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Year : 2015  |  Volume : 23  |  Issue : 1  |  Page : 50-51

Commentary on: The impact of anti depressant drugs on the psychological status of the hospitalized burn patient

Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Web Publication11-Dec-2015

Correspondence Address:
Prof. Pronob Kumar Dalal
Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

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How to cite this article:
Dalal PK, Garg K. Commentary on: The impact of anti depressant drugs on the psychological status of the hospitalized burn patient. Indian J Burns 2015;23:50-1

How to cite this URL:
Dalal PK, Garg K. Commentary on: The impact of anti depressant drugs on the psychological status of the hospitalized burn patient. Indian J Burns [serial online] 2015 [cited 2022 Jan 22];23:50-1. Available from: https://www.ijburns.com/text.asp?2015/23/1/50/171653

The trauma caused by a burn injury far surpasses that of the physical pain and suffering. It is one of the injuries that cause immense psychological problems to everybody involved the patient, the caregiver, and even the treating physician. They have always been considered as one of the most destructive injuries, causing not only morbidity and mortality, but also major economic, psychological impact, and long-term somatic sequelae. [1] As noted by the authors in the current article [2] varying estimates of posttraumatic stress disorder (PTSD) and depression have been found in the burn victims. It is not just in the immediate aftermath of the event that such problems occur, as studies have shown that greater levels of acute pain are associated with negative long-term psychological effects such as acute stress disorder, depression, suicidal ideations, and PTSD for as long as 2 years after the initial burn injury. [3] A plethora of psychological problems have been identified in the burn victims, including in addition to the two conditions mentioned above, acute stress disorder, body image dissatisfaction, sleep disorders, and nightmares. [3] The presence of such a wide range of symptoms is not surprising, given the array of stressors for such patients (e.g., burn event, losses, pain, repeated painful procedures, disfiguring injury, and unfamiliar surroundings). [3]

Selective serotonin reuptake inhibitors (SSRI) are a class of anti-depressants that are currently among the first line treatment of depression, anxiety disorders, and PTSD with good results. Many studies have identified the importance of using anti-depressants in burn patients, resulting in alleviation of depression and other psychiatric co-morbidities, leading to better outcome for the patient. Another serious problem for the burn patient is the pain, especially during the earlier phase of management of their injuries. [4] Anxiety associated with pain is also found to be a risk factor for the patients developing PTSD even after a long time from discharge. [5] Anti-depressants including the SSRI have been identified to be of use in management of chronic pain due to their neurotransmitter modulating properties. [6] Hence, the use of anti-depressant not only helps in alleviating the depression of patients but also useful in burn patients for symptoms of pain and anxiety etc., without depression.

The major emphasis of the treating team in burn patient's case is usually on survival, thus almost always ignoring the emotional needs of the patient. [3] Adjustment to the injury is dictated by a complex interplay of patient's characteristics, treatment modalities, stages of physical recovery, and environmental factors. These require prompt identification and management that runs beyond anti-depressant drugs. A multidisciplinary burns team should employ social workers, vocational counselors, and psychologist. The physiological recovery of burn patients is a continuum divided into three stages, the critical, acute, and long-term stage; with the psychiatric needs of the patient varying in each stage. [7] Stressors of intensive care environment and cognitive changes such as extreme drowsiness and disorientation mark the critical stage, the treatment approach includes patient encouragement to cope with the situation, with supportive psychological interventions and education and support to the family members. The acute phase, which focuses on restorative care and the patient becoming alert, is marked by depression, anxiety, sleep disturbances, and grief. Drug treatment of said symptoms should be instituted along with adequate pharmacological management of pain. Non-drug pain control approaches such as relaxation, imagery, and cognitive behavior therapy can also be employed. The long-term rehabilitation continues after the discharge of the patient from the burn unit. This stage is marked by anxiety, depression, physical problems such as itching, limited work capacity and social upheaval caused by change in roles, return to work, body image dissatisfaction, and sexual issues, including the problems faced in dealing with family, friends, neighbors, and colleagues. The person faces a barrage of emotions at the hands of these people, ranging from curiousness, ridicule, mockery, and even blame for the event. These emotions are a source of significant psychological morbidity and need appropriate management, by medications and/or counseling. Specific psychotherapies may also be used in such situations.

Their management should, therefore, include image enhancements, outpatient counseling, social skills training, support groups, peer counseling, and vocational training, along with the continuation or initiation of appropriate anti-depressants.

To sum up, a burn injury and its subsequent treatment are among the most painful experiences a person can encounter. The presence of psychiatric disorders and their adverse effects on the management and prognosis are well-studied. The usefulness of anti-depressant medications in combating these symptoms and affording betterment is also well-known. However, at the same time understanding the process behind the mental suffering in a patient following burns is a complex process with an array of interwoven factors and recognizing these will help a clinician in providing appropriate psychiatric services to the patient and help in speeding up their recovery.

  References Top

Lowe AJ. It′s not Just a Burn: Physical and Psychological Problems after Burns. Sweden: Digital Comprehensive Summaries of Uppsala University Dissertations from the Faculty of Medicine; 2007.  Back to cited text no. 1
Abdelhafiz A, Makboul M, Azab HM, Khalifa H, Mohamed ZA, Ahmed NM, et al. The Impact of anti-depressant drugs on the psychological status of the hospitalised burns patient (the current article). Indian J Burns 2015;23:31-7.  Back to cited text no. 2
Dalal PK, Saha R, Agarwal M. Psychiatric aspects of burn. Indian J Plast Surg 2010;43 Suppl:S136-42.  Back to cited text no. 3
Summer GJ, Puntillo KA, Miaskowski C, Green PG, Levine JD. Burn injury pain: The continuing challenge. J Pain 2007;8:533-48.  Back to cited text no. 4
Van Loey NE, Van Son MJ. Psychopathology and psychological problems in patients with burn scars: Epidemiology and management. Am J Clin Dermatol 2003;4:245-72.  Back to cited text no. 5
Ryder SA, Stannard CF. Treatment of chronic pain: Anti-depressant, antiepileptic and antiarrhythmic drugs. Contin Educ Anaesth Crit Care Pain 2005;5:18-21.  Back to cited text no. 6
Wiechman SA, Patterson DR. ABC of burns. Psychosocial aspects of burn injuries. BMJ 2004;329:391-3.  Back to cited text no. 7


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