Psychiatric treatment of severly burned adults

An exploratory study of pain, coping, and depressed mood following burn injury

The objectives of this descriptive study were to examine pain, coping, and depressed mood in patients with moderate to severe burn injuries. A secondary objective was to evaluate the appropriateness of prescribed analgesic regimens. Subjects (N = 31) reported high levels of pain intensity, pain distress, and depressed mood, and used many strategies to cope with their pain. The tendency to think the worst or catastrophize was positively associated with pain intensity (r = 0.51; P < .01) and pain distress (r = 0.42; P < 0.05). Depressed mood was significantly correlated with pain intensity (r = 0.45; P < 0.05), but not pain distress. A personal belief in control over pain (r = -0.45; P < 0.05) and one's ability to decrease pain (r = -0.48; P < 0.01) were negatively associated with depressed mood. Significant relationships also were found between severity of injury and depressed mood (r = 0.43; P < 0.05), and between surgical intensity and pain distress (r = 0.36; P < 0.05). Based on the pain management index, 91% of the routine and 84% of the procedural pain regimens were in the acceptable range. Generally, analgesics were prescribed on an "as needed" basis and subjects seldom received more than 50% of their prescribed dose. The finding that pain and depressed mood remain significant problems for burn-injured patients suggests that thoughtful pain assessment, pain management, and quality review are needed.

Burn management in children

Pediatric burn care consists of a coordinated program to provide acute physiological support during the shock phase, prompt wound closure, aggressive ancillary care, and appropriate postdischarge management. Adherence to predetermined burn care guidelines will produce the most optimal results in survival and return to function.

Emotional aspects in burn patients: usage of a health state classification system

The expression of emotional problems and psychological disorders in burn patients may range from minimal reactions of fear and anxiety to, in rare instances, severe psychotic behaviour. Many factors contribute to the psychological problems in burn patients. We have employed a Health State Classification System in 265 burn patients to determine which factors contribute to these emotional disturbances.

Elephant People: The Phenomena of Social Withdrawal and Self-Imposed Isolation of People Dying with AIDS

The phenomena of self-initiated isolation and social withdrawal of people dying from AIDS is described and explained in the context of its irony and detriment to the patients' well being, minimizing access to social support resources. The psychological and the therapeutic relevance of social support during the critical transition phase is explored. Recommendations for curbing the phenomena of self-imposed social death in PWAs, as well as suggestions for future research on the value of psychosocial support to the PWA's well being during the transition phase, are also discussed.

The burn victim--a review of psychosocial issues

Over recent decades, with the introduction of specialist units for the treatment of severely burnt patients, a volume of literature on psychological aspects of burns has accumulated, containing anecdote and opinion as well as research of varying quality. This literature is reviewed under three headings: epidemiology and prevention; reactions following acute hospitalisation; and long-term outcomes. Adverse personal, health, and social factors may predispose to burn injury. In hospital, the psychological course of the patient proceeds in stages that can be related to the well-recognised reactions to loss and overwhelming stress, modified by the major physiological insult. Reactions of family and staff are of great significance. In the longer term, rehabilitation prospects are generally good, although recovery may be complicated by a gradually subsiding level of neurotic symptoms and relationship difficulties.

Discussion groups for chronic hemodialysis patients and their families

The family as well as the patient undergoes many psychological stresses in the adjustment to end stage renal disease and maintenance hemodialysis. Despite the apparent need for psychological support services for families, few are offered. Renal social workers have found it difficult to elicit interest in discussion groups for families dealing with problems associated with dialysis. This report presents two discussion groups that were recruited and conducted for dialysis patients and their families. The process and development of the two groups are described, and recommendations are given for conducting multiple-family groups as an adjunct to the biologic treatment of severe long-term illness.

A personal adaptation group for burn injured hospital patients

This article describes the first reported psychotherapeutic group for hospitalized burn patients. The rationale for the group is based upon an adaptive coping model. Issues typically dealt with in groups include feelings toward hospital staff, emotional reactions to treatments, and feelings concerning their burn injury. Body image and resultant self-esteem issues are a major theme. The importance of clinical services for burn injured patients and the involvement of mental health professionals in service delivery is emphasized.

Behavioral observation and analysis of pain behavior in critically burned patients

Although patients who have been critically burned obviously suffer significant levels of pain, they also appear to engage in adaptive behaviors with greater frequency than previously documented. Observers trained in the use of an objective, reliable coding system recorded 5 min samples of behavior during treatment procedures. Typically, patients report severe pain during procedures such as wound debridement, dressing changes, physical therapy, etc., and many dread having to undergo them. The coding system allowed for the concurrent recording of staff reactions to patients' pain behaviors, well-being behaviors (discussing progress, future plans, complying with therapeutic instructions, etc.), criticism and praise of the hospital and the staff, and focusing on other patient's problems. Results indicate that: (1) patients exhibit a significant higher frequency of psychological and somatic well-being than psychological and somatic complains, even in the context of an intense, typically painful, treatment procedure; (2) differences in the frequency of pain behaviors and of well-beings behaviors were not systematically related to the expected burn-related variables, e.g., total body surface area burned, site of burn, days since onset; and (3) nursing staff who have not received specific training in the behavioral analysis and treatment of pain respond to most patient behaviors with positive reinforcement regardless of whether such reinforcement is therapeutically indicated. Behavioral implications for the theory and treatment of pain are discussed.

Emotional problems of the severely burned patient

In this article we have tried to present an overview of some of the common emotional responses and problems seen in severely burned patients. We have suggested that first consideration be given to learning what sort of person the patient is and becoming familiar with what the burned patient experiences. General preventive measures were suggested that included establishment of clear communication between patient and staff so that the patient has the best understanding possible of the nature of the injury and the treatment, allowing the patients as much control as possible in the treatment process, and providing adequate analgesic medication. We have described what may be observed when patients become anxious, fearful, angry, depressed, regressed, and psychotic, and have attempted to facilitate an understanding of what is occurring in patients showing these responses. Some common reactions of medical and nursing staff to the various emotional reactions were mentioned. In the final section we attempted to deal briefly with the responses of children and measures that can be taken with them. Most of the therapeutic measures suggested can be carried out by nonpsychiatric personnel if they are able to be empathetic and in touch with their own reactions to patients and to utilized common sense.