Clinical Presentation and Therapeutic Interventions for Posttraumatic Stress Disorder Post-Katrina

https://doi.org/10.1016/j.apnu.2007.05.002Get rights and content

It has been almost 2 years since Hurricane Katrina struck the Gulf Coast. These 2 years can be characterized by constant struggle and pain as the people try to reattain some semblance of life as they knew it before Katrina struck. Some have chosen to leave their ancestral homes, homes where they were raised and where they, in turn, raised their own families. Those who did leave are able, in some way, to reestablish some semblance of normality, but those who stayed showed manifestations of and dealt with psychological trauma. These manifestations include regression, inattentiveness, aggressiveness, somatic complaints, irritability, social withdrawal, nightmares, and crying. Longer lasting effects may include depression, anxiety, adjustment disorders, and interpersonal or academic difficulties. These postdisaster manifestations can linger or remain hidden until well after the traumatic event and could persist for years. This article presents issues about the effects of Katrina on the mental health of the people of New Orleans. It discusses the profile of posttraumatic stress disorder and presents evidence-based review of interventions the health care provider can implement to care for those who continue to suffer the effects of this horrific disaster.

Section snippets

Practice recommendations

  • Therapeutic goals must be realistic for the patient.

  • Cognitive–behavioral therapy (CBT) and medication have shown to be of special benefit in the treatment of posttraumatic stress disorder (PTSD).

  • Critical incident stress debriefing (CISD) has not been shown to be consistently successful in treating PTSD.

  • Group therapy is the best therapeutic option for those patients with a mild form of PTSD.

  • Sertraline (Zoloft) and paroxetine (Paxil) are the first medications to have received Food and Drug

Survivors' perspectives

Six months after the disaster, interviews were conducted with low-income hurricane survivors in New Orleans, Houston, and Baton Rouge. These interviews revealed that survivors experienced health problems before and that they are now facing even more daunting challenges in obtaining needed health care (Kaiser Family Foundation, 2003). Despite suffering emotional and mental trauma from the storm, with many experiencing anxiety, depression, and trouble sleeping and eating, almost none had received

Diagnosis and Treatment of PTSD

The best way PTSD or any psychiatric disorder is diagnosed is from structured histories with complete physical assessments (Blank, 1994). This process will determine if individuals might be denying or exaggerating their symptoms. The criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000; DSM-IV-TR, 2000) are often used to assist the health care provider in diagnosing PTSD (Table 4).

For the

References (56)

  • A.S. Blank

    Clinical detection, diagnosis, and differential diagnosis of post-traumatic stress disorder

    Psychiatric Clinics of North America

    (1994)
  • R.A. Bryant et al.

    Acute stress disorder: A critical review of diagnostic issues

    Clinical Psychology Review

    (1997)
  • T. Anderson

    PTSD in children and adolescents (Great Cities Institute MC107)

    (2005)
  • M. Basoglu et al.

    Psychological preparedness for trauma as a protective factor in survivors of torture

    Psychological Medicine

    (1997)
  • K.T. Brady

    Posttraumatic stress disorder and comorbidity: Recognizing the many faces of PTSD

    Journal of Clinical Psychiatry

    (1997)
  • Bring New Orleans Back, Health and Social Services Committee Report and Recommendations to the Commission

  • M. Brodie

    Experiences of Hurricane Katrina evacuees in Houston shelters: Implications for future planning

    American Journal of Public Health

    (2006)
  • R.A. Bryant

    Psychosocial approaches of acute stress reactions

    CNS Spectrum

    (2005)
  • J. Cappiello

    Assessing public health and the delivery of care in the wake of Katrina

    (2005)
  • Department of Health and Hospitals

    Hurricane recovery plans; and LPHI, “Mental and Behavioral Health Services Clinic Operations Summary,” on “NOLA Dashboard,” 19 June 2006

    (2006)
  • Disaster Mental Health Response Handbook. NSW Health. State Health Publication No. (CMH) 001450. North Sydney, NSW, Centre for Mental Health.

    (2006)
  • G.S. Everly et al.

    The prevention of work-related post-traumatic stress: The critical incident stress debriefing process (CISD)

  • L.E. Fletcher

    Rebuilding after Katrina: A population-based study of labor and human rights in New Orleans

  • E. Foa et al.

    Social, psychological, and psychiatric interventions following terrorist attacks: Recommendations for practice and research

    Neuropsychopharmacology

    (2005)
  • E. Foa et al.

    Treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies

    (2000)
  • E.B. Foa et al.

    Symptomatology and psychopathology of mental health problems after disaster

    Journal of Clinical Psychiatry

    (2006)
  • M.J. Friedman

    Current and future drug treatment for posttraumatic stress disorder patients

    Psychiatric Annals

    (1998)
  • R. Glaser et al.

    Stress-induced immune dysfunction: Implications for health

    Nature Reviews Immunology

    (2005)
  • M. Gray

    Behavioral interventions for recent trauma behavioral modification

    Behavioral Modification

    (2005)
  • J. Hamblen

    PTSD in children and adolescents. United States Department of Veteran Affairs National Center for PTSD

  • K.M. Hertlein et al.

    A systematic research synthesis of EMDR studies: Implementation of the platinum standard

    Trauma Violence Abuse

    (2004)
  • Kaiser Family Foundation

    Louisiana: Health insurance coverage of nonelderly 0–64, States (2003–2004), U.S. (2004)

  • Kaiser Family Foundation

    Louisiana: Health status, 2005

  • R.C. Kessler et al.

    Posttraumatic stress disorder in the National Comorbidity Survey

    Archives of General Psychiatry

    (1995)
  • N. Kitchiner et al.

    The use of EMDR in the treatment of PTSD

    Progress in Neurology and Psychiatry

    (2005)
  • C. Koopman et al.

    When disaster strikes, acute stress disorder may follow

    Journal of Traumatic Stress

    (1995)
  • L. Lamberg

    Katrina survivors strive to reclaim their lives

    Journal of the American Medical Association

    (2006)
  • Cited by (0)

    View full text