Substance use and misuse in burn patients: Testing the classical hypotheses of the interaction between post-traumatic symptomatology and substance use

The authors aimed to test whether the three classical hypotheses of the interaction between post-traumatic symptomatology and substance use (high risk of trauma exposure, susceptibility for post-traumatic symptomatology, and self-medication of symptoms), may be useful in the understanding of substance use among burn patients. Substance use data (nicotine, alcohol, cannabis, amphetamines, cocaine, opiates, and tranquilizers) and psychopathology measures among burn patients admitted to a burn unit and enrolled in a longitudinal observational study were analyzed. Lifetime substance use information (n = 246) was incorporated to analyses aiming to test the high risk hypothesis. Only patients assessed for psychopathology in a 6-month follow-up (n = 183) were included in prospective analyses testing the susceptibility and self-medication hypotheses. Regarding the high risk hypothesis, results show a higher proportion of heroin and tranquilizer users compared to the general population. Furthermore, in line with the susceptibility hypothesis, higher levels of symptomatology were found in lifetime alcohol, tobacco, and drug users during recovery. The self-medication hypothesis could be tested partially due to the hospital stay cleaning effect, but severity of symptoms was linked to the amount of caffeine, nicotine, alcohol, and cannabis use after discharge. It was found that the 3 classical hypotheses could be used to understand the link between traumatic experiences and substance use explaining different patterns of burn patient's risk for trauma exposure and emergence of symptomatology

Confidencialidad en las historias clínicas informatizadas en salud mental hospitalaria

El registro informatizado de los datos clínicos abre nuevas perspectivas sobre el uso de la información y el ejercicio de preservar el secreto profesional. La definición más ampliamente aceptada de la confidencialidad es la propuesta por Joseph y Oneck: «[ ] confiar información a otra persona con la expectativa de que se mantendrá en secreto». Los colegios profesionales son en quienes se ha delegado la potestad normativa acerca del cuidado del secreto profesional y sus alcances, a través de los códigos deontológicos de cada profesión. Por otra parte, disposiciones legales, como la Constitución Española, y leyes específicas, como la Ley Orgánica de Protección Civil del Derecho al Honor, la Ley Orgánica de Protección de Datos de Carácter Personal o la Ley Básica Reguladora de la Autonomía del Paciente y de Derechos y Obligaciones en Materia de Información y Documentación Clínica también regulan sobre la extensión de esta preservación de la información. También definen en qué circunstancias los profesionales deberían, o no, ofrecer la información relativa a sus pacientes, que inicialmente fue aceptada bajo criterios asistenciales y, por tanto, está sometida a la protección de su confidencialidad

Substance use and misuse in burn patients: testing the classical hypotheses of the interaction between posttraumatic symptomatology and substance use

Background: We aimed to test whether the three classical hypotheses of the interaction between posttraumatic symptomatology and substance use (high risk of trauma exposure, susceptibility for posttraumatic symptomatology, and self-medication of symptoms), may be useful in the understanding of substance use among burn patients. Methods: We analysed substance use data (nicotine, alcohol, cannabis, amphetamines, cocaine, opiates, and tranquilizers) and psychopathology measures among burn patients admitted to a Burns Unit and enrolled in a longitudinal observational study. Lifetime substance use information (n = 246) was incorporated to analyses aiming to test the high risk hypothesis. Only patients assessed for psychopathology in a six months follow-up (n = 183) were included in prospective analyses testing the susceptibility and self-medication hypotheses. Results: Regarding the high risk hypothesis, results show a higher proportion of heroin and tranquilizer users compared to the general population. Furthermore, in line with the susceptibility hypothesis, higher levels of symptomatology were found in lifetime alcohol, tobacco and drug users during recovery. The self-medication hypothesis could be tested partially due to the hospital stay “cleaning” effect, but severity of symptoms was linked to caffeine, nicotine, alcohol and cannabis use after discharge. Conclusions: We found that the three classical hypotheses could be used to understand the link between traumatic experiences and substance use explaining different patterns of burn patient’s risk for trauma exposure and emergence of symptomatology

Prevalence and Predictors of Posttraumatic Stress Symptomatology Among Burn Survivors

Burns can be a traumatic and stressful experience, although each patient may respond in very different ways. Objective: The aim of this study was to explore the variability on Post-traumatic stress disorder and Acute Stress Disorder prevalence, and evaluate the specific weight of different variables on Post-traumatic stress disorder development among adult burn patients. Methods: A systematic review was carried out to explore the prevalence of acute and Post-traumatic stress disorder and identify their predictors. Meta-analytical methods were used to explore the strength of association between Posttraumatic stress disorder and the latter. From an initial pool of 190 studies, 24 were used in the systematic review, and only 19studies could be used for the meta-analysis due to different methodological limitations. Outcomes: The prevalence of Acute Stress Disorder at baseline ranged from 2 to 30% and prevalence of Post-traumatic stress disorder ranged from 3 to 35% at 1 month, 2-40% between 3 and 6 months, 9-45% in the year post-injury and ranged 7-25% more than two years later. Life threat perception was the strongest predictor for Post-traumatic stress disorder occurrence, followed by acute intrusive symptoms and pain associated with burn injuries. Conclusions: Predictive variables identified in this research may be useful in targeting burn patients who are at risk for developing post-traumatic stress symptoms and stress related psychological symptoms

The Fenix II study: A longitudinal study of psychopathology among burn patients

Psychological symptoms are common among burn survivors. However, knowledge about epidemiology and predictors of psychopathology has shown great heterogeneity in this population. The Fenix-II Project was the first epidemiological study on the psychopatho- logical consequences of burns developed in Spain, providing a detailed analysis of the progression of psychological symptoms during the first six months after injury. Three hundred and thirty-three patients were screened and 183 were included in this study. Posttraumatic, depression and anxiety symptoms showed a general decreasing tendency across time. At 6 months, 34 patients showed clinically significant Posttraumatic Stress Disorder (PTSD) symptoms (20.5% of 166 patients reached at 6 months) as assessed with the MINI Neuropsychiatric Interview. Within this group of patients, anxiety, depression and hyperarousal increased at 30 days, and avoidance 90 days after injury. The most accurate predictors of PTSD were found to be being burned in a Motor Vehicle Crash, risk of social exclusion, low body-image adjustment, anterior trunk location of the burn and life threat perception during the burn-shock period. Considering these factors, clinicians may identify patients at risk of PTSD development, allowing an adequate follow up and preventive interventions which may minimize the psychological consequences of burns

The Fenix II Study: A longitudinal study of psychopathology among burn patients

Psychological symptoms are common among burn survivors. However, knowledge about epidemiology and predictors of psychopathology has shown great heterogeneity in this population. The Fenix-II Project was the first epidemiological study on the psychopathological consequences of burn injuries developed in Spain, providing a detailed analysis of the progression of psychological symptoms during the first six months after injury. Three hundred and thirty-three patients were monitored and 183 were included in this study. Posttraumatic, depression and anxiety symptoms showed a general decreasing tendency across time. At 6 months, 34 patients showed clinically significant Posttraumatic Stress Disorder (PTSD) symptoms (20.5% of 166 patients reached at 6 months) as measured with the MINI Neuropsychiatric Interview. Within this group of patients, anxiety, depression and hyperarousal increased at 30 days, and avoidance 90 days after injury. The most accurate predictors of PTSD were found to be being burned in a Motor Vehicle Accident, risk of social exclusion, low body-image adjustment, anterior trunk location of the burn injury and life threat perception during the burn-shock period. Considering these factors, clinicians may identify patients at risk of PTSD development, allowing an adequate follow up and preventive interventions which may minimize the psychological consequences of burn injuries

Psychosocial Factors and Antiepileptic Drug Use Related to Delayed Diagnosis of Refractory Psychogenic Nonepileptic Seizures

OBJECTIVE: We analyzed clinical and psychosocial factors in patients with refractory psychogenic nonepileptic seizures, seeking characteristics that could hasten diagnosis. BACKGROUND: Psychogenic nonepileptic seizures remain a diagnostic challenge. Prognosis is best if patients are treated within 2 years of symptom onset. Psychosocial factors have been shown to provide important information for differential diagnosis. METHODS: Over a year and 1132 consecutive patients, our hospital's Epilepsy Unit suspected 93 patients of having psychogenic nonepileptic seizures and confirmed refractory psychogenic nonepileptic seizures in 67. We referred these patients to our psychiatric consultation unit for detailed diagnostic interviews, and 53 of the patients followed through. Two months after the psychiatric evaluation we gave them a psychiatric intervention, explaining the diagnosis and treating their comorbidities. We also tracked the patients' use of antiepileptic drugs for 3 months, from just before the psychiatric evaluation until a month after they started the intervention. RESULTS: Women, patients with an inadequate primary support group, and patients who had tried many antiepileptic drugs were most likely to have their diagnosis of psychogenic nonepileptic seizures delayed by >2 years after onset. A stepwise logistic regression showed that the 2 best predictors of late diagnosis were lack of availability of a primary support group and patients trying many antiepileptic drugs. CONCLUSIONS: Clinicians evaluating patients with questionable seizures should raise their suspicion of psychogenic nonepileptic seizures especially in female patients with an insufficient primary support group and a history of taking multiple antiepileptic drugs

Trayectorias psicológicas y evolución clínica post-quemaduras

Los accidentes que ocasionan heridas por quemaduras, son considerados acontecimientos traumáticos y producen consecuencias físicas evidentes en las personas afectadas. La sobrevida conseguida a partir del desarrollo de nuevas técnicas médico-quirúrgicas, generó el interés por conocer y tratar las reacciones psicológicas, después de esos incidentes. En la actualidad existen algunos estudios que describen la psicopatología de los pacientes en las Unidades de Quemados, pero son muy escasas las investigaciones de tipo longitudinal. En este trabajo se presentan los resultados de un estudio realizado en la Unidad Especializada de Quemados, del Hospital Universitario Vall d’Hebron. Las características especiales de este trabajo es que presenta los resultados obtenidos en el seguimiento de una muestra de pacientes durante dos años, a partir del ingreso hospitalario. El objetivo principal fue identificar las respuestas post-trauma, de manera de poder identificar a los pacientes de más vulnerabilidad y actuar de forma precoz, para evitar el desarrollo de psicopatología. El eje principal del mismo, fue la aplicación del modelo de G.Bonanno junto al análisis de variables clínicas específicas de esta población médica. El modelo de trayectorias de G.Bonanno, describe cuatro posibles respuestas después de situaciones consideradas traumáticas, desde una perspectiva de evolución temporal: resilientes, crónicas, de respuesta diferida y de recuperación. Entre los resultados obtenidos, el más destacable es la validación del modelo de las cuatro trayectorias en esta población. Y al igual que en otras publicaciones, los pacientes con trayectoria resiliente, son la gran mayoría, siendo en segundo lugar la trayectoria de recuperación. Los grupos con menor frecuencia, son los pacientes con respuestas cronificadas y con respuestas diferidas. Mientras que la variable sexo diferencia las respuestas al inicio, otras variables influyen sobre la evolución, entre ellas el apoyo social y el nivel de estudios. También la calidad de vida mejora globalmente, pero en las mujeres depende del apoyo social y de la autopercepción de los cambios en la imagen corporal. Entre los hombres, influye fundamentalmente el apoyo laboral.Accidents that cause burn injuries are considered traumatic events and produce obvious physical consequences on those affected. Got survival from the development of new medical and surgical techniques, generated the interest to know and treat psychological reactions after these incidents. At present there are few studies describing the psychopathology of patients Burn Units, but very few longitudinal investigations. In this paper, the results of a study conducted at the Specialized Burn Unit, at University Hospital Vall d'Hebron are presented. The special features of this paper is to present the results of a sample of patients studied for two years after hospital admission. The main objective was to identify the post-trauma responses, so as to identify patients most vulnerable and act early, to avoid the development of psychopathology. The main axis thereof, was the application of G.Bonanno model while analyzing specific clinical variables of this medical population. The trajectories model of G.Bonanno describes four possible responses after traumatic situations, considered from the perspective of temporal evolution: resilient, chronic, delayed response and recovery. Among the results, the most notable is the validation of the model of the four paths in this population. And as in other publications, patients with resilient trajectory are the majority, being second recovery trajectory. Groups with less frequency, are patients with chronified responses and delayed responses. While sex difference variable responses at baseline, other variables influence the evolution, including social support and educational level. It also improves the quality of life globally, but in women depends on social support and self-perception of changes in body image. Among men, mainly influences work support