Anand Pandya

Research on psychiatric outcomes and interventions subsequent to disasters: a review of the literature

Tragic events such as those of September 11, 2001, underscore the increasingly prominent role that psychiatrists play in aiding survivors, emergency workers, and broader communities to cope with disaster. The present review was undertaken to identify whether there exists a scientific basis for the practice of psychiatry in the aftermath of disasters. Most of the extensive literature over the past 30 years suggests that disasters have psychopathological consequences as well as medical and social ones. Pre-existing mood and anxiety disorders, although surprisingly not psychotic illness, appear to be risk factors for further psychopathology after a disaster. Thus, both acute psychopharmacological and psychotherapeutic interventions at disaster sites may prevent long-term sequelae, although their efficacy remains uncertain. Future controlled treatment trials are needed to determine the optimal treatment strategy.

Epidemiological trends in psychosis-related Emergency Department visits in the United States, 1992―2001

Mental health visits represented an increasing fraction of all Emergency Department (ED) visits in the U.S. between 1992 and 2001. This study used the National Hospital Ambulatory Medical Care Survey, a 4-staged probability sample of ED visits from geographically diverse hospitals around the U.S., to assess the contribution of all psychosis-related visits to this overall trend. Unlike other mental-health-related ED visits, the rate of psychosis-related visits did not increase. This lack of change is notable in the context of dramatic changes in both healthcare financing and antipsychotic prescribing practices during this period. There was an unexpected decrease in Medicare-funded psychosis-related ED visits at a time of increasing Medicare enrollment overall. An important demographic trend over this decade was the increasing urbanization of psychosis-related ED visits coincident with a relative decrement in such visits within rural areas.

Services Provided by Volunteer Psychiatrists after 9/11 at the New York City Family Assistance Center: September 12--November 20, 2001

Objective To characterize the experience of volunteer disaster psychiatrists who provided pro bono psychiatric services to 9/11 survivors in New York City, from September 12, 2001 to November 20, 2001. Method Disaster Psychiatry Outreach (DPO) is a non-profit organization founded in 1998 to provide volunteer psychiatric care to people affected by disasters and to promote education and research in support of this mission. Data for this study were collected from one-page clinical encounter forms completed by 268 DPO psychiatrists for 2 months after 9/11 concerning 848 patients served by the DPO 9/11 response program at the New York City Family Assistance Center. Results In this endeavor, 268 psychiatrist volunteers evaluated 848 individuals and provided appropriate interventions. The most commonly recorded clinical impressions indicated stress-related and adjustment disorders, but other conditions such as bereavement, major depression, and substance abuse/dependence were also observed. Free samples were available for one sedative and one anxiolytic agent; not surprisingly, these were the most commonly prescribed medications. Nearly half of those evaluated received psychotropic medications. Conclusions In the acute aftermath of the attacks of September 11, 2001, volunteer psychiatrists were able to provide services in a disaster response setting, in which they were co-located with other disaster responders. These services included psychiatric assessment, provision of medication, psychological first aid, and referrals for ongoing care. Although systematic diagnoses could not be confirmed, the fact that most patients were perceived to have a psychiatric diagnosis and a substantial proportion received psychotropic medication suggests potential specific roles for psychiatrists that are unique and different from roles of other mental health professionals in the early post-disaster setting. In addition to further characterizing post-disaster mental health needs and patterns of service provision, future research should focus on the short- and long-term effects of psychiatric interventions, such as providing acute psychotropic medication services and assessing the effectiveness of traditional acute post-disaster interventions including crisis counseling and psychological first aid. (Journal of Psychiatric Practice 2010;16:193–199).

Mental health as an advocacy priority in the lesbian, gay, bisexual, and transgender communities.

This column reviews the evolution of lesbian, gay, bisexual, and transgender (LGBT) mental health advocacy in relation to modern mental health advocacy efforts. In addition to developments in organized psychiatry (e.g., American Psychiatric Associations LGBT caucus), grassroots LGBT community initiatives are playing an important role (e.g., Trevor Project providing crisis intervention/suicide prevention services to LGBT youth, face-to-face mental health services in LGBT community centers). Studies have found that LGBT individuals are at increased risk for mental health problems (e.g., depression, anxiety, substance misuse, suicidal ideation, self-harm). Mental health advocacy in the LGBT community has been slowed by the long-standing association of the concept of homosexuality with psychopathology in mainstream psychiatry (e.g., homosexuality was only removed from the DSM in 1973, ego dystonic homosexuality still appears in the ICD-10). However, positive developments in LGBT mental health advocacy have been fostered by the proposed minority stress model (i.e., that elevated risk of mental illness in LGBT individuals is a consequence of a hostile stressful environment). A particularly encouraging initiative is the It Gets Better Project, in which thousands of videos, some by prominent individuals, have been posted online to send a message of hope to LGBT youth facing harassment and low self-esteem.

Verbal and Physical Aggression Against Resident Physicians in Two General Hospitals in Baghdad

Aggression in the workplace is an ill-defined and underreported concern for physicians. This study attempts to assess the risk of aggression on resident physicians. From September to October 2001, all 80 resident physicians working in two Baghdad public teaching general hospitals, Al Yarmook and Al Kendi, received a retrospective questionnaire about patient aggression. Sixty-six males and 14 females completed the questionnaire. Seventy participants (87%) had experienced aggression by patients or their relatives, and these aggressive acts were primarily verbal (95%). The rate of experiencing aggression was higher among the junior residents. Only 59% of participants informed the hospital administration about their experience of aggression and 34% of them were satisfied with the response by the administration. Most of the participants avoided talking about their experience and considered it emotionally painful or annoying. The participants continued to experience aftereffects of the aggression. Resident phys...

NAMI in our own voice and NAMI smarts for advocacy: self-narrative as advocacy tool.

In his first Advocacy column for the Journal of Psychiatric Practice, the author discusses the importance and relevance of advocacy for all mental health professionals and researchers in whatever setting they work. Advocacy efforts can and have influenced a range of issues that are important to hospital-based and community psychiatrists, private practitioners, and researchers. The author then discusses the importance of personal self-narrative as a tool for decreasing stigma and increasing understanding of serious mental illness, with a focus on two programs developed by the National Alliance on Mental Illness: NAMI In Our Own Voice and NAMI Smarts for Advocacy. (Journal of Psychiatric Practice 2012;18:448–450)

The challenge of gun control for mental health advocates

Mass shootings, such as the 2012 Newtown massacre, have repeatedly led to political discourse about limiting access to guns for individuals with serious mental illness. Although the political climate after such tragic events poses a considerable challenge to mental health advocates who wish to minimize unsympathetic portrayals of those with mental illness, such media attention may be a rare opportunity to focus attention on risks of victimization of those with serious mental illness and barriers to obtaining psychiatric care. Current federal gun control laws may discourage individuals from seeking psychiatric treatment and describe individuals with mental illness using anachronistic, imprecise, and gratuitously stigmatizing language. This article lays out potential talking points that may be useful after future gun violence.

Advocacy for people with borderline personality disorder.

Although many of the largest and best known consumer and family mental health advocacy organizations do not restrict themselves to a single diagnosis, over the last few decades an increasing number of disease-specific mental health advocacy organizations have emerged. This column describes the development of a movement advocating for consumers and families affected by borderline personality disorder (BPD) as an example of two trends in the mental health advocacy field: closer ties between advocacy and professional groups and specialization to better address the different needs created by different diagnoses. (Journal of Psychiatric Practice 2014;20:68–70)