Guidelines for Psychiatric Care of Torture Survivors

Refugees and asylum seekers who are torture survivors have a high risk of psychiatric disorders. A great deal is known about the biology of these disorders and their treatments. Psychotropic medications can provide rapid improvement in symptoms and therefore need to be initiated early in treatment. All survivors who have positive symptoms should have a full psychiatric evaluation including current history, past psychosocial history, medical history, mental status examination, and a 5-axis diagnosis. There is very strong evidence that associated depression of torture victims may be effectively treated by antidepressant medication. There is good evidence that nightmares and sleep disturbance may be relieved by adrenergic blocking agents, such as clonidine and prazosin. There is some evidence that low doses of an antipsychotic medication, such as risperidone, helps agitation and irritability. There is no evidence that medication can help avoidance and numbing symptoms or prevent exacerbations of symptoms after new trauma.