Cover -- Half-title -- Title -- Copyright -- Contents -- Contributors -- Preface -- PART I Introduction -- 1 Individual and community responses to disasters -- The nature of disaster -- Community response to disaster -- Disorder, distress and health risk behaviors -- Disorder -- Distress and health risk behaviors -- Bereavement and grief -- Risk factors and vulnerable populations -- Pre-existing psychiatric illness -- Demographic risk factors -- Social support and resources -- Treatment, intervention, and recovery -- Risk and protective factors: resilience and response trajectories -- Resilience and post-traumatic growth -- Meaning and cognitive appraisal of disaster events -- Conclusion -- References -- PART II Foundations of disaster psychiatry -- 2 Epidemiology of disaster mental health -- Introduction -- Disaster typology -- Mental health outcomes of disasters -- Predictors of disaster outcomes -- Implications -- Interventions are needed early after disasters, and the need can be expected to continue through the long term -- Postdisaster populations can be most effectively approached by considering levels of exposure and pre-existing characteristics -- Differentiating psychiatric illness from distress facilitates treatment of psychiatric disorders without discounting or unnecessarily pathologizing distress -- Summary -- References -- 3 Children and disasters: public mental health approaches -- Introduction -- Key concepts -- Impact of disasters on children and adolescents -- Stages and strategies of postdisaster intervention -- Psychological First Aid -- Skills for Psychological Recovery -- Enhanced Services -- Treatment -- Three tiers of postdisaster intervention -- Tier 1: broad-scale intervention -- Tier 2: specialized intervention -- Tier 3: highly specialized intervention -- Stages of postdisaster data collection -- References.

4 Disaster ecology: implications for disaster psychiatry -- The nature of disaster from an ecological perspective -- Evolution of a disaster ecology framework -- Epidemiological triad: causal or exposure pathway models -- The Haddon matrix: analyzing the triad factors by event phase -- Disaster ecology model -- Disaster ecology model: exposure to hazards (the forces of harm) -- Forces of harm: disaster type -- Natural disasters -- Human-generated disasters -- Forces of harm: magnitude -- Absolute magnitude -- Relative magnitude -- Measures of magnitude -- Forces of harm: the time dimension -- Frequency and trends -- Seasonality and cyclicity -- Duration of impact/duration of disruption -- Multiplicity -- Predictability -- Forces of harm: the place dimension -- Geography and topography -- Area and path -- Forces of harm: summary -- Disaster ecology model: the ecological context of disaster risk and protective factors -- Ecological context: individual/family factors -- Gender -- Race/ethnicity -- Ecological context: community-level factors -- Social support -- Community socioeconomic status -- Social environment -- Civic society -- Ecological context: societal/structural factors -- Geography -- Physical environment -- Cultural context -- Political structure and governance -- Health and social services infrastructure -- Ecological contextsummary -- Concluding comments -- References -- 5 Neurobiology of disaster exposure: fear, anxiety, trauma, and resilience -- Introduction -- The sympathetic nervous system -- Sympathetic nervous system alterations in PTSD -- Hypothalamic-pituitary-adrenal (HPA) axis -- HPA axis alterations in PTSD -- Stress sensitization -- Fear conditioning -- The amygdala and the hippocampus: key neuroanatomic structures involved in fear and anxiety states -- Stress, plasticity and the hippocampus -- Cortex and neural circuits.

Neuroimaging in fear and anxiety: focus on PTSD -- PTSD: findings from structural neuroimaging studies -- PTSD: findings from functional neuroimaging studies -- Genetic risk of stress-related psychopathology -- Neurobiology of resilience -- Neurochemistry of resilience -- Neuropeptide Y -- Galanin -- Neurosteroids -- Neuroanatomic basis of resilience -- Neurobiology of social support and attachment -- Neurobiology of trust -- Concluding remarks -- References -- PART III Clinical care and interventions -- 6 Early intervention for trauma-related problems following mass trauma -- Empirical literature base -- Studies of the impact of disasters -- Theoretical models of stress, trauma, and disasters -- Intervention studies -- Expert consensus recommendations -- Provide for basic needs -- Triage -- Psychological First Aid (PFA) -- Immediate goals of PFA -- Outreach and information dissemination -- Conclusions -- References -- 7 Acute stress disorder and post-traumatic stress disorder in the disaster environment -- Introduction -- Clinical presentation -- Core clinical features -- Associated clinical features -- Differential diagnosis -- Epidemiology -- Neurobiology -- Neurobiology of the traumatic stress response -- Neurobiology of post-traumatic symptoms -- Management in the disaster setting -- Assessment and screening -- Treatment and prevention -- Psychopharmacology -- Psychosocial interventions -- Future directions -- Early interventions -- Subthreshold and complex PTSD -- Generalizing research to postdisaster populations -- Conclusion -- References -- 8 Assessment and management of medical-surgical disaster casualties -- Introduction -- Phases of individual and community responses to terrorism and disasters: integrating psychiatric management into disaster victim medical-surgical triage and treatment -- Covert exposure -- Announced exposure.

Factors determining presentations to healthcare providers and facilities -- The ATLS(sup[@]) primary and secondary surveys -- The "tertiary" psychiatric survey: early identification of psychiatric casualties -- The mental status examination in critically injured patients -- Medical-psychiatric differential diagnosis -- Unique attributes of biological and chemical terrorist attacks -- Nerve agents -- Cyanide -- Incapacitating agents -- Blister agents -- Cutaneous anthrax -- Inhalation anthrax -- Smallpox -- Tularemia -- Plague -- Botulism -- Delirium -- Depression -- Acute stress disorder and post-traumatic stress disorder -- Generalized anxiety disorder -- Panic disorder -- Hypochondriasis -- Unexplained physical symptoms and conversion symptoms -- Dissociative disorders -- Situational dissociation -- Situational anxiety and worry -- Substance use disorders -- Effects of disaster medications -- Effective medical-psychiatric differential diagnosis -- Initial presentation of patients in the emergency department or triage setting -- Key elements in the differential diagnosis -- Effective community prevention and response to disasters and terrorist attacks as tools to mitigate psychiatric casualties -- Clinical issues in medical-surgical disaster/terrorism casualties -- Clinical treatments that aim to prevent psychiatric sequelae -- Burns patients -- Agitated patients -- Losses of body parts and functions -- Disfigurement and body image -- Guilt and grief -- The dead and dying -- Heroes in hospitals -- Conclusion -- References -- 9 Interventions for acutely injured survivors of individual and mass trauma -- Introduction -- Post-traumatic high-risk behaviors and functional impairment -- Trauma centers provide care for injured civilians after individual and mass traumatic life events.

Refinements in routine acute care mental health evaluation procedures may serve Americans in the wake of mass trauma -- Efficacious interventions for PTSD -- Challenges to acute care mental health service delivery -- Health services approaches to the problem of the development of early acute care intervention -- Clinical epidemiology as a foundation for a health services research approach to intervention development -- Developing early combined interventions for injured trauma survivors treated in the acute care trauma center setting -- A randomized effectiveness trial of the early combined intervention at Harborview -- Care management targeting patient engagement and trauma center-to-community linkage -- Medication and psychotherapy targeting PTSD -- Motivational interviewing (MI) targeting alcohol consumption and injury recurrence -- Results of the early combined intervention (Zatzick et.al., 2004a) -- Looking to the future: how routine health services research in acute care medical settings may inform early intervention after mass trauma -- Acknowledgement -- References -- 10 Nongovernmental organizations and the role of the mental health professional -- Introduction -- (International) nongovernmental organizations [(I)NGOs] -- Challenges for mental health professionals who plan to work in postdisaster and postconflict areas -- Addressing a multiplicity of causal factors -- Addressing additional vulnerability factors within a contextual model -- Addressing the scarcity of mental health professionals -- Handling the complementarity between allopathic "western" and local healing methods -- Taking specific characteristics of the survivors into account -- References -- PART IV Special topics -- 11 Traumatic death in terrorism and disasters -- Traumatic stressors associated with exposure to mass death -- Anticipation of exposure -- Sensory stimulation.

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