Psychopathology and Psychological Problems in Patients with Burn Scars

Abstract

Burn injury is often a devastating event with long-term physical and psychosocial effects. Burn scars after deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in body appearance. In addition, the traumatic nature of the burn accident and the painful treatment may induce psychopathological responses. Depression and post-traumatic stress disorder (PTSD), which are prevalent in 13-23% and 13-45% of cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are pre-burn depression and female gender in combination with facial disfigurement. Risk factors related to PTSD are pre-burn depression, type and severity of baseline symptoms, anxiety related to pain, and visibility of burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social problems include difficulties in sexual life and social interactions. Quality of life initially seems to be lower in burn patients compared with the general population. Problems in the mental area are more troublesome than physical problems. Over a period of many years, quality of life was reported to be rather good. Mediating variables such as low social support, emotion and avoidant coping styles, and personality traits such as neuroticism and low extraversion, negatively affect adjustment after burn injury. Few studies of psychological treatments in burn patients are available. From general trauma literature, it is concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors) interventions have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement reprocessing and desensitization are successful. Psychological debriefing aiming to prevent chronic post-trauma reactions has not, thus far, shown a positive effect in burn patients. Treatment of problems in the social area includes cognitive-behavioral therapy, social skills training, and community interventions. Sexual health promotion and counseling may decrease problems in sexual life.In conclusion, psychopathology and psychological problems are identified in a significant minority of burn patients. Symptoms of mood and anxiety disorders (of which PTSD is one) should be the subject of screening in the post-burn phase and treated if indicated. A profile of the patient at risk, based on pre-injury factors such as pre-morbid psychiatric disorder and personality characteristics, peri-traumatic factors and post-burn factors, is presented. Finally, objective characteristics of disfigurement appear to play a minor role, although other factors, such as proneness to shame, body image problems, and lack of self-esteem, may be of significance.

A survey of burn professionals regarding the mental health services available to burn survivors in the United States and United Kingdom

“…In fact, some survivors find that emotional and social adjustment to burn scarring is one of the most challenging aspects of their recovery [2,3]. Frequently experienced psychological and social problems include post-traumatic stress disorder (PTSD), major depression, substance abuse, sleep disturbance, low body image, social anxiety, stigmatization and discrimination [4][5][6][7][8][9].…”

To Study the Prevalence of Psychiatric Symptoms in Patients to Study the Prevalence of Mental Disorder among Study and in Control Group by Using DSM-IV-TR Criteria Attending Burn Plastic Surgery OPD Hamidia Hospital, Bhopal

“…At the time of discharge from hospital four out of 95m patients (4%) were diagnosed with an ongoing major depression. Madianos et al (66) , face disfigurement was significantly associated with the presence of psychiatric morbidity, at least during acute hospitalization. In a review by Baur (76) comprising studies between 1986 and 1996, the prevalence rates of PTSD in adult burn populations varied between 31% and 45%.…”

“…Using the SCID-Imethodology, Fauerbach et al (21) reported a prevalence of 8% at discharge from hospital and 20% at the 12-month follow up. Madianor (66) who reported a prevalence rata of 18% within the 1 st month post burn and 20% at the 12-month follow-up. In a study from Tabassum Alvi et al(2009), high prevalence of depression was seen with 29 (58%) out of 50 patient and similarly high prevalence of anxiety was seen 41 (82%) patients.…”

Study of fractional ablative laser in surgical and post traumatic scar

“…Physically, scars can impede the patient's range of motion, and can cause pain, dysesthesia and pruritus [5][6][7]. Patients with severely disfiguring scars may also experience such psychological symptoms such as low self-esteem and feelings of psychosocial isolation [8,9]. Various treatments have been developed to improve the appearance of scars and to address these adverse effects, including silicone gel sheets, pressure garments, corticosteroid therapy, dermabrasion, surgical excision, chemical peels and more recently, laser treatments [7][8][9][10][11].…”

“…Patients with severely disfiguring scars may also experience such psychological symptoms such as low self-esteem and feelings of psychosocial isolation [8,9]. Various treatments have been developed to improve the appearance of scars and to address these adverse effects, including silicone gel sheets, pressure garments, corticosteroid therapy, dermabrasion, surgical excision, chemical peels and more recently, laser treatments [7][8][9][10][11]. While some laser therapies have yielded positive results, others, such as the Nd: YAG and traditional ablative lasers, have actually worsened scar appearance [2,11,12].…”