Psychiatric Counseling Research Articles

Psychiatric genetic counseling: A survey of Australian genetic counselors' practice and attitudes.

Genetic counseling plays a critical role in supporting individuals and their families' adaption to psychiatric conditions, addressing the multifactorial nature of these conditions in a personally meaningful and empowering way. Yet data related to the practice and attitudes of Australian genetic counselors about psychiatric genetic counseling (PGC) is limited. This survey investigated the practice of Australian genetic counselors, and their attitudes toward PGC. Genetic counselors (N=393) were invited to participate in an anonymous online survey between March and May 2022. Forty-four genetic counselors (response rate=11%) from Australia and New Zealand responded. No respondents practice in psychiatric genetics as their speciality area; most respondents do not see any patients where the primary indication is a personal and/or family history of psychiatric disorders (91%). Greater than half of respondents (56%) believed there was sufficient evidence to support PGC, and 64% enquire about personal and/or family history of psychiatric disorders, but only 25% provide genetic counseling on this topic. Most respondents do not feel confident providing risk assessments for psychiatric disorders (72%), while the majority expressed interest in attending specialist training (95%), and in incorporating PGC into future practice (77%). Australian genetic counselors would benefit from psychiatric genetic education and training, and establishment of specialized PGC services would address this gap in patient care, while providing opportunities for genetic counselors to gain skills and experience in PGC.

Healthcare decision makers' perspectives on the creation of new genetic counselor positions in North America: Exploring the case for psychiatric genetic counseling.

Mental illnesses are common and highly heritable. Patients and their families want and benefit from receiving psychiatric genetic counseling (pGC). Though the pGC workforce is among the smallest of genetic counseling (GC) specialties, genetic counselors (GCs) want to practice in this area. A major barrier to the expansion of the pGC workforce is limited availability of advertised positions, but it remains unclear why this is the case. We used a qualitative approach to explore drivers for and barriers to the creation of GC positions (including pGC) at large centralized genetic centers in the United States and Canada that offer multiple specialty GC services. Individuals with responsibilities for making decisions about creating new clinical GC positions were interviewed using a semi-structured guide, and an interpretive description approach was used for inductive data analysis. From interviews with 12 participants, we developed a theoretical model describing how the process of creating new GC positions required institutional prioritization of funding, which was primarily allocated according to physician referral patterns, which in turn were largely driven by availability of genetic testing and clinical practice guidelines. Generating revenue for the institution, improving physician efficiency, and reinforcing institutional mission were all regarded as valued outcomes that bolstered prioritization of funding for new GC positions. Evidence of patient benefit arising from new GC positions (e.g., pGC) seemed to play a lesser role. These findings highlight the tension between how institutions value GC (generating revenue, reacting to genetic testing), and how the GC profession sees its value (providing patient benefit, focus on counseling).

Psychiatric consultation in general practitioners’ daily practice: a qualitative study on the experience of consultation-liaison psychiatry interventions in primary care settings in French-speaking Switzerland

BackgroundMental disorders are frequent in primary care settings, which is challenging for primary care physicians. In Neuchâtel (Switzerland), a Consultation-Liaison psychiatrist integrated three primary care group practices, proposing both clinical interventions and supervisions/psychiatric training. Primary care physicians’ experience regarding this collaboration was investigated.MethodsA qualitative study was conducted. Three focus groups were organized in each primary care group practice involved in the project (10 primary care physicians participated in focus groups). Data were analysed with thematic content analysis.ResultsSix major themes emerged from our analysis, describing primary care physicians’ collaboration with psychiatrists: 1) Impact on a difficult to reach and “reluctant to consult” population; 2) Fluidity of the intraprofessional collaboration; 3) Influence on the doctor-patient relationship; 4) Positive emotional experiences; 5) Psychiatric counselling and training; 6) Long-term prospects for the project.ConclusionsConsultation-Liaison psychiatrist’s presence came as a relief for participating primary care physicians, facilitating accessibility to mental healthcare, introducing a common culture of care, and offering “in-situ” psychiatric training. Primary care physicians felt that their relationships with patients benefited from such interventions, being better able to deal with complex emotional experiences and found patients more confident regarding proposed care. Models of psychiatric intervention provided in primary care must establish settings of collaboration that reinforce relationships between primary care physicians, psychiatrists, and patients.

An innovative behavioral health care curriculum: The integrated advanced practice addictions nursing subspecialty.

There is a significant shortage of behavioral health providers trained in caring for patients with problematic substance use, particularly within integrated care settings. An innovative addictions nursing subspecialty curriculum was designed by interdisciplinary faculty from psychiatric nursing, family nursing, counseling, and social work and informed by integrated care, addictions, and telehealth competencies. The subspecialty included prevention, treatment, and recovery approaches to care and encouraged enrollment of students from various health-related disciplines to enhance the students' experiences of integrated care for substance use treatment prior to completion of the program. Subspecialty courses increased the number of advanced practice nurses in the behavioral health care workforce with enhanced knowledge of integrated telehealth substance use treatment. Implementation of similar innovative curricula across health disciplines may significantly improve the care delivered to patients with problematic substance use in traditional medical settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A STUDY TO ASSESS THE IMPACT OF MASS MEDIAON QUALITY OF LIFE DURING COVID 19 PANDEMIC AMONG PARENTS OF NURSING STUDENTS IN SRM COLLEGE OF NURSING, KATTANKULATHUR, CHENGALPATTU DISTRICT

Corona disease (COVID-19) is a deadly disease which continues to affect the world. Media started constant reporting on COVID to the public. The main aim of the study to assess the impact of mass media on quality of life among parents of nursing students.Cross sectional study design was adopted. 203 parents of SRM nursing students who fulfilled the inclusion criteria were selected by Non- Probability convenient sampling technique. Structured questionnaire and Cross - sectional study design was used to conduct the study through google forms. During COVID pandemic most of them prefer (31.6%) social media, participants spent mass media about 1-2 hours (45.6%) per day. Most of the impact form of mass media is television (39%). Many of them have not been attended the psychiatric counselling (66.9%). The people are mostly convinced and moderately satisfied with mass media (45.6%). In the overview opinion of parents of nursing students there is no influence of mass media in relationships (27.9%).They were very satisfied with access to health service (32.4%). They felt panic, most of the time after watching the news (43.4%). They felt very depressed or hopeless after watching the news (41.9%). Most of the time they cannot concentrate on daily routine work and job life after watching the news on COVID-19 (37.5%). Most of the time they are affected emotionally due to physical distancing (36.8%). They felt either satisfied and dissatisfied with energy for every day life (39%). Majority of them dissatisfied with the conditions of living place (30.1%). Parents of nursing student’s quality of life were moderately affected during COVID-19 as compared to the pre COVID-19 period (39%). The demographic variables corresponding to the p values which are less than 0.01, are significantly associated high with “quality of life during COVID-19 such as sex, family income per month and medium of information.

Role of orbital exenteration in management of rhino-orbito-cerebral mucormycosis (ROCM) - A prospective analytical study

Mucormycosis is an uncommon, opportunistic fungal infection. The most crucial decision in the management of rhino-orbital mucormycosis is when to advise exenteration. This study aims at understanding the pattern of cases which progressed and had extensive involvement of the entire orbital cavity with mild intra cranial extension requiring exenteration as life salvage measure in the setting of epidemic of mucormycosis in a pandemic of COVID – 19. Patients suspected or diagnosed with invasive orbital mucormycosis visiting our hospital were admitted and included in the study. CT PNS with orbit were done for all patients and MRI brain with orbit were done in patients in whom intracranial spread and involvement of optic nerve were present. Patients were started on liposomal intravenous amphotericin B (5mg/kg/day) and intraorbital amphotericin B injection when indicated and closely monitored for clinical progression. All patients were taken up for FESS and if positive for mucormycosis on histopathological examination. In cases wherever exenteration was indicated, after confirming that there was no perception of light and obtaining informed consent with psychiatric counselling patient was taken up for orbital exenteration. Lid sparing exenteration was the method of choice. A total of 41 patients out of 696(5.89%) underwent exenteration out of which 21(51.2%) were right sided and 20(48.8%) were left sided. 12 patients (29.2%) of those who had undergone exenteration did not have a history of being tested positive/ been symptomatic for COVID 19. 1 patient (2.4%) was not diabetic. All patients (100%) had sinonasal involvement (Involvement of one or more paranasal sinuses) with involvement of orbital cavity to different degrees. 4 out of 41(9.75%) patients had deteriorated and required ICU care. 1 patient succumbed to death (2.4%) due to multiple comorbidities. On histopathological examination of exenteration specimen, 2(4.87%) patients turned out to be negative for mucormycosis. In 32(78.04%) of them the socket healed well while 5(12.1%) had slough who required 2 or more sittings of sloughectomy. As mucor is angio invasive rapidly progressive highly fatal infection close monitoring for invasion into structures like apex of orbit and intra cranial spread is essential for timely intervention and decision to perform exenteration. This is crucial for arrest of progress and life salvage.

TREATMENT MODALITIES OF COMPLEX REGIONAL PAIN SYNDROME AFTER HAND SURGERY A SYSTEMATIC REVIEW AND META-ANALYSIS STUDY

Background: complex regional pain syndrome is a complex medical condition. Physical/occupational treatments, psychiatric counseling, neuropathic pain medicines, anti-inflammatories, and surgical intervention are utilized to treat complex regional pain syndrome (CRPS).

Association of Glaucoma with Poor Quality of Sleep in an Ethiopian Glaucoma Population - A Comparative Cross-Sectional Study.

Glaucoma is a group of ocular disorders characterized by progressive optic nerve damage resulting in irreversible visual field defects. Poor quality of sleep in glaucoma patients could be explained by the reduction of the light input to the circadian system as a result of damage to photosensitive retinal ganglion cells in the retina. Information is limited on the association of poor quality of sleep with glaucoma in general and the Ethiopian glaucoma population in particular. The study aimed to explore the association between poor quality of sleep and glaucoma at a Tertiary Eye Care Center in Ethiopia. An institutional-based comparative cross-sectional study was conducted among 200 glaucoma and 201 non-glaucoma participants recruited by systematic random sampling. Each group was administered with a Pittsburgh Sleep Quality Index (PSQI) questionnaire. Stata-14 was employed for data analysis; an independent t-test was used to show the statistical difference in the global mean PSQI score for the two groups. A binary logistic regression model was applied to identify factors associated with poor quality of sleep. Statistical significance was declared at a 95% confidence interval and a p-value of <0.05. The prevalence of poor quality of sleep was 82.5% among the glaucoma population, which statistically differed (p<0.001) from the non-glaucomatous population (55.7%). Poor quality of sleep in glaucoma was associated with older age (adjusted odds ratio (AOR)=4.4, 95% confidence interval (CI): 1.5-5.4), depression (AOR=2.9, 95% CI: 1.1-7.3), visual impairment (AOR=3.9, 95% CI: 1.3-12.3) and severe glaucoma (AOR=2.5, 95% CI: 1.1-5.9). Poor quality of sleep was significantly higher in the glaucoma population compared to their non-glaucoma control. It was associated with older age, depression, visual impairment and advanced glaucoma. Incorporating psychiatric counseling into the existing glaucoma follow-up was recommended.

Implication of COVID-19 Pandemic on Adolescent Mental Health: An Analysis of the Psychiatric Counseling from the Emergency Room of an Italian University Hospital in the Years 2019-2021.

Introduction: Although the COVID-19 pandemic had profound consequences on youths’ mental health, few data are available about its longitudinal implications. Method: In this study, from 655 counseling requests by the Emergency Room (ER) of the University Hospital of Bari, we retrospectively examined 380 requests for psychiatric counseling of pediatric subjects, during the pre-pandemic, the first pandemic, and the second pandemic wave of COVID-19. Results: We found a significant upward trend between 2019 and 2021 for the counseling requests for acute psychopathological symptoms (p = 1.469 × 10−5), patients in adolescent age (p = 0.022), females (p = 0.004), and those taking psychotropic medications (p = 2.28 × 10−5). Moreover, a significant difference in the proportions of depression (p = 0.003), post traumatic (p = 0.047), somatic (p = 0.007) and psychotic symptoms (p = 0.048), and self-injuring behaviors (p = 0.044) was observed. The proportion of counseling for psychotic symptoms (p = 0.014) and self-injuring behaviors (p = 0.035) also showed an increasing trend over time, with self-harming behaviors becoming more severe and diversified in modalities. Discussion: The pandemic’s persistence over time may have had an impact on youth’s psychopathology, influencing the frequency, type, and complexity of mental health problems; as a result, it is vital to implement timely integrated interventions and find strategies to prevent self-harm, in particular with the identification of vulnerable categories of patients.

Psychiatric genetic counseling for patients with schizophrenia and their families.

Steady progress in the field of psychiatric genetics, generating new and fascinating insight into the genetic and phenotypic complexity of schizophrenia and other serious mental illnesses, have created an increased need of psychiatric genetic counseling. It is a crucial aspect of psychiatric clinical practice to ensure a balanced approach that takes into consideration genetic and environmental risk factors and ongoing education in this rapidly developing field is essential. Genetic counseling will be increasingly important to assist patients with schizophrenia and their families to make a meaningful informed decision about genetic testing. It will preempt unrealistic expectations, discrimination and stigma related to incomplete understanding of genetic test results in the psychiatric context.

EMOTIONAL STATE OF CHILDREN OF UKRAINE WHO WERE AFFECTED BY WAR FACTORS IN THE OCCUPIED TERRITORY

Relevance. The infliction of war and military aggression is a violation of children's basic rights, because during war children gain experiences that are in stark contrast to their needs to grow up in a physically and emotionally safe and predictable environment.&#x0D; Objective of the work was to establish the frequency and manifestations of emotional disorders in children who lived in the occupied territory of Ukraine in February-March 2022.&#x0D; Material and methods. In May-July 2022, 184 children aged 3-17 years who lived in February-March 2022 in Kyiv and Chernihiv regions in the territories occupied by Russian troops were examined. Psychological and psychiatric counseling of 119 children was carried out. The "Child's Dream" method was used to identify themes of disturbing thoughts (the child was asked to draw a sleeping child and a dream that she had). Parents of 81 children were also surveyed using the Pediatric Symptom Checklist-17 (PSC-17): 29 children from May 3 to May 17 (Group I); 17 children from May 19 to May 31 (II group); 35 children from June 6 to July 14 (III group).&#x0D; Results. Anxiety disorders were detected in 27.7% of children, and conditions associated with high anxiety (insomnia, phobias, post-traumatic stress disorder, behavioral disorders) were found in another 24.4%. In 72.4% of the children of the I group, 29.4% of the children of the II group, and 17.1% of the children of the III group, internalization disorders were found; disorders of attention and externalization were found only in children of I (55.2% and 51.7%, respectively) and II groups (20.4% and 11.8%, respectively).&#x0D; Conclusions. More than half of the children who lived in the occupied territory were found to have psychoemotional disorders with a predominance of anxiety. 3 months after experiencing acute stress, internalization problems remain in 17% of children. These emotional disorders indicate the need to develop psychological correction measures.

Neuropsychiatric symptoms in the psychiatric counseling of patients admitted with COVID-19 infection

BackgroundCovid-19 patients suffer from psychiatric disorders too. The present study was designed to investigate the rate of psychiatric consultation requests in a general hospital. Reasons for consultation requests, types of psychiatric diagnoses, and factors in consultation requests were also investigated. MethodsThis cross-sectional study included all patients admitted with Covid-19 and referred to psychiatric consultation service in a major Covid-19 center in Tehran, Iran (2020). After acceing patients’ electronic files, records of patients’ demographic information, positive psychiatric symptoms, past psychiatric history and DSM5 diagnoses were made. Statistical analyses were done in SPSS 26 using descriptive statistics and chi-square and Fisher's exact test (p<0.05). ResultsOut of 1791 Covid-19 hospitalized patients, 132 patients (7.3%) had been referred to psychiatric consultation service. The most common reason for requests were restlessness and aggression (23.5%). Meanwhile, 92.4% of the patients were diagnosed to suffer from at least one psychiatric disorder including insomnia (64%), delirium (30.3%), anxiety due to hypoxia (15.3%) and generalized anxiety disorder (10.6%). ConclusionAlthough studies report a high prevalence of psychiatric disorders in Covid-19 patients, requests for psychiatric consultations and consideration of psychiatric disorders are still remarkably low. The most common disorders appeared to be insomnia, delirium and anxiety.

Stigmatizing attitudes towards depression among university students in Syria.

BackgroundDepression is a prominent cause of mental disability globally, having a severe impact on mental and physical health. Depression rehabilitation and treatment, whether through psychiatric management or counseling therapy, is hampered by stigmatizing attitudes regarding psychiatric illness patients impacted by societal and cultural factors. However, little is known about the stigma toward people with depression among the students in Syria.MethodologyA total of 1,056 students in Syria completed a questionnaire that included a case narrative illustrating depression. A total of 1,056 students in Syria completed a questionnaire that included a case narrative illustrating depression. The survey looked at attitudes toward depression, the desire to keep a safe distance from depressed people, stigma attitudes toward people with depression among college students, perceived beliefs about depressive people, gender (male and female), and the major section (medical and medical and non-medical) differences.ResultsFour questionnaires have refused to finish the survey, out of 1259 issued. Around 47.80% of respondents, most of whom were females, felt that sad people might snap out of it. 14.60 percent believe depression isn’t even an actual medical condition. Surprisingly, 2% of respondents with a medical background thought the same thing. Regarding more extreme stigmatization, 16.80% of respondents thought depressed persons were harmful. People with depression will be avoided by 19.50 percent of respondents, and people with medical backgrounds will be avoided by 5.20 percent of respondents. Nearly one-fifth of those polled said they would not tell anyone if they were depressed. Only a tiny percentage of respondents (6.90 percent) said they would not hire or vote for a politician who suffers from depression (8.40 percent).ConclusionAccording to the study, Syrian college students had a significant level of stigma and social distance toward mentally ill patients. Female students and non-medical students had a higher stigma in most subscale items for people with depression.

Psychiatric genetic counseling for people with copy number variants associated with psychiatric conditions.

22q11.2 deletion is one of the most well-known copy number variants (CNVs) associated with developing a psychiatric condition (e.g., schizophrenia), but there is a growing list of other CNVs which also confer substantial risk for developing psychiatric conditions. With increased use of chromosome microarray and exome sequencing, the frequency with which these CNVs are detected is increasing. While individuals with such CNVs often receive genetic counseling, research shows that associated psychiatric conditions are less often addressed-clinicians tend to focus on the nonpsychiatric manifestations of the CNV. This represents an important service gap for people with these CNVs and their families, as research shows that not only do these families want genetic counseling about psychiatric illness, it can also produce meaningful positive outcomes for people, including increases in empowerment, and self-efficacy. Therefore, there is a need to ensure that individuals with psychiatric condition-associated CNVs are being counseled about these manifestations of their condition in a way that can promote the best outcomes. In this paper we describe the process of providing genetic counseling in two clinical scenarios in which a psychiatric susceptibility CNV is identified: (1) in an individual who has not been diagnosed with a psychiatric condition and (2) in an individual with an established psychiatric condition.

Animism and Magical Thinking: Clinical Review of Dereism

From a clinical viewpoint, dereism can be an evil warning sign, which may hint at disruption of thought organization, damaged reality testing, impaired insight, compromised judgement and serious mental condition. So, in the realm of descriptive psychopathology and phenomenological diagnosis, dereistic thinking or animism, demands, first of all, exclusion of organic problems, like space occupying lesions of brain, and, then, ruling out psychosis, like schizophrenia. On the other hand, dereism can be found in neuroses or personality syndromes, a finding that may indicate its multidimensional connotation. In the present article, while dereism has been appraised from psychoanalytic and cognitive viewpoints, it has been tried to delineate some of its valuable aspects, as well, which may be ignored clinically during routine psychiatric evaluation, counseling or psychotherapeutic approaches.

Evaluation of Psychiatric Counseling for Patients Hospitalized with COVID-19 in a University-Affiliated General Hospital in Tehran, Iran

Background: Coronavirus disease 2019 (COVID-19) is associated with a number of psychiatric problems in patients; however, mental healthcare in these patients does not appear to be adequate. Objectives: This study aimed to evaluate the extent of psychological care provided to COVID-19 patients admitted to the hospital and the most common reasons for psychiatric counseling. Methods: This study examined the electronic medical records of all COVID-19-positive patients admitted to Rasoul-e-Akram hospital in Tehran, Iran, within April 1 and September 30, 2020 (approximately 2200 cases). Results: Psychiatric consultation was requested for 5.45% of admitted patients with COVID-19 diagnosis based on a positive real-time reverse transcription-polymerase chain reaction. More than half of those who received psychiatric counseling had a previous psychiatric disorder. The most common reason for requesting psychiatric counseling in patients with a previous psychiatric disorder was the patient’s evaluation and management; the most common reason in patients without a psychiatric disorder was agitation and lack of cooperation. The most common diagnosis in patients with a positive history of psychiatric disorder was bipolar disorders (33.9%), followed by opioid use disorder (29%). Adjustment disorder (54%) and delirium (26%) were the most common diagnoses in patients without a history of psychiatric disease. Conclusions: The current study showed that psychiatric counseling in COVID-19 patients was limited to a small number, including those with a positive history of psychiatric illnesses and prominent psychiatric symptoms.

The vision-related quality of life and anxietydepression levels of age-related macular degeneration during COVID-19 Pandemic

Purpose: To evaluate anxiety, depression status, and vision-related quality of life (QoL) in patients with age-related macular degeneration (AMD) during the early phase of the COVID-19 pandemic. Results: There was no statistically significant difference in HADS-A and HADS-D between the AMD group and controls (p&lt;0.05) When the patients with AMD were assigned to two distinct groups according to binocular visual acuity, the proportion of patients above the HADS cut-off points for anxiety did not differ between the groups (p=0.208) and 55.6 % of patients above the HADS cut-off points of depression in low vision AMD group were significantly different from other groups (p=0,022). The statistically significant lower means of NEI-VFQ-25 parameters except for general health and ocular pain were observed in AMD patients compared with controls (p&lt;0.05). Conclusions: Higher rates of depression were observed in subgroup of AMD having poor visual acuity. The AMD patients had lower vision-related QoL scores during the COVID-19 pandemic and it is recommended psychiatric counseling opportunities are needed for AMD patients having low binocular visual acuity.

Monitoring of Intentional Self-Harm as a Tool to Detect Mental Disorders and Improve Access to Psychiatric Care.

This article discusses the early diagnosis of mental disorders in connection with non-fatal intentional self-harm and suicide prevention. To substantiate the efficacy of an intentional self-harm monitoring system as a tool for detecting mental disorders and improving access to psychiatric care for people who have attempted suicide. A cohort study was performed using materials obtained after the introduction of an intentional self-harm monitoring system and its implementation in the Stavropol Territory. We studied 2738 cases of intentional self-harm reported between 2016 and 2021. Study data were grouped using dual criteria based on a history of psychiatric follow-up, a history of psychiatric counseling, first/recurrent intentional self-harm, psychiatric examination after intentional self-harm, and a diagnosis of a mental disorder on psychiatric examination. The official suicide attempt registration system was found to identify less than 15% of attempts. The primary incidence of mental disorders in suicide attempters was 61.4 times higher than the primary incidence of mental disorders in the general population of the Stavropol Territory. A supposedly healthy suicide attempter was 169 times more likely to be diagnosed with a mental disorder than a member of the general population. Primary diagnoses of mental disorders were 14.8 times more common in multiple suicide attempters without a diagnosis of a mental disorder at the time of the last attempt than in first-time attempters. Access to psychiatric care increases the mental disorder diagnosis rate in general and in suicide attempters in particular. Monitoring of intentional self-harm is instrumental in the early diagnosis of mental disorders, suicide prevention, and improving access to psychiatric care for suicide attempters, also having an enormous research potential.

Outcomes following burn injury in intensive care patients with major psychiatric disorders

AimsPatients with psychiatric comorbidity have been shown to experience high rates of burn injury. Burn epidemiology, etiology, and outcomes have been sparsely documented for patients with major psychiatric disorders. The aim of this study was to analyze the epidemiologic characteristics and outcomes in intensive care burn patients with pre-existing and acute major psychiatric disorders . MethodsA retrospective study was performed including intensive care burn patients admitted between March 2007 and December 2020. Demographic, clinical and epidemiological data were collected and analyzed. Major psychiatric co-morbidities were collected according to ICD-9 and ICD-10 classifications. Patients were stratified according to F-diagnoses. ResultsA total of 1325 patients were included. 16.6 % of all patients had one or more major psychiatric disorders- 9.3 % with anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders, 9.2 % with mood (affective) disorders, 3.5 % with schizophrenia and other non-mood psychotic disorders, and 1.8 % with disorders of adult personality and behavior. Patients with major psychiatric disorders presented with significantly higher burn severity, reflected by higher abbreviated burn severity index (ABSI) scores (5.9 vs. 5.3, p < 0.001) and larger total body surface area (TBSA) affected (15.9 vs. 12.5 %, p = 0.002). Burned TBSA ≥ 30 and inhalation injuries were observed more frequently in patients with MDP, however without statistical significance. They also experienced prolonged hospital length-of-stay (LOS) (25.5 vs. 16.3 days, p < 0.001), prolonged intensive care unit LOS (14.8 vs. 7.7 days, p < 0.001), underwent surgical interventions (3.5 vs. 2.3, p < 0.001) and mechanical ventilation more frequently (34.1 % vs. 16.5 %, p = 0.43) and had significantly longer ventilation durations (73.5 vs. 31.2 h, p = 0.002). Mortality rates were lower compared to patients without major psychiatric disorders (5.9 vs. 8.1, p < 0.001). ConclusionsThe prevalence of major psychiatric disorders in burn patients is considerably high. Patients with psychiatric comorbidities were found to have greater burn severity, prolonged total hospital and ICU LOS, underwent surgical interventions and mechanical ventilation more frequently and had prolonged ventilation duration. Our results highlight the importance of identifying burn patients with major psychiatric disorders who may necessitate additional resources and require extensive inpatient psychiatric care and counseling.

Pediatric complex regional pain syndrome: a review

IntroductionComplex regional pain syndrome (CRPS) is a chronic localized pain condition that can have a significant impact on the quality of life. It affects children and adolescents as well as adults, but is more common among adolescent girls.ObjectivesTo present up-to-date clinical information regarding CRPS in pediatric population.MethodsA review of recent literature.ResultsIn contrast to adults, CRPS appears after an initial event that is typically a minor trauma and occurs more frequently in the lower extremity than in the upper extremity. This syndrome is characterized by spontaneous or stimuli-induced pain, which is disproportionate to the actual incident trauma/stimulus, in the presence of a wide variety of autonomic and motor disturbances. The exact mechanism of CRPS is unknown, although several different mechanisms have been suggested. In many cases, CRPS follows a relatively minor trauma, in some cases, no previous injury was recalled and there are psychological factors implicated. It has been found a high prevalence of anxiety and depression in patients with CRPS and it is considered stress has an important role in inducing or perpetuating CRPS. Standard care consists of a multidisciplinary approach with the implementation of intensive physical therapy in conjunction with psychological counseling; in some patients, pharmacological treatments may help to reduce pain.Conclusions A multidisciplinary approach with psychological and psychiatric counseling are needed for effective management of CRPS. Further research in targeting specific mechanisms involved in the pathophysiology of CRPS should lead to prevention of this condition.DisclosureNo significant relationships.