD symptoms. Mental health professionals have been observed to converge on the scene of mass disasters. Rather than immediately preparing for early intervention targeting post-traumatic stress, newly arriving mental health professionals could be assigned as care managers to injured patients triaged through acute care settings.
  • 10 - Nongovernmental organizations and the role of the mental health professional
    pp 206-224
    • By Joop de Jong, Director of Public Health & Research Transcultural Psychosocial Organization Keizersgracht 329 1016EE Amsterdam The Netherlands
  • View abstract

    Summary

    This chapter highlights the role of (international) non-governmental organizations. It focuses on mental health professionals who plan to get involved in post disaster or post-conflict work. The chapter addresses psychiatrists, psychologists, psychiatric nurses, social workers, and trainees who are, or who would like to get, involved in disaster work. Most armed conflicts are the result of political, economic, and sociocultural processes. Survivors of extreme stressors such as earthquakes, hurricanes, war, genocide, persecution, torture, ethnic cleansing or terrorism are prone to a range of additional vulnerability factors. From a public health perspective traditional healers often have the advantage that they are easily accessible from a cultural and geographic point of view. In developing services for survivors one has to realize that survivors often belong to a different ethnic or socioeconomic group from those who seek to offer help.
  • 11 - Traumatic death in terrorism and disasters
    pp 227-246
  • View abstract

    Summary

    Exposure to traumatic death is common in natural and man-made disasters and is a significant psychological stressor that can make victims of rescuers. The handling of the remains of the dead following natural disasters, disasters of human origin, terrorism and other forms of traumatic death is known to cause distress. The stress of anticipation has important psychological and physiological effects. Profound sensory stimulation is often an extremely bothersome aspect of handling the dead. Identification or emotional involvement with the deceased may produce a high degree of distress. Close supervision is important for monitoring the welfare of the worker as well as the accomplishment of the many tasks associated with recovery and identification of the dead following a disaster. Numerous strategies are used to cope with the stresses of body handling. Most appear to be effective in the short run; however, which are more effective and their long-term consequences are unclear.
  • 12 - Weapons of mass destruction and pandemics: global disasters with mass destruction and mass disruption
    pp 247-264
  • View abstract

    Summary

    This chapter reviews individual and community psychological and behavioral responses to two types of disaster with global reach: Weapons of mass destruction (WMD) used by terrorists; and pandemics, outbreaks of infectious disease which span the globe. Although there have been thousands of terrorist attacks throughout the world using conventional weapons, the use of WMD, in particular chemical and biological agents is a relatively new phenomenon. Behavioral responses to chemical, biological, radiological, nuclear (CBRN) agents represent several areas of special concern including the overwhelming of medical facilities, mass sociogenic illness, panic and responses of hospital staff and first responders. Mental health intervention is a prompt and effective medical response to a bioterrorism attack. SARS and avian influenza have brought worldwide attention to the possibility of a pandemic spreading across the globe. Mental health surveillance is important for directing services and funding.
  • 13 - Workplace disaster preparedness and response
    pp 265-283
  • View abstract

    Summary

    This chapter describes the evolution of the workplace as an environment responsive to the mental health of employees; the kinds of traumatic incidents that occur in workplaces requiring planning and on-site interventions; and the roles and opportunities for health and mental health providers to assist organizations in planning, responding to and recovering from critical incidents. It concludes by providing a conceptual framework for mental health and occupational health providers to join with corporate professionals and workplace stakeholders in the public sector in developing, integrating and implementing disaster psychiatry principles and evidence-based interventions that can protect and help sustain the United States economic and social capital in the face of disasters and terrorism in the twenty-first century. Mental health professionals can consult with the employee assistance provider (EAP) and crisis management industry to ensure that providers and sub-contractors are providing quality crisis response services.
  • 14 - Healthcare systems planning
    pp 284-308
    • By Brain W. Flynn, Adjunct Psychiatry Professor Department of Psychiatry Center for the Study of Traumatic Stress Uniformed Services University of the Health Sciences P.O. Box 1205 Severna Park, MD21146, USA
  • View abstract

    Summary

    This chapter begins by stating that the need for and value of preparation for extraordinary events are axiomatic in the disaster mental health field. It assumes a healthcare system that is, at minimum, composed of public health, hospital and community medical services, emergency medical services and specialty health and medical care. Although the field of disaster mental health is relatively young, overall planning has evolved significantly over a long period of time. The National Response Plan (NRP) forms the basis of how the federal government coordinates with state, local, and tribal governments and the private sector during incidents. There are many useful sources of information and guidance for healthcare system disaster planning found throughout the chapter. Overall relationships in the disaster response environment should be guided and informed by the requirements of the NRP. The chapter concludes with describing implications for public health, clinical care, and research.
  • 15 - Public health and disaster mental health: preparing, responding, and recovering
    pp 311-326
    • By Robert J. Ursano, Professor and Chairman Department of Psychiatry Uniformed Services University of the Health Sciences, Carol S. Fullerton, Research Professor Department of Psychiatry Uniformed Services University of the Health Sciences, Lars Weisaeth, Professor Division of disaster psychiatry University of the Oslo/ The Military Medical, Beverly Raphael, Professor University of Western Sydney
  • View abstract

    Summary

    Mental health and behavior are important elements of our healthcare system for responses to disasters. New models of monitoring shifting community healthcare needs in real-time as well as innovative models for delivering care are required. Disaster behaviors and preparedness behaviors such as decisions about when and how to evacuate, and response to alerts and alarms are a relatively new focus of attention and intervention for mental health and behavior specialists. There are many milestones of a disaster that affect the community and may offer opportunities for recovery. Public health planning for the psychological consequences of disasters must address the range of psychological and behavioral responses. Developing better ways to prepare the workplace-business and industrial communities to embrace the challenges of human continuity as part of their efforts to assure business continuity is a major challenge. An integrated approach that includes security, human resources, occupational health, and leadership may be effective.

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