Medical Approach to the Management of Traumatized Refugees

Abstract

Refugees are a highly traumatized and culturally diverse group of patients who present many clinical challenges. Refugees have a high prevalence of traumas from torture, ethnic cleansing, and the effects of long civil wars. The most common diagnoses associated with the effects of such traumas are posttraumatic stress disorder (PTSD) or PTSD with comorbid depression; however, psychosis and neurocognitive disorders are also common. For those with PTSD, a suggested treatment approach is long-term supportive psychotherapy with drug treatment directed at reducing the most disruptive symptoms, such as insomnia, nightmares, and irritability or psychosis. The author recommends a sedative tricyclic antidepressant, clonidine or prazosin, and aripiprazole as a useful combination of medications to provide rapid relief. In addition to PTSD, long-term studies indicate a high prevalence of diabetes and hypertension in traumatized refugees. It is therefore important to perform a thorough evaluation for these disorders that includes the measurement of blood pressure and a blood test for diabetes. When managed with such a medical approach, refugees are generally accepting of psychiatric treatment and can obtain relief from the symptoms associated with the massive trauma and losses they have experienced.

Posttraumatic Stress Disorder and Related Disorders among Female Yazidi Refugees following Islamic State of Iraq and Syria Attacks—A Case Series and Mini-Review

“…Refugees are a highly traumatized group of patients who present many clinical challenges, partly because many have experienced trauma related to long civil wars, torture, and ethnic cleansing The diagnosis commonly associated with the initial effects of trauma is PTSD with or without comorbid depression; however, psychosis and neurocognitive disorders are also prevalent ( 49 ). Our adult case series both confirms and extends earlier research showing that Yazidi refugee children and adolescents do not just suffer from PTSD but from various other problems such as ADs ( 8 , 50 ).…”

“…It is possible that the evaluation process itself may have a beneficial effect on survivors’ emotional well-being, e.g., by helping the survivor understand the necessity of telling her story, illuminating the often poorly understood link between ongoing emotional suffering and past torture, strengthening the development of cognitive and emotional control, and healing the wounds of fear, humiliation, marginalization, and mistrust ( 56 ). Long-term studies indicate that, in addition to mental disorders, medical disorders such as diabetes and hypertension are also prevalent in traumatized refugees and so it is important that they receive a thorough medical evaluation that includes, e.g., the measurement of blood pressure and diabetes testing ( 49 ).…”

“…Future research should address the aforementioned evidence gaps, involve larger samples wherever possible ( 4 ) and, among others, explore the correlating neurobiological backgrounds ( 73 ). Refugees are generally accepting psychiatric treatment if it is wisely chosen and managed, e.g., through individual evaluation and personalized treatment plans, and it can give them relief from symptoms associated with the massive trauma they have experienced ( 49 ).…”

Individual, collective, and transgenerational traumatization in the Yazidi

“…The concept of post-traumatic stress disorder can be applied to all ethnic groups. Yet, the different notions of health and/or illness as well as cultural or medical treatment traditions when dealing with traumatic experiences require different concepts or therapeutic modifications [ 13 – 16 ].…”

Survival after Sexual Violence and Genocide: Trauma and Healing for Yazidi Women in Northern Iraq

“…[68]. Germany accepted 1000 very physically ill and mentally traumatized Yazidi women and children for integrated care as part of a special quota project to support 2500 women and children who had been held hostage by ISIS[53].These integrated care interventions aim to heal the trauma of humiliation and bodily invasion by giving women platforms and allowing them to tell their stories [69].…”