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Wait for Burn Patient's Cues to Readiness Before Starting Psychological Intervention: Presented at ADAA

By Fran Lowry

MIAMI, F.L. -- March 29, 2006 -- Patients with severe burns who report greater symptoms of acute stress disorder (ASD) in hospital continue to have significant pain and other health problems a year later, according to a study presented here at the 26^th Annual Conference of the Anxiety Disorders Association of America (ADAA).

"The finding suggests that the psychology of what is going on when these patients are in hospital is really important, and tells us we need to be aware and intervene early in those people who have persistence of acute stress disorder," Gina Magyar-Russell, PhD, post-doctoral fellow, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.

She cautioned, however, that intervening too early can be just as dangerous and ineffective as intervening too late, or not at all.

"We found that if patients suppress thoughts of their trauma while they are in a state of acute medical emergency, and then wait to process when they are in more of a safe place, and have gotten their cognitive abilities back, they do better," Dr. Magyar-Russell said.

Dr. Magyar-Russell and colleagues assessed the prevalence of ASD among 80 adult hospitalized burn patients (mean age 38 years) and in a cross-sectional analysis looked at the relation between a diagnosis of ASD and physical and psychological functioning while in hospital and at 6 and 12 months post-discharge.

They administered the Acute Stress Disorder Scale, Short Form Health Survey (SF-36), Satisfaction with Appearance Scale, and McGill Pain Questionnaire during hospitalization in all patients. A subset of these scales was administered at 6 and 12 months post-discharge.

Almost 40% of patients had ASD while in hospital, Dr. Magyar-Russell said. Symptoms of ASD were associated with dissatisfaction greater with body image, poorer mental health function, and higher levels of self-reported pain in hospital. Symptoms of ASD continued to be related to poor mental health at 6 months, and greater levels of pain at 12 months.

"Symptoms of ASD should be assessed, and treatment recommendations made by a qualified mental health professional during hospitalization for severe burn injury," Dr. Magyar-Russell concluded.

A diagnosis of ASD may help identify individuals at risk for continued health problems, in particular, symptoms of continued mental distress and chronic pain, she added.

She also stressed that clinical judgment is essential for determining the right time to start psychological intervention in such patients.

"A lot of times our staff will want the psychologists to come in right away, but it may be that supportive therapy alone is to be preferred and then, as the patient becomes ready to talk, that may be the time for the psychologist's visit," she explained. "So, while our study tells us that it is important to intervene with these patients, it should also remind us that we should bide our time to approach them."


[Presentation title: Acute Stress Disorder During Hospitalization for Burn Injury: Implications for Long-Term Functioning. Abstract 398]

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