Unit 1 (9) Behavioral Med - Psychological Care of Physically Injured

Importance of assessment and treatment of psychological distress following physical injury

The need for emotional care after traumatic physical injury

What DOES NOT act as a risk factor for development of lasting psychological morbidity post-injury

The severity of injury predicts mortality but NOT morbidity

Responses to head injury

- Personality change - Difficulties with regulating affect, executive function, and cognition

Responses to spinal cord injury

- Issues around dependency are very significant- Suicide rate 4-5 times higher than general population- Self-neglect- Cognitive impairment

Responses to burns

- Disfigurement- Severe pain involved in treatment

Responses to amputations

- Grief- Phantom pain

Psychiatric diagnoses common in trauma survivors

- Acute Stress Disorder- PTSD- Depression- Anxiety (avoidance of things that they think will cause them pain)- Substance Abuse and Dependence

Treatment Options for Psychological care of physically injured

- Good communication with provider- Encouragement of good social support networks- Work with patient to minimize avoidance- Teach coping skills- Refer for psychotherapy- Medication (do not use benzos long term)

Being in the ICU usually causes what?

Delirium(no sense of day/night, inability to speak, lack of personal control, dependency on others for basic needs)

Interventions for ICU patients to lower psychiatric morbidity

- Liberal policies around visits from support- Provide orientation cues (window, clocks, calendar)- Provide pen/paper for patients unable to speak- Encourage family to bring familiar objects- Maximize mobility