Psychopharmacology
Psychotropic drugs are widely used in the treatment of trauma survivors. In fact, many non-English speaking survivors expect their physicians to provide medications for their symptoms within the first visit. An extensive discussion of the proper utilization of medications will soon be presented elsewhere on this website. In general, it must be remembered that dosages of medications and side effects vary among different ethnic and cultural groups. For example, lower dosages of psychotropic drugs can be used in Asians without compromising their therapeutic efficacy. If too high a drug dose is used, it can cause side effects, destroying compliance. Refugee patients also have a tendency to share drugs with family or neighbors, stop medication at first relief of symptoms, as well as fear that the use of therapeutic drugs is “addicting”. In addition, refugee patients often have only partial responses to medications which are not adequately evaluated, resulting in sub-clinical chronic conditions that have not been adequately treated. The use of screening instruments can provide more objective measures of symptom change over time.
Duration and Intensity of Treatment
Highly traumatized refugee patients initially can only tolerate limited discussions of their lives. Scarce resources limit the ability of most staff to provide each patient with a standard one-hour therapy session. Using a brief contact model, therapy must provide continuous weekly support of the patient through which even the most symptomatic refugee patient or trauma survivors can be safely managed as these patients develop less symptoms and a more hopeful attitude toward their lives. Most important, HPRT’s slogan, “a little, a lot, over a long period of time” underscores the need for the staff to maintain a long-term commitment to the trauma survivor. These patients need to be told by the staff that they can be seen indefinitely until their situation improves. This verbal commitment of long-term treatment support by staff to the patient is especially helpful to those survivors who are socially isolated and feel hopeless about their ability to recover from the atrocities they have experienced.
