Sequelae of Crisis Trauma or Disaster 6 Weeks to Lifetime

Although many patients completely recover from a crisis within 4 to 6 weeks, others may suffer with the sequelae of trauma or a crisis. The prognosis generally depends on three groups of factors: pretraumatic, traumatic, and posttraumatic risk factors (Ursano et al., 1995). Pretraumatic factors may include prior psychiatric illness, genetics, typical coping styles, gender, and culture. Traumatic risk factors relate to the type of trauma, severity and duration of the trauma, and seriousness of a physical injury. Posttraumatic risk factors involve coping styles, resources available for repair, individual or community response, capacity for problem solving, and adaptation. In general, recovery is more likely if the crisis is not too severe and is short in duration. If the crisis is prolonged or totally devastating to the fabric of a community (as with a hurricane or earthquake), the resources available for repair and the coping strategies used are the best predictors of outcome.

When dealing with a patient who has been in a crisis or suffered a trauma, it is important for the family physician to assess for associated trauma-related conditions. This assessment begins with attention to physical illness or psychosomatic complaints, then focuses on basic health care needs (food, warmth, shelter, clean drinking water, good sanitation). From a psychiatric standpoint, the family physician must remember that it is normal to have symptoms of trauma after a crisis event. Most patients' symptoms will wane gradually or resolve spontaneously and may not require psychological treatment. At 1 year, however, 30% to 40% of those exposed to a disaster will show lingering evidence of psychiatric morbidity (Raphael, 1986). For example, 1 year after being involved in a car crash, about 25% of patients will show signs of a psychiatric disorder, and 11% will go on to develop PTSD (Mayou et al., 1993). Table 45-1 summarizes the spectrum of psychiatric disorders that can occur in the wake of a crisis or trauma.

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