Transcript PSYCHOLOGICAL EFFECTS OF LONG TERM EXPOSURE AND RADIATION INJURY Module XX Syllabus        Module Medical XX Introduction Medical consequences of radiation accidents Psychological consequences of radiation accidents What is psychological stress.

PSYCHOLOGICAL EFFECTS OF
LONG TERM EXPOSURE AND
RADIATION INJURY
Module XX
Syllabus
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Module Medical XX
Introduction
Medical consequences of radiation
accidents
Psychological consequences of radiation
accidents
What is psychological stress caused by
the accident?
What can we do about stress?
Management of psychological effects
Summary
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Introduction
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Importance of psychological impact of radiation
accidents underestimated in past
Psychosocial effects may far outnumber any
direct health effects
Reactions to nuclear and radiological accidents
similar
Role of scientific community, and physicians in
particular, in influencing public perception of risk and addressing psychological consequences of
accidents
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Medical consequences of
radiation accidents
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Health effects directly related to radiation
exposure
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Health effects indirectly related to
radiation exposure
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Deterministic
Stochastic
Caused by accident
Caused by intervention
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Health effects directly related
to radiation exposure
 Not
related to awareness of exposure
or to subjective perception of risk
 Can
be prevented or reduced by
protective action minimizing public
exposure
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Health effects indirectly
related to radiation exposure
Can far outnumber any direct effects
 Need to be taken into account
 Can affect hundreds of thousands
 Can last for many years
 Do not correlate well with actual exposure
but with subjective perception of risk
 Protective action to reduce exposure may
be counterproductive with regard to such
effects
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Why do people fear
ionizing radiation?
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Unknown threat
Can not be seen or felt
Conflicting information in mass media
Contradictory data from different
“scientists”
Use of “radiation theme” in economic and
political discussions
Long term consequences of radiation
exposure
Lack of education of general public,
physicians and other professionals
Social understanding of any situation
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Psychological effects
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Psychological effects include
Mental suffering
 Changes in risk perception
 Modification in individual and social
behaviour
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Psychological effects
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Major accidents (Chernobyl, TMI, Goiânia)
show that affected people
believe health threatened
 doubt reports about accident and resulting
radiation doses
 get life style modified
 have somatic complains
 abuse drugs (alcohol, tranquilizers, sleeping
pills)
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Severity of psychological
reactions
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Depends on
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factors related to accident:
 abruptness,
intensity, duration, availability of social
support, etc.
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factors related to individual:
 experience,
personal loss, perception of threat,
personal coping ability, etc.
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What is psychological stress
caused by accident?
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Normal reaction to abnormal event
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Unusually strong psychological and
emotional reactions which could interfere
with ability to function during or after
accident
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Can become post traumatic stress
disorder
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What is psychological stress
caused by accident?
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New diagnostic entity “chronic
environmental stress disorder” proposed
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Principal characteristics:
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apathy, asthenia, diminished interest and “learned
helplessness”
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Changes in health behaviour
of affected people
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Extensive medical examinations
(active screening) increase anxiety
about current and future effects
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Change in illness behaviour and
greater diagnostic capability together
with vast screening programmes
increase disease diagnoses in most
organs and systems
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Stress reactions
Physical
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Early
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Nausea
Muscle tremors
Sweating
Dizziness
Chills
Increased heart rate
Increased blood
pressure
Hyperventilation
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Late
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Fatigue
Increased use of
alcohol and drugs
Exaggerated startle
response
Sleep - related
difficulties
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Stress reactions
Cognitive
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Early
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Confusion
Difficulty in making decisions
Impaired thinking
Difficulty problem solving
Memory loss
Calculation difficulties
Difficulty remembering names
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Delayed
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Decreased attention
span
Poor concentration
Memory problems
Flashbacks
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Stress reactions
Emotional
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Early
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Anxiety
Anger
Fear
Irritability
Guilt
Feeling overwhelmed
Grief
Hopelessness
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Delayed
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Feeling abandoned
Resentment
Feeling alienation
Withdrawal
Numbness
Depression
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Psychological problems
Late
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Continuation of some early problems
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Discrimination by other people
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Establishment of illness behaviour
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Concern about consequences of
exposure
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Psychological effects of
relocation
Relocation dubious
 Negative impact on mental well being
 If aimed to reduce risk of stochastic
effects:
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Consider only future avoidable dose
 Dose already achieved cannot be reduced
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Involuntarily relocated people suffer most
 Elderly people especially likely to suffer
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What can we do about
stress?
Accidents can not be predicted
BUT
 Psychological reaction to radiation
accident could be
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prevented / mitigated
using different methods applied
before / during / after accident
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Management of psychological
consequences after accident
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Response to reduce psychological
consequences
Medical response
 Public health follow-up
 Social assistance
 Government action guidelines
 Community accountability
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How to reduce
psychological effects
Have ongoing information programme
 Give clear, simple and timely advice
 Provide consistent advice and assessment
(one official point)
 Use international guidance
 Ensure protective action justified
 Correct false information
 Consider education and counselling
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Warning population
Timely warning one of most important
psychological aspects of dealing with
accidents
 Provide people with sense of control over
situation
 Call for active attitude:
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Searching process
 Preparation for protective action
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Requirements for
warning message
Consistent
 Accurate, timely and complete
 Clear
 Simple
 Sufficient
 Concrete
 Provided through multiply channels
 Frequently repeated
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Psychological support in
different types of accidents
Accident
Psychological support is
needed for:
Affected
victims
Yes
General
public
Yes
Emergency
responders
Yes
Criticality
Yes
Yes
Yes
Involving lost/stolen sources
Yes
Yes
Not always
Transportation
Yes
Yes
Not always
Yes, if any
Yes
Not always
Laboratory accidents
Yes
No
No
Result of use/misuse of
industrial sources
Medical misadministration in
diagnosis and therapy
Yes
No
No
Yes
No
No
Nuclear (reactor)
Nuclear power satellite re-entry
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Psychological stress of
injured individuals
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Patient needs
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Comfort, relief of
symptoms
Stability and
authoritative support
Information
Concern
Hope
Control
Stimulation
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Patient problems
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Overly scientific
approach
Repeated tests,
examinations
Photographs
Reactions of others
Too many “experts”
Too much media
attention
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Medical staff problems
Fear / anxiety
 Isolation by others
 Lack of knowledge (medical treatment,
long term effects, etc.)
 New experience:
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Interactions with “experts,” public officials,
reporters, etc.
 Loss of autonomy (activities may be
monitored/managed by authorities)
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Mitigation of psychological
consequences
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One of the functional requirements
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Applicable for all planning categories
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Should be performed by facility, local or
national level of response
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Depending on planning category
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Mitigation of psychological
consequences
 Establish
written process for
justifying, optimizing and
authorizing different intervention
or action levels following event
for longer term protective action
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Consider effects on mental health,
economic conditions, employment, long
term needs for social welfare and other
non-radiological impact caused by
taking longer term protective action
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Mitigation of psychological
consequences
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Establish capability for addressing
public concerns and reactions during
actual or perceived nuclear or
radiological emergency
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Mitigation of psychological
consequences
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Ensure that affected people perceive,
understand, believe, personalize, and
respond to warning
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Mitigation of psychological
consequences
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Before long term monitoring or other
activities are conducted in areas designed
for unrestricted use after accident, ensure
public understand reasons for these
continuing activities (e.g. scientific
investigations of behaviour of
radioisotopes in environment)
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Mitigation of psychological
consequences
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Establish process to develop system of
compensation for emergency workers and
public following emergency after careful
consideration of benefits and long term
social, psychological and economic
effects
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Summary
Psychological effects – more important in
current situation
 What is stress caused by accident?
 What can we do about stress?
 Management of psychological effects
 Psychological support in different types of
accidents
 Mitigation of psychological consequences
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