1. PSYCHOLOGICAL EFFECTS OF LONG TERM EXPOSURE AND RADIATION INJURY Module XX Module XX

2. Module Medical XX - 2 Syllabus l Introduction l Medical consequences of radiation accidents l Psychological consequences of radiation accidents l What is psychological stress caused by the accident? l What can we do about stress? l Management of psychological effects l Summary

3. Module Medical XX - 3 Introduction l Importance of psychological impact of radiation accidents underestimated in past l Psychosocial effects may far outnumber any direct health effects l Reactions to nuclear and radiological accidents similar l Role of scientific community, and physicians in particular, in influencing public perception of risk - and addressing psychological consequences of accidents

4. Module Medical XX - 4 Medical consequences of radiation accidents l Health effects directly related to radiation exposure Deterministic Stochastic l Health effects indirectly related to radiation exposure Caused by accident Caused by intervention

5. Module Medical XX - 5 Health effects directly related to radiation exposure l Not related to awareness of exposure or to subjective perception of risk l Can be prevented or reduced by protective action minimizing public exposure

6. Module Medical XX - 6 Health effects indirectly related to radiation exposure l Can far outnumber any direct effects l Need to be taken into account l Can affect hundreds of thousands l Can last for many years l Do not correlate well with actual exposure but with subjective perception of risk l Protective action to reduce exposure may be counterproductive with regard to such effects

7. Module Medical XX - 7 Why do people fear ionizing radiation? l Unknown threat l Can not be seen or felt l Conflicting information in mass media l Contradictory data from different “scientists” l Use of “radiation theme” in economic and political discussions l Long term consequences of radiation exposure l Lack of education of general public, physicians and other professionals l Social understanding of any situation involving “radiation” is negative

8. Module Medical XX - 8 Psychological effects l Psychological effects include Mental suffering Changes in risk perception Modification in individual and social behaviour

9. Module Medical XX - 9 Psychological effects l 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)

10. Module Medical XX - 10 Severity of psychological reactions l Depends on factors related to accident:  abruptness, intensity, duration, availability of social support, etc. factors related to individual:  experience, personal loss, perception of threat, personal coping ability, etc.

11. Module Medical XX - 11 What is psychological stress caused by accident? l Normal reaction to abnormal event l Unusually strong psychological and emotional reactions which could interfere with ability to function during or after accident l Can become post traumatic stress disorder

12. Module Medical XX - 12 What is psychological stress caused by accident? l New diagnostic entity “chronic environmental stress disorder” proposed l Principal characteristics: apathy, asthenia, diminished interest and “learned helplessness”

13. Module Medical XX - 13 Changes in health behaviour of affected people l Extensive medical examinations (active screening) increase anxiety about current and future effects l Change in illness behaviour and greater diagnostic capability together with vast screening programmes increase disease diagnoses in most organs and systems

14. Module Medical XX - 14 Stress reactions l Early Nausea Muscle tremors Sweating Dizziness Chills Increased heart rate Increased blood pressure Hyperventilation l Late Fatigue Increased use of alcohol and drugs Exaggerated startle response Sleep - related difficulties Physical

15. Module Medical XX - 15 Stress reactions l Early Confusion Difficulty in making decisions Impaired thinking Difficulty problem solving Memory loss Calculation difficulties Difficulty remembering names l Delayed Decreased attention span Poor concentration Memory problems Flashbacks Cognitive

16. Module Medical XX - 16 Stress reactions l Early Anxiety Anger Fear Irritability Guilt Feeling overwhelmed Grief Hopelessness l Delayed Feeling abandoned Resentment Feeling alienation Withdrawal Numbness Depression Emotional

17. Module Medical XX - 17 Psychological problems Late l Continuation of some early problems l Discrimination by other people l Establishment of illness behaviour l Concern about consequences of exposure

18. Module Medical XX - 18 Psychological effects of relocation l Relocation dubious l Negative impact on mental well being l If aimed to reduce risk of stochastic effects: Consider only future avoidable dose Dose already achieved cannot be reduced l Involuntarily relocated people suffer most l Elderly people especially likely to suffer

19. Module Medical XX - 19 What can we do about stress? l Accidents can not be predicted BUT l Psychological reaction to radiation accident could be prevented / mitigated using different methods applied before / during / after accident

20. Module Medical XX - 20 Management of psychological consequences after accident l Response to reduce psychological consequences Medical response Public health follow-up Social assistance Government action guidelines Community accountability

21. Module Medical XX - 21 How to reduce psychological effects l Have ongoing information programme l Give clear, simple and timely advice l Provide consistent advice and assessment (one official point) l Use international guidance l Ensure protective action justified l Correct false information l Consider education and counselling

22. Module Medical XX - 22 Warning population l Timely warning one of most important psychological aspects of dealing with accidents l Provide people with sense of control over situation l Call for active attitude: Searching process Preparation for protective action

23. Module Medical XX - 23 Requirements for warning message l Consistent l Accurate, timely and complete l Clear l Simple l Sufficient l Concrete l Provided through multiply channels l Frequently repeated

24. Module Medical XX - 24 Psychological support in different types of accidents Psychological support is needed for: Accident No YesMedical misadministration in diagnosis and therapy No YesResult of use/misuse of industrial sources No YesLaboratory accidents Not alwaysYesYes, if anyNuclear power satellite re-entry Not alwaysYes Transportation Not alwaysYes Involving lost/stolen sources Yes Criticality Yes Nuclear (reactor) Emergency responders General public Affected victims

25. Module Medical XX - 25 Psychological stress of injured individuals l Patient needs Comfort, relief of symptoms Stability and authoritative support Information Concern Hope Control Stimulation l Patient problems Overly scientific approach Repeated tests, examinations Photographs Reactions of others Too many “experts” Too much media attention

26. Module Medical XX - 26 Medical staff problems l Fear / anxiety l Isolation by others l Lack of knowledge (medical treatment, long term effects, etc.) l New experience: Interactions with “experts,” public officials, reporters, etc. Loss of autonomy (activities may be monitored/managed by authorities)

27. Module Medical XX - 27 Mitigation of psychological consequences l One of the functional requirements l Applicable for all planning categories l Should be performed by facility, local or national level of response Depending on planning category

28. Module Medical XX - 28 Mitigation of psychological consequences l Establish written process for justifying, optimizing and authorizing different intervention or action levels following event for longer term protective action 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

29. Module Medical XX - 29 Mitigation of psychological consequences l Establish capability for addressing public concerns and reactions during actual or perceived nuclear or radiological emergency

30. Module Medical XX - 30 Mitigation of psychological consequences l Ensure that affected people perceive, understand, believe, personalize, and respond to warning

31. Module Medical XX - 31 Mitigation of psychological consequences l 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)

32. Module Medical XX - 32 Mitigation of psychological consequences l 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

33. Module Medical XX - 33 Summary l Psychological effects – more important in current situation l What is stress caused by accident? l What can we do about stress? l Management of psychological effects l Psychological support in different types of accidents l Mitigation of psychological consequences