Transcript PSYCHOLOGICAL CONTEXT Els Vandermeulen

PSYCHOLOGICAL CONTEXT
Els Vandermeulen - Thibaut Deprez – Leen Braem – Anne-Sofie
Goemanne – Marianne Verhaegen – Pascaline Gomez (Laëtitia De Wulf)
Jean-Marc Hougardy – Virginie Deschamps – Koen Maertens
Psychological Context
1.
A Review
2.
The Psychologist Today
3.
Psychopathology and Psychological Problems
4.
Research
5.
Future
1. A Review
20 years ago:
• burns : medical-somatical issue
• psycho-social problems  nurses
80-ies: explosion in UCL
• many young victims
• priority : medical  survive
• no time for psychological support
1. A Review
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External psychologist
‘Stranger’
Difficult to approach
‘Competition’
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Several disasters with burn injuries
Medical evolution and improvement
More victims survive burns
Quality of life and well-being
2. The Psychologist Today
1. ACUTE STAGE
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2.
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Reduce anxiety during
painful period
SECUNDARY
STAGE
Inform about possible psychological responses that may be
experienced
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Independency and activity
3.
• REHABILITATION
Inform likely course of STAGE
the injury and likely course of recovery
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Self-confidence and self-esteem
•
image
concerns
A newBody
range
of stressors
develop after the patient returns home
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Evaluate excessive avoidance tendencies (PTSD)
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Conflict
of interests
staff – psychological
patient
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Identify patients
requiring
intervention
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Availability
to staff
•
Ongoing support
formembers
parents and family
 family becomes the primary care giver
3. Psychopathology and
Psychological Problems
• Psychiatric disorders
 Depression
 Anxiety disorders (e.g. PTSD)
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Neuropsychological
Social interaction
Sexual and Marital
Generalized Anxiety
…
3. Psychopathology and
Psychological Problems
POST-TRAUMATIC STRESS DISORDER:
DSM-IV criteria1
1.
2.
3.
4.
5.
6.
Exposure to a traumatizing event
The traumatic event is persistently re-experienced
Persistent avoidance of stimuli associated with the trauma and
numbing of general responsiveness
Persistent symptoms of increased arousal
Duration of the disturbance (symptoms) is more than 1 month
The disturbance causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning
American Psychiatric Association,
Diagnostical and Statistical Manual
of Mental Disorders (DSM-IV), 1994
1
3. Psychopathology and
Psychological Problems
 Integration of the traumatic event
• Post-trauma:
 re-experiencing of the trauma
 avoidance of triggers related to the trauma
• Modify intern schemes (about self, others, world, future)
 Prevention of PTSD
• Adequate pain management
• Creation of a predictable, controlable environment
• No evidence-based psychological interventions in acute stage
3. Psychopathology and
Psychological Problems
Remarks
• Physical harm is not necessary for PTSD
• Witnessing an event with feelings of intense fear, helplessness, or
horror can lead to (symptoms of) PTSD
• Initial stress-reaction is a ‘normal’ reaction in an ‘abnormal’
situation
• Not every trauma causes PTSD
• Not every trauma victim develops PTSD
3. Psychopathology and
Psychological Problems
Risk factors
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Inadequate coping strategies
Psychiatric comorbidity
Neurotical personality structure
Localisation of burns (face, hands)
(Perception of) responsability
Extreme pain/anxiety during hospitalization
Women
3. Psychopathology and
Psychological Problems
Incidence and Evolution of Trauma-Related Stress
• Prospective and logitudinal Dutch-Belgian research
Ghislenghien(n=30)
Age
# operations
# days in BU
TBSA
% Men
39,7
4,9
64,4
35,5
86
Reference group(n=300)
38
1,3
24
13
76
 Impact of Event Scale (IES): re-experience and avoidance
3. Psychopathology and
Psychological Problems
Mean 50
IES
45
15 %
40
35
30
25
20
15
10
5
0
Cut-off
PTS
AS
No PTS
18 %
67 %
2wk
3md
6md
12md
Time post burn
3. Psychopathology and
Psychological Problems
Mean 40
IES
35
30
25
Gellingen
Ref
20
15
10
5
0
2wk
3md
6md
12md
24md
Time Post Burn
3. Psychopathology and
Psychological Problems
CONCLUSIONS² :
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Disaster: more psychological impact
Need for psychological treatment: evident at 3 - 6 months PB
Delayed onset: onset of symptoms ≥ 6m after the stressor
Psychosocial support at long term is indispensable
² Van Loey, N., Reynders, C., Faber, A. Posttraumatische stress-symptomen bij
slachtoffers met ernstige brandwonden. ANPI-Magazine, september 2005, n° 176
4. Research
Ongoing studies concerning Psychosocial
Consequences of Burns in Children
1. Impact of Burn Camps on the psychosocial development of the child and
the experience of the parents4
 in collaboration with NBC
2. Impact of Thermal Cures on scar formation4  in collaboration with Pinocchio
3. Vertical follow-up4 medical, psychological and functional screening from
2y PB until the age of 18
 in collaboration with Greet Rouffaer Huis
4. Prospectif child study5
4 Maertens,
K. – Scientist – VUB – in
co-operation with the Belgian Burn
Centers
 VSBN in collaboration with Belgian Burn Centers
5 Van
Loey, N., Protocol kinderonderzoek: gedragsproblemen en
levenskwaliteit bij kinderen met
brandwonden. 2007.
5. Future
September 2006 : start workgroup psychologists of Belgian burn units
 meetings every 3 months
 discussion of items related to psychosocial issues in burn care
Some goals
• Standardized and structured approach in order to come to uniform
guidelines for psychosocial support for patient and family
• National network of psychologists
• First-schoolday project
• Return-to-work project
Psychologists Belgian Burn Centers
• Antwerpen:
• Brussels:
• Gent:
• Leuven:
• Liège:
• Loverval:
• Scientist VUB:
Leen Braem
Els Vandermeulen
Thibaut Deprez
Anne-Sofie Goemanne
Hanne Hendrickx (1/12/07)
Marianne Verhaegen
Jean-Marc Hougardy
Virginie Deschamps
Pascaline Gomez
Laëtitia De Wulf
Koen Maertens