After terror, patients see primary care docs first

After a terrorist attack, the majority of mental health patients will first present to a primary care physician, Thomas Rosenthal, MD, professor and chair, family medicine, University at Buffalo told listeners at the AAFP's annual meeting.

"After 9/11, 80% of all PCPs in New York City saw patients with terrorism-related psychosocial complaints. And three-quarters of the time, the PCP will see these patients before a mental health professional will," he said.

Intentional disasters such as terrorist attacks are more stressful than natural disasters and will produce more mental illness, added Rosenthal.

A primary care physician's first job with these mental health patients is to allow them to tell their story. However, do not force patients who do not want to talk. "Not everyone is ready to debrief," Rosenthal said.

Also listen intently without judgment and summarize back to the patient to help with disorientation.

Educate patients about normal responses to trauma and tell them to expect to be affected for 4-6 weeks. Good sleep hygiene is especially important during this period.

"Encourage patients not to drink alcohol. It will help someone fall asleep, but they may not stay asleep," said Dr. Rosenthal. "Intact sleep provides improved resiliency after disasters and facilitates emotional integration of stressful events."

If anxiety is present, educate and medicate the patient. Treatment choices include sedatives and antidepressants. Also, don't hesitate to hospitalize psychotic patients.

Physicians caring for post-terrorist attack patients should be aware that they are vulnerable themselves. "We are at risk for isolation and the toll of emotional burdens. The good news is that doctors tend to be hardy and optimistic," said Dr. Rosenthal.