Assessment of psychopathological consequences in children at 3 years after tsunami disaster.

BACKGROUND: At 1 year after the Tsunami disaster, 30% of students in two high risk schools at Takuapa district of Phang Nga Province still suffered from post traumatic stress disorder (PTSD). The number ofpatients was sharply declined after 18 months. The psychological consequences in children who diagnosed PTSD after the event were reinvestigated again at 3 years, as there were reports of significant comorbidity and continuing of subsyndromal post traumatic stress symptoms in children suffered from other disasters. OBJECTIVE: To assess psychological outcomes and factors contributed at 3-year follow up time in children diagnosed PTSD at 1-year after the Tsunami disaster MATERIAL AND METHOD: There were 45 students who were diagnosed PTSD at 1-year after the disaster At 3-year follow up time, clinical interview for psychiatric diagnosis was done by psychiatrists. RESULTS: 11.1% of students who had been diagnosed as PTSD at 1-year after Tsunami still had chronic PTSD and 15% had either depressive disorder or anxiety disorder 25% of students completely recovered from mental disorders. Nearly 50% ofstudents were categorized in partial remission or subsyndromal PTSD group. Factors which influenced long-term outcomes were prior history of trauma and severe physical injury from the disaster. CONCLUSION: Although the point prevalence of PTSD in children affected by Tsunami was declined overtime, a significant number of students still suffer from post traumatic stress symptoms, depressive disorder or anxiety disorder which need psychological intervention.

Cognitive-behavioral intervention for young tsunami victims.

OBJECTIVE: To evaluate the efficacy of the cognitive-behavioral intervention provided to children by volunteer professionals in a tsunami-hit area in Thailand. The intervention was aimed to prevent the severe development of post traumatic stress symptoms, and to help the children who might recover spontaneously to do so more quickly. MATERIAL AND METHOD: One hundred and sixty children in Ranong province voluntarily participated in 2-days group activities on the 57h day after the tsunami. The manualized intervention had been designed based on cognitive-behavioral model. Three domains of post traumatic stress reactions were targeted, intrusion, arousal, and avoidance. The Children's Impact of Events Scale (13) (CRIES-13) was completed by the participants before and 2 weeks after the intervention. RESULTS: The program was generally well understood by the children. No difference in CRIES scores was observed before and after the children entered the intervention program. However when the sample was categorized into two groups, the group that was more likely to develop PTSD showed a significant reduction in the scores, whereas a significant increase in the scores was evident in the other group. CONCLUSION: The findings supported the efficacy of cognitive-behavioral intervention in the children who were prone to develop PTSD. The program needed to be adapted to suit the religious, socio-economic, and cultural background of the sample. The unchanged Avoidance scores in the present study were possibly explained by the general feeling that a tsunami might happen again and the parental involvement. The increase of post-intervention scores in otherwise normal sample, though not exceeding the cut-off raised some concern, and possibly the need for screening before the intervention.

Advances in alternative pharmacotherapy of ADHD.

Several alternatives to psychostimulants have been developed and expanded the variability of the treatment of ADHD. Clonidine is a good option for managing core behavioral symptoms, especially hyperactivity and impulsivity. Bupropion and venlafaxine seem potentially promising. Significant new options include norepinephrine reuptake inhibitors, such as atomoxetine, and possibly selective dopamine agonists. Central anticholinesterases, such as donepezil, may improve core ADHD symptoms.