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Took this from medscape............
Medscape: How widespread is anxiety related to the Iraq war and/or to fears of repercussion with additional terrorist attacks on American soil?
Dr. Riggs: It is not yet clear how widespread anxiety related to the war in Iraq is or will become. I suspect that outside of persons residing in the Middle East, most anxiety will arise from the potential threat of terrorist attacks in the United States or in other countries that are allied or associated with the United States. The probability of such a terrorist attack is raised by the start of the war, but it is not clear how high the threat has become. People's anxiety is likely to be somewhat elevated over the short-term as the war unfolds, but will likely decrease again as it becomes clear how the conflict will play out. However, should an attack occur in the United States or to U.S. interests in other countries, feelings of anxiety will be exacerbated. Similarly, should news from Iraq become more negative ? U.S. casualties, large numbers of civilian casualties, escalation to include more countries, or use of chemical or biological weapons ? I would expect anxiety to increase.
For people who are anxious about the condition of loved ones who are serving in the conflict or who live in the Middle East, anxiety will remain high until specific information regarding the condition of troops and the course of the war become clear. If, as in the Gulf War of 1991, it becomes clear that the Iraqi resistance will be minimal and U.S. combatants sustain minimal casualties, the anxiety of those at home will be reduced. However, should U.S. troops begin to sustain significant casualties or even if they begin to experience significant resistance, anxiety may increase among those with friends or family in combat.
Medscape: Are patients likely to relate their anxiety to their healthcare providers, or should physicians ask about their specific concerns and reactions to perceived threat?
Dr. Riggs: I suspect that patients are not likely to report anxiety related to the war as a problem to healthcare providers. Given the opportunity, they may report concerns or worries, but this is most likely to arise as part of a conversation rather than as a complaint or request for care. The exceptions to this might be people with a pre-existing anxiety disorder who might complain of increased anxiety.
Medscape: What are the warning signs of pathological stress response to war and terrorism?
Dr. Riggs: This soon after the onset of a war, it would be difficult to identify a pathological response. It is normal for people to feel stressed and anxious under such circumstances. Assuming that there are no terrorist attacks and that the war goes generally well, I would expect people to become less anxious and stressed rather quickly. If the anxiety persists for more than three or four weeks in the absence of another tragedy, it might reflect a problem that needs treatment.
Medscape: Do you anticipate an increase in psychogenic symptoms such as headache, neck pain, or gastrointestinal (GI) symptoms? Should physicians modify their usual protocol for evaluation and treatment of these symptoms?
Dr. Riggs: As stress can impact on physical systems leading to symptoms such as headache, muscle pain, GI distress, and sleep disturbance, I would expect an increase in such complaints. I am not sure that physicians should alter their normal approach to these symptoms unless they do not currently consider stress a potential contributing factor. If they do not normally assess stress and anxiety in relation to such symptoms they may wish to begin.
Medscape: How should physicians counsel their patients about coping effectively with anxiety related to war and terrorism?
Dr. Riggs: Most patients will cope well with the stress associated with the onset of hostilities using the strategies they normally use to manage stress. In general, physicians can encourage this as long as the coping strategy is not problematic. If the patient feels that they need additional help, I would recommend some basic strategies such as relaxation techniques and exercise.
Medscape: What are your recommendations for speaking with children about fears related to war and terrorism, and for recognizing when they may need extra support?
Dr. Riggs: It is difficult to lay out specific guidelines for speaking with children as the approach should be different depending on the child's age and developmental status. Children, like adults, are more likely concerned about the potential for attacks at home rather than what is happening in Iraq. However, concerns about events in Iraq are quite likely to occur among the children of those serving in the military. In general, if children are scared or anxious, one can reassure them about their own safety and parents can reinforce the idea that they, as parents, will do everything they can to protect the child. However, I would not recommend trying to convince a child that nothing bad will happen, in general or to them specifically, because if an attack at home does occur the child may feel betrayed.
Medscape: Are there guidelines for when physicians should intervene with recommendations for counseling, psychotropics, or other measures?
Dr. Riggs: There are no strict guidelines for when intervention is required to help patients manage stress related to events such as the war in Iraq. In general, we would expect symptoms to dissipate in the absence of another terrorist attack or significant bad news from the front line. If symptoms persist for more than a few weeks, if they exacerbate pre-existing mental or physical symptoms or if they are severe enough to cause the patient to complain to a physician, I would consider intervening.
Medscape: What do you feel has been the effect of constant media coverage of the war and of terrorism alerts?
Dr. Riggs: The prolonged and constant media coverage probably has many effects. One is to make the general population more aware of what is happening in Iraq, which may increase the sense of stress and anxiety as the war begins. Also, if aspects of the war go badly, for example US casualties, the coverage may increase the sense of stress among those of us at home. Alternatively, if the war progresses well for the US troops, having that information may help alleviate stress. In the aftermath of the incident at the World Trade Towers, some people became "information junkies" watching television coverage for extended periods of time. This probably contributed to increased distress for many of these people.
Took this from medscape............
Medscape: How widespread is anxiety related to the Iraq war and/or to fears of repercussion with additional terrorist attacks on American soil?
Dr. Riggs: It is not yet clear how widespread anxiety related to the war in Iraq is or will become. I suspect that outside of persons residing in the Middle East, most anxiety will arise from the potential threat of terrorist attacks in the United States or in other countries that are allied or associated with the United States. The probability of such a terrorist attack is raised by the start of the war, but it is not clear how high the threat has become. People's anxiety is likely to be somewhat elevated over the short-term as the war unfolds, but will likely decrease again as it becomes clear how the conflict will play out. However, should an attack occur in the United States or to U.S. interests in other countries, feelings of anxiety will be exacerbated. Similarly, should news from Iraq become more negative ? U.S. casualties, large numbers of civilian casualties, escalation to include more countries, or use of chemical or biological weapons ? I would expect anxiety to increase.
For people who are anxious about the condition of loved ones who are serving in the conflict or who live in the Middle East, anxiety will remain high until specific information regarding the condition of troops and the course of the war become clear. If, as in the Gulf War of 1991, it becomes clear that the Iraqi resistance will be minimal and U.S. combatants sustain minimal casualties, the anxiety of those at home will be reduced. However, should U.S. troops begin to sustain significant casualties or even if they begin to experience significant resistance, anxiety may increase among those with friends or family in combat.
Medscape: Are patients likely to relate their anxiety to their healthcare providers, or should physicians ask about their specific concerns and reactions to perceived threat?
Dr. Riggs: I suspect that patients are not likely to report anxiety related to the war as a problem to healthcare providers. Given the opportunity, they may report concerns or worries, but this is most likely to arise as part of a conversation rather than as a complaint or request for care. The exceptions to this might be people with a pre-existing anxiety disorder who might complain of increased anxiety.
Medscape: What are the warning signs of pathological stress response to war and terrorism?
Dr. Riggs: This soon after the onset of a war, it would be difficult to identify a pathological response. It is normal for people to feel stressed and anxious under such circumstances. Assuming that there are no terrorist attacks and that the war goes generally well, I would expect people to become less anxious and stressed rather quickly. If the anxiety persists for more than three or four weeks in the absence of another tragedy, it might reflect a problem that needs treatment.
Medscape: Do you anticipate an increase in psychogenic symptoms such as headache, neck pain, or gastrointestinal (GI) symptoms? Should physicians modify their usual protocol for evaluation and treatment of these symptoms?
Dr. Riggs: As stress can impact on physical systems leading to symptoms such as headache, muscle pain, GI distress, and sleep disturbance, I would expect an increase in such complaints. I am not sure that physicians should alter their normal approach to these symptoms unless they do not currently consider stress a potential contributing factor. If they do not normally assess stress and anxiety in relation to such symptoms they may wish to begin.
Medscape: How should physicians counsel their patients about coping effectively with anxiety related to war and terrorism?
Dr. Riggs: Most patients will cope well with the stress associated with the onset of hostilities using the strategies they normally use to manage stress. In general, physicians can encourage this as long as the coping strategy is not problematic. If the patient feels that they need additional help, I would recommend some basic strategies such as relaxation techniques and exercise.
Medscape: What are your recommendations for speaking with children about fears related to war and terrorism, and for recognizing when they may need extra support?
Dr. Riggs: It is difficult to lay out specific guidelines for speaking with children as the approach should be different depending on the child's age and developmental status. Children, like adults, are more likely concerned about the potential for attacks at home rather than what is happening in Iraq. However, concerns about events in Iraq are quite likely to occur among the children of those serving in the military. In general, if children are scared or anxious, one can reassure them about their own safety and parents can reinforce the idea that they, as parents, will do everything they can to protect the child. However, I would not recommend trying to convince a child that nothing bad will happen, in general or to them specifically, because if an attack at home does occur the child may feel betrayed.
Medscape: Are there guidelines for when physicians should intervene with recommendations for counseling, psychotropics, or other measures?
Dr. Riggs: There are no strict guidelines for when intervention is required to help patients manage stress related to events such as the war in Iraq. In general, we would expect symptoms to dissipate in the absence of another terrorist attack or significant bad news from the front line. If symptoms persist for more than a few weeks, if they exacerbate pre-existing mental or physical symptoms or if they are severe enough to cause the patient to complain to a physician, I would consider intervening.
Medscape: What do you feel has been the effect of constant media coverage of the war and of terrorism alerts?
Dr. Riggs: The prolonged and constant media coverage probably has many effects. One is to make the general population more aware of what is happening in Iraq, which may increase the sense of stress and anxiety as the war begins. Also, if aspects of the war go badly, for example US casualties, the coverage may increase the sense of stress among those of us at home. Alternatively, if the war progresses well for the US troops, having that information may help alleviate stress. In the aftermath of the incident at the World Trade Towers, some people became "information junkies" watching television coverage for extended periods of time. This probably contributed to increased distress for many of these people.
