Katz Craig L, Jutras-Aswad Didier, Kiliman Marta, Pilatowicz Iwona, Akerele Evaristo, Marrone Kathryn, Ozbay Fatih
Mount Sinai School of Medicine, New York, NY 10029, USA.
J Psychiatr Pract. 2012 Jan;18(1):55-63. doi: 10.1097/01.pra.0000410989.46346.14.
More than 35,000 individuals are estimated to have responded to the World Trade Center (WTC) site following the terrorist attacks of September 11, 2001. The federally funded WTC Medical Monitoring and Treatment Program (WTCMMTP) provides medical monitoring and occupational medicine treatment as well as counseling regarding entitlements and benefits to the workers and volunteers who participated in the WTC response. A major component of the WTCMMTP is the WTC Mental Health Program (WTCMHP), which offers annual mental health assessments and ongoing treatment for those found to have 9/11 associated mental health problems. In the program's 9.5 years of evaluating and treating mental health problems in thousands of Ground Zero responders, diversity in multiple domains (e.g., gender, family, profession and employment status, state of physical health, cultural identity, and immigration status) has been a hallmark of the population served by the program. To illustrate the types of issues that arise in treating this diverse patient population, the authors first present a representative case involving a Polish asbestos worker with an alcohol use disorder. They then discuss how accepted alcohol treatment modalities can and often must be modified in providing psychiatric treatment to Polish responders, in particular, and to foreign-born patients in general. Treatment modalities discussed include cognitive and behavioral therapy, relapse prevention strategies, psychodynamic therapy, motivational approaches, family therapy, group peer support, and pharmacotherapy. Implications for the practice of addiction psychiatry, cultural psychiatry, and disaster psychiatry are discussed.
据估计，在2001年9月11日恐怖袭击事件发生后，有超过35000人对世界贸易中心（WTC）遗址做出了响应。由联邦政府资助的世贸中心医疗监测与治疗项目（WTCMMTP）为参与世贸中心救援行动的工人和志愿者提供医疗监测、职业医学治疗以及有关权益和福利的咨询服务。WTCMMTP的一个主要组成部分是世贸中心心理健康项目（WTCMHP），该项目为那些被发现患有与9·11事件相关心理健康问题的人提供年度心理健康评估和持续治疗。在该项目对数千名世贸中心遗址救援人员进行心理健康问题评估和治疗的9.5年时间里，多个领域（如性别、家庭、职业和就业状况、身体健康状况、文化身份和移民身份）的多样性一直是该项目所服务人群的一个特点。为了说明在治疗这一多样化患者群体时出现的问题类型，作者首先介绍了一个涉及一名患有酒精使用障碍的波兰石棉工人的典型案例。然后，他们讨论了在为波兰救援人员，特别是为一般的外国出生患者提供精神科治疗时，如何以及为何常常必须对公认的酒精治疗方式进行调整。所讨论的治疗方式包括认知行为疗法、预防复发策略、心理动力疗法、动机疗法、家庭疗法、团体同伴支持和药物疗法。文中还讨论了对成瘾精神病学、文化精神病学和灾难精神病学实践的启示。
