Guantanamo Bay, Cuba 1996: psychiatric services to Cuban migrants in the final days of Operation Sea Signal.

Conditions during the final days of Operation Sea Signal in Guantanamo Bay, Cuba, presented a unique challenge for the U.S. Naval Hospital psychiatry/mental health team. The team was charged with evaluation and treatment of Cuban migrants and with determining suitability for immigration to the United States. Degradation of social support networks appeared to be a factor in the course of psychiatric symptoms. The cases of two Cuban migrant males presenting with psychiatric disorders in the final month of the operation illustrate the complexities of the operation's psychiatric mission. Our focus was on behavioral interventions and social supports rather than definitive pharmacologic management of the underlying psychiatric disorders. Suggestions for management of similar missions in the future are provided.

Acute stress disorder, subsequent posttraumatic stress disorder and depression after a series of typhoons.

From August to November 1992, five typhoons struck the U.S. Pacific island territory of Guam. Three hundred and twenty subjects exposed to all five typhoons participated in a population survey measuring their acute stress symptoms and subsequent diagnoses of posttraumatic stress disorder (PTSD) and depression. A 23-item scale approximating the new DSM-IV diagnosis of acute stress disorder (ASD) was used to classify subjects into three groups based on their symptoms one week after the first typhoon: (1) probable ASD, (2) an early traumatic stress response (ETSR) of fear, intrusion, avoidance, and arousal, without dissociation, and (3) no acute diagnosis. A multi-dimensional measure of PTSD and the Zung Self-Rating Depression Scale were used to assess PTSD and depression 8 months after the first storm. The point prevalence of ASD at one week was 7.2%. An additional 15% of subjects had ETSR. Subjects with probable ASD at one week had significantly increased rates of PTSD and somewhat higher rates of depression at 8 months than those without ASD. In contrast, subjects with ETSR at one week did not have a poorer outcome than those with no acute diagnosis. These findings suggest that ASD is prognostically important, but also indicate that all acute stress symptoms do not have the same discriminative value. In this study, the acute dissociative symptoms of emotional numbing and derealization differentiated highly symptomatic subjects at risk for subsequent psychopathology (ASD) from others who were highly symptomatic at one week, but then had a more benign, posttraumatic course (ETSR).

Fever and survival: the role of serum iron.

1. The effects of bacterial infection and temperature on serum iron levels were investigated in the lizard Dipsosaurus dorsalis. 2. Changes in body temperature from normal (38 degrees C) to febrile (41 degrees C) did not alter serum iron levels. Injection with Aeromonas hydrophila led to a significant reduction in serum iron levels, comparable to that found in mammals. This reduction in serum iron level was independent of the lizard's body temperature. 3. When grown in vitro, A. hydrophila grew equally well at afebrile (38 degrees C) and febrile (41 degrees C) temperatures. When the iron levels of the growth medium were reduced, the bacterial growth was diminished at the febrile temperature but was not significantly affected at the afebrile temperature. 4. The addition of iron supplements to bacterially infected lizards led to an increase in the percent mortality. 5. These results indicate that one of the mechanisms behind the beneficial, or adaptive value of fever in D. dorsalis is the decrease in iron available to the pathogenic micro-organisms.