Psychopharmacological possibilities in the acute disaster setting

Preventing post traumatic stress disorder: are drugs the answer?

In the field of traumatic stress, chemoprophylaxis is a term that is often used but rarely well understood. There has been no shortage of debate on the issue, but few rigorous studies to ground the discussion. The purpose of the current paper is to explore the issues surrounding this contentious area. Databases including PubMed, PsychArticles and Web of Knowledge were searched using the key words 'chemo or pharmaco', 'prevention or prophylaxis', and 'PTSD or post-traumatic stress'. Relevant journals and reference lists of the papers obtained through this search were scanned for additional references. Studies that investigated the use of pharmacotherapy to prevent the onset of post-traumatic stress disorder were considered for this paper. Studies that examined the treatment of established PTSD were excluded. A total of 15 empirical studies were included in the review (including five randomized controlled trials), and twice as many non-data-driven papers. Evidence for the prophylactic use of alcohol, morphine, propranolol, and hydrocortisone is presented, followed by a discussion of the many challenges of using pharmacological interventions in this context. While attention to this issue has increased in recent times, the dearth of empirical data has done little to further the field. Larger studies are indicated following small trials with medications such as propranolol and hydrocortisone. There remain a number of ethical and practical questions to be answered before the widespread use of chemoprophylaxis can be recommended.

Psychiatric consultation with medical evacuees of Hurricane Katrina

OBJECTIVE

To study the scope of clinical activities and the postoperational attitudes of mental health professionals responding emergently to a mass urban evacuation.

METHODS

Eleven mental health care providers participating in a reception team for medical evacuees after Hurricane Katrina were asked to complete a survey seeking data regarding cases encountered, psychopharmacologic interventions, and mental health support for evacuated medical personnel. Participants rated their levels of agreement with statements characterizing various aspects of the clinical experience.

RESULTS

Nine of 11 providers returned surveys, for a response rate of 82%. Among 35 evacuees requiring immediate psychiatric consultation, acute stress disorder and dementia, equally represented among these cases, accounted for half the diagnoses. Medication interventions were relatively uncommon. Consultants provided mental health support to 14 evacuated medical professionals. Although somewhat uncertain about their role, psychiatric consultants strongly agreed that they would be willing to serve in future disaster operations of this type.

CONCLUSIONS

In major disasters, psychiatric consultants are likely to play a critical role in providing emergency mental health services for both medical evacuees and evacuated medical professionals.