??????????? ??????(Post-traumatic Stress Disorder)

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?????????????????(Post-traumatic Stress Disorder)
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Commonpost-disaster psychiatric disorders

• Post-traumatic stress disorder
• Depressive disorders
• Major depression
• Dysthymic disorder
• Mixed anxiety depression
• Panic disorder
• Generalized anxiety disorder

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Commonpost-disaster psychiatric problems

• Insomnia
• Substance abuse (alcohol )
• Suicide
• Survivor guilt
• Domestic violence

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Post-traumatic Stress Disorder

• Events
• Actual or threatened death or serious injury
• Threat to physical integrity
• Response
• Intense fear, helplessness, or horror

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• ???????? (Re-experience)
• ??????????? (Avoidance)
• ????????? (Emotional Numbness)
• ???? (Hyperarousal)

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• ???????? (Re-experience)
• ???????????? (Intrusive recollection)
• ???? (Recurrent nightmare)
• ???? (Dissociative flashback)
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• ????????? (Emotional Numbness)
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• Sense of forshortened future

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• ???? (Hyperarousal)
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• Hypervigilance
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Post-traumatic Stress Disorder

• ?? (Types)
• ?????? (Acute Stress Disorder)
• ???????? (Acute PTSD)
• ???????? (Chronic PTSD)
• ??? (Delayed onset)

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Risk Factors of PTSD

• Demographic correlates
• Sex
• Age
• Education
• Income
• Marital status
• Region
• Urbanity

• Trauma related
• Type of trauma
• Severity of trauma
• Biological correlates
• Genetics
• Personality
• Psychophysiology

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• SSRIs ? SNRI ???
• Nefazodone, Trazodone
• ?????
• Benzodiazepines

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• ???? (Anxiety Management)
• Relaxation training
• Breathing training
• Positive thinking
• Assertive training
• Though stopping

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• ???? (Psychoeducation)
• ???? (Cognitive therapy)
• ???? (Play therapy)
• ???? (Exposure therapy)
• Imaginal exposure
• In vivo exposure

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MHRP at Puli town

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THANK YOU !
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MHRP at Puli town

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Mental Health Relief Programme

• Debriefing group for hospital staffs
• Screening in community
• Establishment of psychiatric services in
  community and shelter-camp
• Home visit and treatment for severe
• psychiatric morbidity

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Subjects and Methods

• 13114, ? 18 years old, surveyed
• Mean age 41 ? 16
• 53.3 female, 46.7 male

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Subjects and Methods

• Damage of house
• complete destroyed 16.4
• partial destroyed 35.1
• Injury of relatives
• death 6.4
• serious injured 2.2
• mild injured 9.6

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Subjects and Methods

• Financial status
• Marked difficulty 10.8
• Moderate difficulty 17.4
• Mild difficulty 46.6

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Subjects and Methods

• Death witness 16.0
• Personality traits
• Nervous trait 38.0
• Obsessive trait 28.5
• Inhibition trait 16.7

????
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Assessment Instruments

• Psychiatric Morbidity
• CHQ-12
• Symptom Check List for
• PTSD symptoms
• Depressed mood
• Guilt feeling
• Suicide idea

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Outcomes

• Post-traumatic Stress Disorder
• Psychiatric Morbidity
• Depression
• Suicide idea

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Anxiety symptoms
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Depression symptoms
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Post-traumatic stress symptoms
According to DSM-IV
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Cross-section prevalence (6-month)

• Post-traumatic Stress Syndromes
• Three dimension syndrome 593 ( 4.5 )
• Any two dimension syndrome 2596 (19.9)
• Re-experience Avoidance 122 ( 0.9 )
• Re-experience Hyperarousal 2445 (18.7 )
• Avoidance Hyperarousal 29 ( 0.2 )
• Any one dimension syndrome 4745 (36.3)
• Re-experience 3731 ( 6.4 )
• Avoidance 29 ( 0.2)
• Hyperarousal 985 ( 7.5)

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Cross-section prevalence (6-month)

• Suicide idea
• 386 (2.9 )
• Psychiatric morbidity
• 0-2 9648 (73.6 )
• 3-4 1703 (13.0 )
• 5-6 921 ( 7.0 )
• ? 7 842 ( 6.4 )
• Probable psychiatric case (CHQ? 4)
• 2457 (18.8)

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Psychiatric Disorder among Victims (N149)

• Major depression
• First episode 39 (26.2)
• Recurrent 13 ( 8.7)
• Dysthymic disorder 20 (13.4)
• Panic disorder 7 ( 4.7)
• PTSD 50 (33.6)
• GAD 17 (11.4)

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Psychiatric Disorder among subjects with suicidal
ideation (N 71)

• All psychiatric disorders 55 (77.5)
• Major depression
• First episode 22 (30.9)
• Recurrent 9 ( 12.7)
• Dysthymic disorder 18 (25.4)
• PTSD 28 (39.4)

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Demography and occurrence of PTSD, suicide idea,
and psychiatric morbidity
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Damage index and occurrence of PTSD, suicide
idea, and psychiatric morbidity
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Death witness, personality and occurrence of
PTSD, suicide idea, and psychiatric morbidity
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(No Transcript)
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CONCLUSIONS

• Depression and PTSD are major psychiatric
  disorders
• Measures to reduce financial strain of victims
  facilitate process of psychological
  rehabilitation
• Neurotic personality traits are vulnerability
• Out-reach team is important for efficiently
  conveying psychiatric care

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THANK YOU !