A study of psychiatric comorbidity after traumatic limb amputation: A neglected entity

Abstract

Background:Amputation following trauma is emerging as a major health burden on the medical services and on the families and the society as well. Loss of limbs causes inability to support self and the family that further leads to various psychiatric disorders in many patients. Therefore, the present study is planned to explore psychiatric comorbidity in patients with amputation following trauma.Materials and Methods:Fifty-nine amputees were recruited by consecutive sampling within 6-month period from amputation clinic of a tertiary care hospital. All participants were interviewed on a semi-structured pro forma of sociodemographic and amputation-related parameters and assessed on psychiatric comorbidity using Mini-International Neuropsychiatric Interview scale.Results:Majority of the patients were male (88.1%) and belonged to younger age group of 16–30 years (71.2%). Approximately, 97% of patients had single-limb amputation (96.6), predominantly right limb (55.9%). Lower limb amputation was noted in 79.7% of participants. Motor vehicle accident was the most common mode of injury followed by railway track injury and others. The most common psychiatric comorbidities in our sample were major depressive disorder (71.2%), suicidality (30.5%), and posttraumatic stress disorder (PTSD) (20.3%). PTSD was positively correlated with phantom sensation (rs = 0.295, P = 0.05) and phantom pain (rs = 0.279, P < 0.05).Conclusion:A substantial proportion of amputees had alarming sign of depression, suicidal ideation, and PTSD. Thus, there is a need to form liaison between surgical treatment providers and psychiatrists and psychologists to manage psychiatric comorbidity in amputees.

Association Between Osseointegration of Lower Extremity Amputation and Mortality Among Adults

“…Pierce et al highlighted several associated risks among individuals who have undergone amputation: unemployment, substance abuse, additional surgical procedures, chronic pain, and mobility problems associated with prosthesis sockets. The rate of suicidal ideation among these patients varies and depends on many factors, but it has been estimated to be at 15% to 30% . A full discussion of mental health and suicidal ideation among this population far exceeds the scope of this article, but some points are common and noteworthy.…”

“…The rate of suicidal ideation among these patients varies and depends on many factors, but it has been estimated to be at 15% to 30%. 35,36 A full discussion of mental health and suicidal ideation among this population far exceeds the scope of this article, but some points are common and noteworthy. Individuals who have undergone amputation rely on caregivers, particularly in the immediate postoperative and early rehabilitation periods.…”

Outcomes of Total Knee Arthroplasty with a Prior Contralateral Above-Knee Amputation: A Report of 10 Cases

“…Comorbidities such as renal disease, atherosclerosis, and diabetic neuropathy have been reported to be independent predictors of subsequent contralateral lower extremity amputations when present during a nontraumatic, nontumor lower extremity amputation [ 16 ], suggesting a higher incidence of functionally limiting pathology in the intact extremity in patients with these comorbidities. Furthermore, amputees have been shown to have an increased incidence of psychiatric comorbidities such as psychiatric disability and depression, which are known risk factors for adversely affecting pain and function after TKA [ 17 , 18 ]. Therefore, comorbidities may predict long-term outcomes and function with continued health deterioration in this population.…”

Radicalizing realist legitimacy

“…As Paul Sagar argues, James Scott's influential study of oppressed constituencies provides substantial historical evidence suggesting they are normally fully cognizant of their situation. 31 Far from being 'happily oppressed', they acknowledge that they are treated substantially unjustly but develop ways of communicating this acknowledgement in such a way that is concealed from their oppressors. This way, they maintain a kind of dignity among their peers, while avoiding possible violent retribution from their oppressors.…”