الفهرس 
BurnOnly 14 pages are availabe for public view
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Abstract
Burn is a traumatic injury to the skin or other organic tissue due to energy transfer
most commonly in the form of heat (thermal burn).This may be a consequence of
exposure to flames or scalding liquids through direct contact, inhalation or radiation.
There are other special types of burn like electrical and chemical burn.
Psycological distress among people who have sustained burns is common. The
time taken for burn wounds to heal can not be fully explained by physical factors such as
burn type, wound size and depth only. Clinicians should not ignore the importance of
psycological influences on the wound healing process and also give consideration to the
potential for psycological rehabilitation to lessen patients’ distress and improve wound
healing outcomes.
Few areas of medicine are as challenging medically and surgically as burn care.
Burn injuries affect the very young and the very old, both men and women. Burn injuries
can vary from small wounds that can be easily managed in the outpatient clinic to
extensive injuries resulting in multiorgan system failure, a prolonged hospital stay and
long term functional and psychosocial sequelae.
As the major burn patient suddenly faces pain, loss of control, fear and the
demands of burn rehabilitation, psychiatric disorders begin to arise such as depression,
anxiety and losing the will of living. And with time and neglecting dealing with these
disorders, wound healing and recovery are negatively affected in comparison to normal
population and even to trauma population.
Aim of this study is to assess psychiatric status of burn patients during
hospitalization, determination of psycological intervention methods and observation of
impact of psycological rehabilitation on healing of burn patients.
Burns are tissue damage that results from heat, overexposure to the sun or other
radiation, or chemical or electrical contact. Burns can be minor medical problems or lifethreatening
emergencies. The treatment of burns depends on the location and severity of
the damage. Sunburns and small scalds can usually be treated at home. Deep or widespread
burns need immediate medical attention. Some people need treatment at specialized burn
centers and months long follow-up care.
The burn injured patient is distinctive in resuscitation requirements, metabolic
stress, pattern of complications, and determinants of outcome when compared with other
forms of trauma. Fluid resuscitation in burn patients is critical.
Psychological distress is among the most frequent and debilitating complications
post-burn injury. Preliminary reports using the Burn Model System (BMS) dataset
indicated that one-third of patients with major burns had clinically significant
psychological distress at the time of discharge.
The impact of psychological factors on wound healing has been recently a basic
corner in developing recent strategies of burn treatment, as it is an aspect that has been
poorly covered in older strategies; but has been found to have great influence on burn
healing, especially in major burn patients.
Summary
55
Pain is another serious problem for burn survivors, particularly during the early
phases of burn care when open wounds are being subjected to debridement and movement
therapies. In addition, pain remains a concern for years after burn injury wounds have
closed.
Burn survivors may deal with diverse psychosocial issues in the recovery from a
major burn injury. Common concerns include adapting to physical limitations and
permanent changes; dealing with grief and loss; experiencing traumatic stress, anxiety,
pain, sleep disturbance, depression, and body image concerns; and other adjustment
issues. Approximately 30% of survivors experience long-term psychosocial difficulties.
The present non-randomized, prospective, cohort study was conducted on 40
injured patients with partial or full-thickness burns that attend burn unit of Plastic Surgery
Department, Menoufia University Hospital between January and December 2019.
Studied populations were divided into two groups:
group A (case group): 21 patients who received psychological support in the form
of psychotherapy sessions, pain control methods and social support.
group B (control group): 19 patients with usual burn care.
Both groups will be examined psychologically by Beck depression inventory
scoring scale and Zung self-rating anxiety scale two times the first one at the first 48 hours
and the second one before discharge.
Furthermore, Case group will have psychological support in the form of
psychotherapy sessions, pain control methods and social support.
Statistical methods: Data were collected, tabulated, statistically analyzed using an
IBM personal computer with Statistical Package of Social Science (SPSS) version 20 and Epi
Info 2000 programs, where the following statistics were applied.
Treatment of people with burn injuries includes recovery of optimal function for
survivors to fully participate in society, psychologically and physically. Increased likelihood
of physical survival has led to greater concern for potential psychological morbidity for the
burn survivor.
The impact of psychological factors on wound healing is an important and interesting
field of research. There is sound evidence to demonstrate that the effects of psychological
stress on wound healing are significant. The number of recently published reviews that focus
on psychological influences on wound healing, post-surgical recovery and psychological
interventions that have impacted on healing is in growing interest.
In the present study, most of the patients had scaled burn (55%) and the mean burn
surface area was 18.45 ±8.51%. The majority of the patients had mixed burn degree (57.5%).
So far, the Beck Depression Inventory-II (BDI-II) has become one of the most
widely used measures to assess depressive symptoms and their severity in adolescents
and adults. The BDI-II is a 21-item self-report measure that taps major depression
symptoms according to diagnostic criteria listed in the Diagnostic and Statistical Manual
for Mental Disorders. Items are summed to create a total score, with higher scores
indicating higher levels of depression. It is worth noting that the BDI-II is not only
extensively applied for research purposes but also in clinical practice, being the third test
most used among Spanish professionals.
In the present study, we used BDI-II to assess depressive symptoms among patients
affected by burn. Before the psychological interventions, we found that the mean BDI was 27.7
±16.2; 40% of the patients had moderate depression and 20% had severe depression.
Summary
56
The Zung Self-Rating anxiety Scale (ZSRAS) is a commonly utilized norm-referenced
scale. The ZSRAS is a 20-item Likert scale covering symptoms that were identified in factor
analytic studies of the syndrome of anxiety. Items tap psychological and physiological
symptoms and are rated by respondents according to how each applied to them within the past
week, using a 4-point scale ranging from 1 (none, or a little of the time) to 4 (most, or all of the
time). The scale has a raw score range of 20 to 80 points. The raw score is then converted to an
index score by dividing the raw score by the maximum score (80) and either expressing this as
a decimal or multiplying by 100 to express it as a whole number with an index score range of
25 to 100. Index scores of 25 to 49 indicate nil anxiety, 50–59 indicate mild to moderate anxiety,
60–69 indicate moderate to severe anxiety, and scores over 70 indicate severe anxiety.
In the present study, in the pre-intervention period, we found that the mean SDS was
47.7 ±18.4; 35% of the patients had mild-to-moderate anxiety.
With regard to BDI-II score after the intervention, we found that there was statistically
significant difference between studied groups in terms of BID score at the end of follow-up
(p =0.0045), with higher score in patients with no psychological support. On the other hand,
there was no statistically significant difference between studied groups in terms of rate of
BDI category (p =0.32).
It was also noted that study group patients improved clinically with psychological
rehabilitation in many ways such as patient’s compliance for treatment and wound care,
significant decrease in the dosage of analgesics needed by the patient and shorter hospital stay
period.
To the best of our knowledge, our study is the first trial of its kind that assessed
the role of psychological intervention on depression during hospitalization of burn
patients.
A number of studies have demonstrated a link between psychological distress and
longer hospital stays following a burn injury, where longer stays are taken to indicate
longer wound healing time.
In our study, we found that there was significant difference between studied
groups in terms of hospital stay (p =0.001), with shorter hospital stays among patients
receiving psychological support.
In conclusion, Psychological interventions appear to effectively reduce burn
patient psychological morbidities. We demonstrated that psychological interventions
significantly reduce the risk of depression, anxiety, and hospital stay compared to usual
care. These findings are very important as it confirms the promising role of psychological
interventions in burn patients. Nevertheless, further studies with rigorous design, large
sample size and multiregional cooperation are required.
Our recommendation is psychiatrist interventions are effective options for
reducing psychiatrist comorbidities of burn patients. Therefore, we recommend further
progress towards the development of the highest standards of both psychiatrist and
medical care for patients and their families.