This article was originally published in Italian Unibadis ..
The arrival of Ukrainian refugees in Italy, especially the arrival of women and children from the cities most affected by the attack, made local medical services the first contact for the diagnosis and care of the psychological consequences of the war. bottom.
Many studies Post-traumatic stress disorder (PTSD), depression, And anxiety among refugees. For example, the 2019 Refugee Mental Health Study provides disturbing epidemiological insights. 10% of refugees fleeing conflict in Nepal show signs of PTSD, 27.5% suffer from depression and 22.9% suffer from anxiety. In all studies conducted on survivors of torture, the rate of depression is over 90%.
Official guidelines
Post-traumatic stress is a type of mental disorder that manifests itself after experiencing a highly traumatic event. PTSD, defined and studied in the United States, especially in the Vietnam War veterans, and subsequently considered in connection with more recent conflicts, can appear in people of all ages. It can also occur in family members, witnesses, and aid workers involved in traumatic events. PTSD can also result from repeated exposure to episodes of violence and debilitation.
Diagnosis of PTSD is by no means easy because it is a complex mental disorder that results from multiple factors, both personal and environmental. This is commonly referred to as “a state of acute stress that appears after exposure to a traumatic event.”
According to experts, among the most common symptoms of war-related trauma are the onset of annoying memory flashbacks, intrusive trauma-related thoughts, and panic attacks. insomnia Night terrors, and social avoidance. For children, elements of regression are observed, such as having to sleep next to their parents.
Studies conducted directly in different areas of the brain have shown that people affected by PTSD produce abnormal levels of hormones that are involved in responding to stress and fear. The area of ​​the brain that causes this reaction is the amygdala. The amygdala activates at the moment of fear and produces molecules that relieve natural pain. In people with PTSD, the production of these molecules can last long after the event is over, causing changes in emotional state. In addition, the levels of neurotransmitters that reach the hippocampus change, affecting memory and learning abilities. These same changes in neurotransmitter levels are the basis of sudden flashbacks.
People with PTSD also undergo changes in blood flow to the brain and structural changes in brain tissue.
Social factors
“The factor that worsens the mental state of Ukrainian refugees is the rate of transition from normal life, like many other Western countries, to a state of war, death and injury,” wrote Dr. Arashjabanbakt. increase. He is an associate professor of psychiatry at Wayne State University in Detroit, Michigan, and an expert in PTSD for war refugees. “In addition, they experience terrible injustice because they do not feel that the democracy and freedom they have fought so hard is at stake and fully supported by their allies. There. “
At the time of writing this article, the World Health Organization estimates that there are 3.6 million Ukrainian refugees. This population has already experienced war and its psychological consequences. According to a 2019 survey, 1.5 million Ukrainian PTSD (27%) and depression (21%) had to leave home after the first Russian invasion in 2014 and a rebellion mainly in the Russian region. ) Was evaluated.
Children are particularly at risk of developing PTSD, as evidenced by studies conducted in Syrian refugees.Occurs with a probability of about 70% Separation anxiety, A state that many workers and volunteers have experienced directly recently. Some children do not accept leaving their parents even if they go to the bathroom or wash themselves. This exacerbates the stress level of adults. Infant trauma also increases the risk of developing physical or mental illness in adulthood, such as depression, chronic pain, heart disease, and diabetes.
War-related trauma also involves epigenetic changes in infectivity, as evidenced by studies of trauma infectivity at the biological level.
Diagnosis and treatment
People with PTSD have difficulty controlling their emotions, causing irritability, sudden anger and emotional confusion, depression and anxiety, and insomnia. They are also determined to avoid actions that remind us of traumatic events. Another common symptom is a feeling of shame as a result of surviving or failing to save others.
Physical symptoms include chest pain, dizziness, gastrointestinal disorders, Migraine, And a weakened immune system. Diagnosis of PTSD can be made according to the National Center of Neurology and Psychiatry (NIMH) if the patient has characteristic symptoms for more than a month from the event that caused the symptoms.
NIMH emphasizes that diagnosis is not always done in a systematic way. Patients with PTSD often receive treatment for physical symptoms only, without considering the big picture.
The American Psychiatric Association (APA) has produced a detailed list of PTSD symptoms. According to APA, these symptoms usually appear within 3 months of trauma, even if stress appears later. Symptoms fall into three well-defined categories:
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Impressive memories. People with PTSD suffer from sudden, vibrant memories with painful emotions and traumatic sensations. From time to time, this experience is so strong that stakeholders feel that traumatic events are recurring.
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Avoidance and paralysis.. Individuals try to avoid contact with people or anything that recalls the traumatic memory. First, the person experiences an emotional state of indifference and separation, diminishes the ability of emotional interactions, and participates only in simple, routine activities. Lack of emotional processing causes anxiety and an accumulation of tension, which can lead to chronic conditions and depression. At the same time, people often experience embarrassment.
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Hypervigilance and hypervigilance.. People behave as if they are constantly threatened. They suddenly react violently, lose concentration, and have memory problems. Sometimes they use alcohol or other medicines to relieve pain. People with PTSD can also lose control of their lives and are therefore at risk of suicidal behavior.
Why do some people go through unharmed and traumatic situations, while others carry scars forever? It correlates not only with the severity of the trauma, but also with biological and genetic factors, as well as previous experience that contributes to improved individual resilience. Another important factor is the rapid and effective treatment of symptoms. It also has implications for personal and financial security.
It is no coincidence that the first guidelines clinicians follow when treating traumatized patients are not strictly medical. Not only do we need to guarantee the financial safety of refugees, but we also need to guarantee the safety of some valuable items (such as souvenirs and pets) that refugees carry. Clinicians are advised to facilitate contact with the patient’s family elsewhere as much as possible. It is appropriate to use a relaxation technique that is compatible with the patient’s cultural approach. Clinicians also check the most common condition of the refugee population. She is advised to constantly check for trauma-related symptoms and listen to the patient. Parents should be allowed to stay close to their children and be well informed, but not overwhelmingly.
There is no consensus on how to treat people with PTSD. If affected people are cared for and helped in their families and communities, and their personal condition makes this possible, the possibility that PTSD can be resolved without specific treatment is ruled out. Is not … However, in general, some treatment is beneficial before the symptoms become chronic.
Pharmacological and psychological treatment may be given. In the latter case, NIMH and APA suggest that cognitive-behavioral therapy, in which patients learn to manage anxiety and depression and correct dangerous behaviors such as releasing their emotions, yields good results. According to these organizations, group therapy and other forms of psychotherapy have also yielded good results. The indicated duration of treatment is usually 6-12 weeks, even if this duration is highly dependent on the individual’s condition, followed by regular follow-up. The involvement of the patient’s family and community is very important.
The National PTSD Center in Washington, DC, operated by the US Department of Veterans Affairs, emphasizes the importance of detailed case-by-case assessments to implement accurate treatment plans. If a patient needs to remain in a crisis situation, such as during a war or domestic violence, first efforts must be made to eliminate the cause of stress before starting treatment.
An important aspect is making the victim aware of the disability. Therefore, treatment should be started after informing patients and their families about the potential for PTSD and how it develops. Recognizing symptoms over the next few weeks and working swiftly to manage and treat them can have a significant impact on the success of treatment.
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