Primary intervention for memory structuring and meaning acquisition (PIMSMA): Study of a mental health first-aid intervention in the ED with injured survivors of suicide bombing attacks

Abstract

Objective: To assess the impact of a structured intervention, the “primary intervention for memory structuring and meaning acquisition” (PIMSMA) performed randomly in the emergency department with survivors of suicide bombing attacks, on their mediumterm mental health outcome.Design: Follow up and assessment 3-9 months postinjury, and 24 months thereafter.Setting: A tertiary referral general hospital in Tel Aviv, Israel.Participants: Injured survivors of 9 suicide bombing and suicide shooting, men and women aged 16-72 at the time of the incident.Main outcome measures: Diagnosis of posttraumatic stress disorder (PTSD) was made using the Hebrew validated version of the DSM-IV SCID-PTSD rating scale. Other psychiatric symptoms were assessed using the following rating scales: impact of event scale (IES), Hamilton rating scale for depression (HAM-D) and for anxiety (HAM-A), and the Pittsburgh sleep quality index (PSQI). Effects of PIMSMA and PTSD level of psychological distress were analyzed using ANOVA and for change over time for continuous variables repeated measured multivariate analyses was performed, and for categorical variables nonparametric-related sample McNemar. Logistic regression for variable associated with PTSD was performed.Results: Out of 213 eligible injured survivors evacuated to our ER, 129 were retrieved 3-9 months after the incident, and 53 were available for assessment 2 years later. Multivariate analyses for being PTSD vs non-PTSD at the first evaluation, being hospitalized OR = 5.6 (95 percent CI 1.1-27.6) and treated OR = 24.5 (95 percent CI 2.8-200) were the only predictors, with no effect (p = 0.9) for PIMSMA vs other supportive intervention. Predictor for PTSD at the second evaluation were IES severity score at first evaluation OR = 1.1 (95 percent CI 1.04-1.2).Conclusion: The PIMSMA approach is as good as the nonspecific supportive treatment performed routinely in the ED with all survivors of traumatic events of any origin. Further studies are needed to establish valid, evidence-based treatment approaches for the acute aftermath of exposure to severe potentially traumatic events.

A mouse model of blast-induced mild traumatic brain injury

“…Our previous work has utilized a mouse model of mechanical mTBI (Tashlykov et al, 2007; Tashlykov et al, 2009; Zohar et al, 2003) to study neural bases for behavioral alterations. This communication describes findings in a rodent model for low level, open field blast exposures that replicate features of our clinical experience with civilian survivors of suicide bombings (Dolberg et al, 2007; Schreiber et al, 2007). …”

Postdisaster psychological intervention since 9/11.

“…Since 9/11, some innovative interventions have been tested. For example, brief telephone interventions using adapted cognitive–behavioral techniques (e.g., relaxation breathing and challenging maladaptive thoughts) have been associated with decreased anxiety and PTSD symptoms postintervention and at three- to four-month follow-up, with some techniques showing gender effects that call for more research (Gega, Marks, & Mataix-Cols, 2004; Gidron et al, 2001, 2007; Greist, Osgood-Hynes, Baer, & Marks, 2000; Mohr, Lutz, Fantuzzo, & Perry, 2000; Schreiber et al, 2007; Somer, Tamir, Maguen, & Litz, 2005). In an uncontrolled study, Difede et al (2007) determined that virtual reality strategies may constitute an effective treatment tool for enhancing exposure therapy for disaster workers with PTSD and may be especially useful for those who cannot engage in imaginal exposure therapy.…”

A decrease in psychiatric consultations at the emergency room and inpatient wards of a large general hospital in Israel during the SARS-CoV-2 (COVID-19) pandemic

“…The Tel Aviv Sourasky Medical Center (TASMC) is a 1500-bed university-affiliated institution and the main hospital of the city of Tel Aviv. It has standing protocols for contending with a variety of mass casualty threats, including those of war, terror attacks and chemical and biological threats [ [1] , [2] , [3] ]. However, we had no means to assess the scope of psychiatric referrals and interventions needed in the emergency room (ER) when the present large-scale SARS-CoV-2 (Covid-19) pandemic hit Israel towards the end of January 2020 [ 4 , 5 ].…”