Psychosocial responses to disaster: An Asian perspective.

The psychological and psychiatric impact of great natural disasters are beginning to be understood leading to new methods of prevention, intervention and mitigation. There is limited data from the Asian continent, however, which has been the location of some of the greatest disasters of recent times. In this paper, we outline the psychosocial intervention efforts from nine Asian nations when confronted with large-scale natural catastrophic events. These include reports from situations where local services have some capacity to respond as well as those where services are destroyed or overwhelmed. From this it is possible to draw some general principles of psychosocial disaster intervention: (1) Assessment of disaster, extant service systems and incoming resources. (2) Assessment of help-seeking pathways and cultural models of illness. (3) Facilitation and support for family reunion, identification of the dead and cultural and religious practices to address death and grief. (4) Foster and bolster community group activities where possible. (5) Psychosocial training of community, aid and health workers using a train the trainer model to promote case identification, psychoeducation and intervention, with specific emphasis on vulnerable groups, especially children. (6) Promote general community psychoeducation. (7) Train medical and health staff in basic psychiatric and psychological assessment and intervention for post-traumatic stress, mood and anxiety disorders. (8) Minimise risk factors for psychiatric morbidity such as displacement and loss of gainful activity. (9) Reshape mental health systems recognising the long-term psychiatric sequelae of disaster. The collective learnt experience from Asian natural disasters may be constructively used to plan strategies to respond appropriately to the psychosocial consequences of disaster both within Asia and in the rest of the world.

Comparison of risperidone, olanzapine and quetiapine: effects on body weight, serum blood glucose and prolactin.

Schizophrenia is a chronic illness with a lifetime prevalence of 1% and with serious physical, social and economic consequences. Over the past decade, atypical antipsychotic medications have become the first-line treatment for schizophrenia (Breier et al, 2005).

Post-traumatic stress disorder among Afghan refugees following war.

There was a large influx of Afghan refugees into Pakistan during the 1980s and in particular after the US invasion of Afghanistan in 2001. That refugees have high rates of mental health problems has been well established (e.g. De Jong et al, 2000) - causes include migration, often with painful transit experiences, difficult camp life and the experience of major trauma, including multiple losses of family members as well as the loss of property and traditional lifestyle. However, the Afghan refugees in Pakistan have been poorly studied. Although the mental health problems of Afghan refugees have been studied in the West, the numbers of participants in such research have been relatively small.

A 12-year follow-up of a sample of patients dependent upon heroin.

Heroin addiction is a chronic, relapsing and remitting condition. Each year 2-5% of addicts discontinue drug use permanently and 1-2% die, mostly of overdose (Robins, 1993). A study of 129 opiate-addicted patients on a monthly maintenance regimen found that those with a family history of opium use had an earlier age at onset (Chaudhry et al, 1991). Long-term follow-up studies of people who misuse opiates have revealed that opioid dependence appears to run a chronic, relapsing and remitting course with a significant mortality (10-15%) over 10 years (Robson, 1992). Metrebian et al (1998) reported that long-term heroin abstinence was associated with less criminality, psychological distress and morbidity; Hser et al (2001) reported it was associated with higher employment rates.

Psychiatric problems in an Afghan village.

BACKGROUND: The rates of psychiatric disorders might be very high in Afghanistan. The country has faced many years of war and violence and therefore this is hardly surprising. We are describing the results of a community survey conducted by clinicians in a small village of Eastern Afghanistan. This study was carried out to measure prevalence of psychiatric disorders among the people living in a small village in the Nangerhar, Afghanistan. We also wanted to measure the associated demographic variables. METHODS: A structured interview schedule, Mini International neuropsychiatry Interview Schedule (MINI), was used to measure psychiatric morbidity. RESULTS: More than 70% of the population fulfilled criteria for some form of mental illness. CONCLUSIONS: The rates of mental health problems are very high in Afghanistan. Any efforts to rebuild this war torn country should take sufficient measures in building mental health services with special emphasis on mental health problems.

Psychiatric morbidity among Afghan refugees in Peshawar, Pakistan.

BACKGROUND: A review of the literature shows that refugees in different parts of the world have high rates of psychological and emotional problems. However, psychiatric morbidity among Afghan refugees in Pakistan has been poorly studied. Most of the studies of psychiatric disorders come from western countries. However, these studies may not be representative of the Afghan refugees in Pakistan. This study was carried out to measure psychiatric morbidity among a group of Afghan refugees attending a psychiatric clinic in Peshawar, Pakistan. METHODS: This is a cross sectional study, to measure prevalence of psychiatric morbidity among the residents of Afghan refugee camps in Peshawar, Pakistan, who attended a psychiatric clinic between November 2003 and February 2004. Data were collected using Mini International neuropsychiatry Interview Schedule (MINI), and a form specifically developed for the study. RESULTS: Nearly 80% of our patients had a diagnosis of Post Traumatic Stress Disorder. Nearly half (47.9%) reported family history of mental illness, while almost a quarter (23.3%) had a physical disability or long term illness. Only 13.7% (106) had contacted health services prior to seeking help for their psychiatric illness. CONCLUSIONS: A high number of patients presenting with PTSD is not an unusual finding when one considers the traumatic experiences faced by the general population of Afghanistan. Only a small number of the patients had been in contact with the health services prior to their contact with the psychiatric service. This study highlights the importance of health education among Afghan refugees and to establish the mental health services for them.

Five year follow up of 100 heroin addicts in Peshawar.

BACKGROUND: Drug addiction has increased rapidly during the last 2 decades in Pakistan, however little has been done to explore and evaluate different treatments which are available locally. This paper describes five years follow up of heroin addicts from Peshawar, Pakistan, after an extended period of in patient detoxification. METHODS: This was a longitudinal cohort study of 100 clients who were followed up for 5 years. The main interventions included: an extended in patient detoxification for 30 days, Motivational Interview, and training in coping strategies. Patients participated in both in-patient, and then after discharge, community based group therapy, as well as indigenous self-help groups as an integral part of the treatment. A modified version of Addiction Severity Index (ASI) was used along with urine analysis, to assess substance misuse in clients. Improvement was defined as being drug and crime free and being in purposeful employment. RESULTS: At the end of the study period, out of a total of 70 clients, 16 (23%) had improved. 54 (77%) had relapsed, while 04 (5%) had dropped out of the programme. As far as abstinence from drugs and crimes was concerned, 28% were abstinent at the end of 5 years follow up. CONCLUSIONS: An integrated community based indigenous approach can had good effect on outcome of heroin addiction in a medium term follow up.