Background:
The sudden jolt of becoming an amputee brings with it the realization of loss of independence and self-built psychological and physical security. Advances in the field of prosthesis give the individual hope for better future, but the presence of psychological morbidity is a hurdle to be crossed in the road to satisfactory rehabilitation.
Aim:
This study aimed to assess the psychiatric morbidity in amputees and the response to treatment.
Materials and Methods:
One hundred newly amputated soldiers were assessed by means of clinical interview, General Health Questionnaire, Impact of Event Scale, Hospital Anxiety Depression Scale, McGill Pain Questionnaire, and Dallas Pain Questionnaire. Individuals were treated with appropriate medications and psychotherapy, and response to treatment was assessed.
Results:
Psychiatric disorders were diagnosed in 66% including adjustment disorders (40%), depressive episode (20%), and posttraumatic stress disorder (6%). Phantom sensation and phantom pain were noted in 72% and 64% of participants, respectively. More psychiatric disorders and phantom sensation were found in the early months after amputation. Psychiatric morbidity was associated with negative body image, distressing pain, and restriction of activities of daily life. Treatment produced complete remission of symptoms in 65.15% of individuals suffering from psychiatric disorders and statistically significant reduction in the scores of psychiatric rating scales.
Conclusions:
There is a high prevalence of psychiatric morbidity among amputees. Psychiatric treatment produces significant improvement in the psychological well-being of amputees and underlines the need to focus on the psychological rehabilitations of the amputee apart from physical rehabilitation.
Background:Delirium tremens (DT) is a medical emergency. Many cases are treated and discharged from emergency services (ES), after complete or partial resolution of delirium. Few receive comprehensive inpatient addiction treatment (CIAT) after the initial emergency management.Objective:The objective of this study was to compare 6-month outcomes of treatment in alcohol-dependence syndrome (ADS) patients presenting with DT receiving either only emergency care or emergency care along with CIAT.Materials and Methods:In this prospective observational study, all patients of ADS presenting in DT over a 1-year period were followed up for 6 months. Patients who received care only in the emergency services (ES) (111) were compared with patients who received ES followed by CIAT (90). Primary followup measure was regular followup (RFU) at outpatient department, and patients not presenting for RFU received telephonic followup (TFU). Alcohol use status was monitored at 6 months, as per Feuerlein and Küfner criteria.Results:Patients who received both ES and CIAT had better RFU compared to patients treated in the ES alone at 6 months (71/90 vs. 17/111, respectively, P < 0.005). CIAT also resulted in better combined follow-up (RFU and TFU) (85/90 vs. 60/111, respectively, P < 0.005). Compared to ES treatment group alone, ES plus CIAT group had fewer relapses (41/85 vs. 42/60, respectively, P < 0.05). The most common reason for direct discharge from ES was nonavailability of beds for inpatient treatment.Conclusions:Merely emergency treatment of ADS patients presenting with DT does not provide satisfactory treatment outcome with respect to alcohol use. ES treatment followed by CIAT ensures better outcome in the form of fewer relapses and better follow up.
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