Research notes

Terror’s aftermath tough on psychiatric patients

Patients under psychiatric care on Sept. 11, 2001, were particularly distressed after the day’s terrorist attacks on the World Trade Center and Pentagon.

The conclusion is based on a new Brown study. The researchers surveyed 221 psychiatric patients and 87 medical patients at outpatient facilities at Rhode Island Hospital two to three weeks following Sept. 11. They found that 33 percent of psychiatric patients compared to 13 percent of medical patients reported significant symptoms (except for duration of at least one month) of post-traumatic stress disorder (PTSD).

However, no differences were found between the patient groups in learning about the attacks or in personal involvement with its victims or survivors.

“We needed data to back up the belief that psychiatric patients are more vulnerable,” said lead investigator Laurel Franklin, research fellow in the Department of Psychiatry and Human Behavior.

The attacks led to speculation by mental health groups about the vulnerability of psychiatric patients to psychological distress. Studies of people indirectly exposed to traumatic events have shown greater stress-related symptoms in individuals who saw themselves as similar to the victims, saw themselves as potential victims, or viewed the event as highly personal.

Trauma-related symptoms may include thinking and/or dreaming about the attacks, avoiding reminders of them, and irritability following the attacks. Overall 28 percent of those surveyed reported experiencing such symptoms. The psychiatric patients had a range of diagnoses, including major depression, mood disorders, non-PTSD anxiety and other conditions.

Additional hypotheses as to why psychiatric patients may be at increased risk to developing PTSD symptoms include deficits in coping skills, deficits in social support, poor psychological resiliency, biological vulnerability, or an increased willingness to report psychiatric symptoms, said Franklin

“It is also important to note that medical patients reported some significant psychological reactions and significant stress symptoms,” she said. “Our suggestion to doctors is to talk with all patients about the Sept. 11 terrorist attacks whether or not those patients say they are experiencing distressing symptoms. In particular be sensitive to the effect of these tragedies on psychiatric patients.”

Franklin presented the findings May 20 during the annual meeting of the American Psychiatric Association. Study co-authors are Diane Young, clinical assistant professor of psychiatry and human behavior, and Mark Zimmerman, M.D., associate professor of psychiatry and human behavior and director of outpatient psychiatry at Rhode Island Hospital. – Scott J. Turner

Home is where you kick the habit

A new stop-smoking program employs the Visiting Nurses Association of Rhode Island (VNA of RI) to counsel homebound, medically ill smokers to kick the habit.

Typically these patients lack access to treatment or don't seek treatment on their own, said project leader Belinda Borrelli, assistant professor of psychiatry and human behavior.

To help patients quit smoking and decrease health risks, the VNA-based effort provides brief, tailored behavioral intervention in the form of support, state-of-the-art treatment and follow-up care. Previous research has shown these methods are practical and cost-effective.

"Underlying these methods is the understanding that behavioral change for smokers takes a long time and that it is typical for smokers to be ambivalent during that period of change,” Borrelli said. "The nurses are empathetic to that ambivalence and are trained to work with it and either help those who want to quit or motivate those who are not ready to quit move toward that goal."