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ORIGINAL ARTICLE
Year : 2015  |  Volume : 23  |  Issue : 1  |  Page : 43-49

The impact of antidepressant drugs on the psychological status of the hospitalized burn patients


1 Department of Plastic Surgery, Assiut University, Assiut, Egypt
2 Department of Neuropsychiatry, Sohag University, Sohag, Egypt
3 Department of Neuropsychiatry, Assiut University, Assiut, Egypt
4 Faculty of Nursing, Assiut University, Assiut, Egypt

Date of Web Publication11-Dec-2015

Correspondence Address:
Dr. Mohamed Makboul
Department of Plastic Surgery, Assiut University Hospital, Assiut 71526
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-653X.171648

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  Abstract 

Burn injury is often a devastating event with long-term psychosocial effects. Selective Serotonin Reuptake Inhibitors (SSRIs) antidepressants alleviate depressive symptoms by preventing serotonin that has been released into the brain by nerve cells from being taken back into the cells. This study investigated the impact of antidepressant drugs on the psychological status of hospitalized burn patients. This study was conducted on two equal groups of 60 adult patients in the burn unit at Assiut University Hospital, Egypt. The control group received the hospital routine medical and nursing managements, while the second group received the antidepressant drug after the third day post burn and continued to 6 weeks in addition to the routine medical and nursing managements. Studying the relations among scores of patient cooperation, nurse satisfaction, and levels of depression in the study and control groups showed that, at admission all the patients in both groups suffered from severe depression. From the second to the sixth week, the depression level in the study group changed to normal, the patients were cooperative and the nurses were satisfied.

Keywords: Antidepressants, burned, depression, nurse satisfaction, patient cooperation


How to cite this article:
Abdelhafiz AH, Makboul M, Azab HM, Khalifa H, Mohamed ZA, Ahmed NM, Magboul FR. The impact of antidepressant drugs on the psychological status of the hospitalized burn patients. Indian J Burns 2015;23:43-9

How to cite this URL:
Abdelhafiz AH, Makboul M, Azab HM, Khalifa H, Mohamed ZA, Ahmed NM, Magboul FR. The impact of antidepressant drugs on the psychological status of the hospitalized burn patients. Indian J Burns [serial online] 2015 [cited 2022 May 23];23:43-9. Available from: https://www.ijburns.com/text.asp?2015/23/1/43/171648


  Introduction Top


Burn is one of the serious injuries affecting the patients' psychological status; either during its early management, as a result of the trauma itself and the painful experience during the burn treatment, or because of its disfiguring scars. In literature, depression and posttraumatic stress disorder (PTSD) were found in 13-23% and 13-45% of burn patients, respectively. [1]

Patients who develop PTSD usually have some risk factors like their pre-burn psychological condition, anxiety to pain, site of burn injury, social problems, and others. [2],[3]

Psychological examination of post-burn patients should stress on the risk factors related to PTSD including premorbid psychiatric disorders besides pre-traumatic social factors which have to be managed. Post-burn deformities, lack of self-esteem, and body image problems have a role in developing mood and anxiety disorders including PTSD. [4]

An antidepressant for adult hospitalized burn patients could be necessary to alleviate depression, which is often manifested by biological signs and symptoms like insomnia, agitation, loss of appetite, and constipation. The burn patients are often uncooperative and neglect their physiotherapy. [5] Antidepressant drugs may have an effect on the burn patients' cooperativeness, subjective feelings, and lead to reduction of the biological signs and symptoms of depression, which in turn will improve the health and quality of life of the patients. [6]

Antidepressant drugs which are known as selective serotonin reuptake inhibitors (SSRIs) alleviate depression by preventing serotonin that has been released into the brain by nerve cells from being taken back into the cells. A high concentration of serotonin in the brain gives a feeling of happiness and relaxation, so by preventing serotonin's reabsorption, SSRIs can reduce feelings of sadness and fear. Besides depression, they are also used to treat obsessive-compulsive disorder, panic disorder, phobias, and generalized anxiety disorder. [7]

The SSRIs block the reuptake of serotonin into the nerve terminal of the central nervous system (CNS), thereby enhancing its transmission at the serotonergic synapse. SSRIs do not block the uptake of dopamine or norepinephrine, and they do not block cholinergic and alpha1-adrenergic receptors. [8],[9]

The SSRIs are as effective as tricyclic antidepressants and they do not cause hypotension, sedation, or anticholinergic effects. However, they cause nausea, insomnia, and sexual dysfunction. [10]

Aim of the study

This study investigated the impact of SSRI drug (escitalopram) on the psychological status of hospitalized burn patients.

Study design

Quasi experimental research design has been utilized in this study.


  Patients and Methods Top


This study was conducted in the burn unit at Assiut University Hospital, Assiut, Egypt. The study was done on 60 recently hospitalized adult burn patients, of both genders, who were classified into two groups.

The first group included 30 patients as a control group and the second group included 30 patients which is the study group, who were available and met the following criteria:

Their ages ranged from 18 to 45 years. The burn extent ranged from 15 to 45% of the total body surface area, and the depth of the burn was mixed between the first, second, and third degrees.

Patients with chronic diseases requiring specific therapy as anemia, peptic ulcer or gastrointestinal tract disturbance, cardiac or thyroid disease, liver function disturbance, renal diseases, diabetes mellitus, and pregnancy were excluded from the study.

An official permission was taken from the director of the hospital and head of the burn unit after explaining the nature, design, and the objective of the study and ethical approval for the study was obtained from Faculty of Medicine Research Ethics Committee (REC), Assiut University, Assiut, Egypt.

Patient's verbal and written consent were also obtained from both study and control groups. They were assured about confidentiality and maintenance of their privacy.

The control group did not receive the antidepressant drug, but they received the hospital routine medical and nursing managements in the form of morphine (0.1 mg/kg intravenously every 6 h) for pain management, fluid therapy (Parkland's formula), penicillin G or penicillin V as prophylaxis against infection for the first 5 days then the antibiotic used according to the culture and sensitivity, and fever protocol in the form of paracetamol and nonsteroidal anti-inflammatory drugs.

The second group received the antidepressant drug starting from 3 rd day post burn and continued for 6 consecutive weeks, in addition to the hospital routine medical and nursing managements. Escitalopram was chosen as an antidepressant for this study because it is one of the new SSRIs that is well-tolerated and accepted by the patients.

Four tools were utilized for data collection:

Tool I: Patient physical assessment structured interview schedule

This tool was directed to burn patients. It was conducted by the researchers based on the current national and international review to assess the patient's physical status. It consisted of two parts:

Part (1): Patients sociodemographic data

This part included sociodemographic data of burn patients such as: Age, sex, educational level, marital status, family size, occupation, date of admission, and discharge date.

Part (2): Physical Assessment of burn injury

It included assessment of physical condition and burn injury as: Type, cause, percent, site, depth, and place of burn injury.

Tool II: Beck Depression Scale (BDS)

This scale was developed by Beck et al., 1996. [12] It was designed to evaluate the level of patient's depression, for example, sadness, hopelessness, dissatisfaction, failure, guilty, punishing, disappointing, anhedonia, killing himself, crying, irritating, social isolation, decision making, body image, low effort, sleeping, etc.

The score for each item was collected and their final results in range determine the level of depression [Table 1].
Table 1: Score for depression


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Tools I and II were both used with the control and the study groups. All patients were interviewed at the 1 st day of admission using tool I concerning demographic data, the patient's condition of burn circumstances, burn wound, and presence or absence of physical illness or medical condition requiring specific therapy.

On the 3 rd day of burn onset, the study group patients started antidepressant drug (Escitalopram 10 mg/day orally as single daily dose before sleep) and was continued for 6 weeks.

Beck Depression Scale (tool II) was fulfilled twice weekly for 6 weeks or until the patient's discharge.

Tool III: Assessement of patients' cooperation with the nurses and the nurses' satisfaction

This tool was performed using nurses structured interview schedule which is an Arabic language questionnaire. It included the transfer of the patient from bed to the dressing room, removing the old dressing, shower bath before dressing, cleaning and dressing of the wound, physiotherapy, taking blood samples, feeding the patient, giving the prescribed medications, etc [Table 2]. This assessment was done daily for 2 weeks, for both the control and the study group.
Table 2: Assessment of patients' cooperation


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Tool IV: Antidepressant drug monitoring

It was developed by the researchers to monitor the side effect of antidepressant drug provided for the patients. It included name, dose, route, time, and the possible side effect of the drug (nausea, vomiting, insomnia, diarrhea, etc).

Data was collected and analyzed by computer program (Statistical Package for Social Sciences (SPSS), version 17).

Data was expressed as mean ± standard deviation (SD), number, and percentage. Chi-square test was used to compare data, while t-test was utilized for the comparison between groups. Pearson correlation was done to determine significance between variable in each group.


  Results Top


This study was conducted in the burn unit at Assiut University Hospital, Assiut, Egypt. The study was done on 60 recently hospitalized adult burned patients who were classified into the study and the control groups. Each group included 30 patients.

There was no significant difference between both groups regarding sociodemographic characteristics including gender, age groups, marital status, and employment; which indicate the match between both groups [Table 3].
Table 3: Sociodemographic data for the control and the study groups


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Also no significant difference was detected regarding physical assessment of burn patients including type, cause, percent, site, depth, and place of burn injury (P > 0.05) [Table 4], [Table 5], [Table 6].
Table 4: Etiology of burn


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Table 5: Percentage of burn surface area


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Table 6: Site of burn injury


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As regards the scores of BDS, both groups showed severe degree of depression on admission and on the first follow-up with no significant difference between the study and the control groups (mean ± SD was 55.0 ± 10.34 in the study group and 48.1 ± 12.28 in the control group). While on the second follow-up, there were low significant differences shown between both groups. From the third to the 11 th follow-up, there were high significant differences shown between both groups (the mean ± SD was 10.2 ± 2.14 in the study group and 46.0 ±17.36 in the control group (P-value < 0.00)) [Figure 1] and [Table 7].
Figure 1: Depression score between study and control groups


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Table 7: Means of depression score among patients in the study and control groups throughout the study


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Concerning assessment of the patients' cooperation with the nurses in the 1 st week, no significant difference was detected (mean ± SD at the 3 rd day was 38.0 ± 11.24 for the study group and 36.2 ± 9.75 for the control group). From the 4 th to 7 th day, there were high significant differences (mean ± SD at the 7 th day was 58.0 ± 16.71in the study group and 39.2 ± 14.23 in the control group (P < 0.000)) [Table 8].
Table 8: Patients' cooperation and nurses' satisfaction score in the 1st week

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In relation to the assessment of nurses' satisfaction in the 1 st week of patient's admission, there was no significant differences in first 3 days between both study and control groups (P > 0.05). While from the 4 th to 7 th day, a high significant difference was present (P < 0.000).

Regarding the patients' cooperation during the 2 nd week, the study group patients were more cooperative than the control group. Furthermore, the nurses were more satisfied to deal with the study group patients than with the control group during the same period [Figure 2].
Figure 2: Patients' cooperation and nurses' satisfaction in the 2 nd week


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Throughout the study, the relationship between scores of patient cooperation, nurse satisfaction, and levels of depression in the study and control groups showed that at admission all the patients in both groups suffered from severe depression; therefore, the patients were uncooperative and the nurses were unsatisfied. From the 2 nd to 6 th week, the study group was started with antidepressants, so the level of depression changed from severe to normal. Therefore, the patients were cooperative and the nurses were satisfied. In the control group, the patients were still suffering from severe depression, and were uncooperative and the nurses were unsatisfied [Figure 3].
Figure 3: Relations among scores of patient cooperation, nurses' satisfaction, and level of depression in the study and control groups throughout the study


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Monitoring of the side effects of the drug used in the study showed that no side effect happened during the treatment by the SSRIs.


  Discussion Top


Burn injury affects the psychosocial condition of the patients. Post-burn scars and deformities have serious effects on the patients' social life. PTSDs and depression are frequent psychiatric disorders affecting burn patients. [13]

Fauerbach et al., (2007) stated that a burn injury is one of the most traumatic, dehumanizing injuries an individual can experience and implied the patient's whole world. Drury and Cocking (2008) also stated that the psychosocial impact of burns should be considered as an integral part of their long-term management. So it can reduce the psychosocial morbidity of severe burn injury.

In 2004, Kidal et al., summarized some of the many consideration of psychosocial problems after burn injury such as fear which was perceived as handicapped, fear of initiating of new relationships, fear of infection, loss of self-esteem, fear of resuming sexual intimacy, alteration of body image and self-concept, and fear of unrecovered and dealing with work place reentry; all of these may lead to a depressed patient. [14],[15],[16]

Depression is known to be the most common psychiatric disorder in hospitalized burned patients, especially who have major burn injuries. Moreover, burn injuries are well-known by their devastating, sudden, and unpredictable forms of trauma which affect the victim physically and psychologically. [17]

In the present study, by using BDS, it was found that 70.0% of the patients were suffering from high scores of depression on the 1 st week of admission. This result was similar to that of Wiechman et al., (2001), who studied the rates and severity of depression over 1 month using the Beck Depression Inventory; they discovered that 54% of patients showed symptoms of moderate to severe depression. [18] Dyster-Aas and his colleagues (2008), found that 66% of their patients suffered from severe form of depression. [19]

Also Fauerbach et al., (2007) and Thombs et al., (2007), reported severe symptoms of depression in 45% of their burn patients. [14],[20] These results are considered high in their studies as compared to others and could be probably attributed to the facial burn.

In the present study, 76.7% of our total patients' number, the arm was the common site of burn, and there might be a correlation between the site of burn injury and depression that explains this increased incidence of depression level. This result was in agreement with that of Fauerbach et al., (2007) and Dyster-Aas et al., (2008); both suggested that there is a correlation between the site of burn injury and the psychological impairment, especially the depression. [14],[19]

In the present study, the level of depressive symptoms improved within 3weeks in patients who took antidepressant drug, while in the control group who did not take antidepressant drug, are still suffering from high scores of BDS from admission to discharge. This was similar to Alex et al., (2005) who studied the effect of the antidepressant drugs on burn patient and found that the response to treatment occurs after 8 weeks from the treatment. [21]

Concerning the depressive symptoms, the current study showed that the level of these symptoms improved within 3weeks in the patients who took antidepressant drug; while in the control group who did not take antidepressant drug, suffered from high scores of BDI since the time of admission till the time of discharge. This was quite similar to Alex et al., (2005), who found that the response to the treatment occurred after 8 weeks of the treatment. [21]

Regarding the use of antidepressive drugs as a treatment for depression in burned patients, Lyketsos et al., (2003) also stated that there was clinical improvement in 50-60% of the patients with severe depression. [22] This result was consistent with our study results as compared to other studies. This could be attributed to the use of the new SSRI antidepressant drugs (escitalopram), which is better tolerated than the traditional antidepressant drugs. Although escitalopram is considerably more expensive than the other agents, it often works faster. [23],[24] Moreover, the current study showed no side effects during treatment with SSRIs. This was partially in agreement with that reported by Joyce et al., (2000) who stated that the SSRIs are more commonly used to treat depression than the other drugs, even though they are more costly, because they have fewer side effects than other drugs do. [8]

In 2005, Alex and his colleagues discovered that disturbances in the serotonin system of the brain are key factors in the development of depression and its related disorders, especially the patients' ability to cope with daily activities. [21]

Therefore, we studied the effects of SSRI antidepressant on the physical status of the patients, the nurse's satisfaction in dealing with the patients, and the patients' cooperation with the nurses (during dressing, pre- and postoperative care, physiotherapy care, and nutritional management). The results showed that SSRI antidepressants helped the patients to cooperate with the nursing staff, increased their ability to cope with daily tasks, and the nurses were more satisfied in working with the patients in the burn unit. These findings were in agreement with that of Ruzek (2007), who stated that antidepressants or SSRIs, helped to formalize the levels of serotonin in the brain. [25]


  Conclusion Top


From this study, we concluded that the use of SSRI antidepressants for hospitalized burned patients improves the depressive symptoms, increases patients' cooperation, and improves nurses' satisfaction.

 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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