Psychological Care in Trauma Patients

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Psychological Care in Trauma Patients

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Content of Topics

• Introduction
• Causes of psychological problems
• Symptoms of ICU psychosis
• Psychological reactions
• Assessment
• Interventions to prevent psychological problems
• Management of PTSD/ASD
• Specific patient groups
• Families of trauma patients
• Conclusions

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Introduction

• What is ICU psychosis?
• ICU psychosis is ICU syndrome.
• ICU psychosis is also a form of delirium, or
  acute brain failure.
• How long does ICU psychosis last?
• it may last 24 hours or even up to two weeks
  with fluctuations of the level of consciousness
  and behavior patterns.

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Causes of psychological problems

• Sudden and unexpected nature of events
• Pain
• ICU environment
• Other factors .The loss of control over their
  lives that patients often feel in an ICU.

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What causes ICU psychosis?

• Environmental Causes
• Sensory deprivation (being put in a room often
  without windows, away from family, friends and
  all that is familiar)
• Sensory overload (being tethered to noisy
  machines day and night)
• Sleep disturbance and deprivation
• Continuous light levels
• Stress
• Lack of orientation
• Medical monitoring

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What causes ICU psychosis?

• Medical Causes
• Pain (which may not be adequately controlled in
  an ICU)
• Critical illness The pathophysiology of the
  disease, illness or traumatic event - the stress
  on the body during an illness can cause a variety
  of symptoms.
• Medication (drug) reaction or side effects
• Infection creating fever and toxins in the body.
• Metabolic disturbances electrolyte imbalance,
  hypoxia (low blood oxygen levels), and elevated
  liver enzymes.
• Heart failure (inadequate cardiac output)
• Cumulative analgesia (the inability to feel pain
  while still conscious)
• Dehydration

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Symptoms of ICU psychosis

• extreme excitement
• anxiety
• restlessness
• hearing voices
• clouding of consciousness
• hallucinations
• nightmares
• paranoia
• disorientation
• agitation
• delusions
• abnormal behavior
• fluctuating level of consciousness which include
  aggressive or passive behavior.

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Specific problems threatening traumatised patient

• Helplessness
• Humiliation
• Body image
• Mental symptoms

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Psychological reactions

• Conservation withdrawal
• Denial
• Regression
• Anger
• Anxiety
• Depression
• Grief
• (Denial,bargaining,anger,depression and
  acceptance )

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Assessment

• Impact of event scale (IES) a self-report 15-item
  scale
• Clinician administered PTSD scale (CAPS) 30-item
  structured interview
• Brief symptom inventory (BSI)
• Structured clinical Interview for DSM-IV
  disorders (SCID-IV)
• Post-traumatic diagnostic scale (PTDS)
• Davidson trauma scale (DTS)
• Mississippi scale for post-traumatic stress
  disorder(MISS)

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Can ICU psychosis be prevented?

• using more liberal visiting policies
• providing periods for sleep
• protecting the patient from unnecessary
  excitement
• minimizing shift changes in the nursing staff
  caring for a patient, orienting the patient to
  the date and time
• reviewing all medical procedures with an
  explanation about what to expect
• asking the patient if there are any questions or
  concerns
• talking with the family to obtain information
  regarding religious and cultural beliefs, and
• even coordinating the lighting with the normal
  day-night cycle, etc.

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Interventions to prevent psychological problems

• Pain control?analgesic drugs
• Liberal reassurance
• Family support
• Day-awake,night-asleep
• Removing many wires and tubes
• Constant and monotonus sounds like that of an air
  conditioner should be minimished.
• Large clock,calendar and and outside window
  visible to the patients to help with
  orientation.
• Personally familiar beside objects such as
  clock,radio or family photographs.
• Use spectacles or hearing aids. Such as radio or
  television sets to provide meaningful sensory
  stimuli
• The atmosphere created by staff members can be
  made more supportive.
• Repeated explanations or instructions may become
  necessary due to deficit in recent memory.
• Medical discussions should be avoided.
• Social support to overcome their financial
  problems.

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Management of PTSD/ASD

• Psychotherapy
• Cognitive-behavioural therapy(CBT) ,includes
  exposure procedures , cognitive restructuring
  procedures , Anxiety Management programs
• Pharmacotherapy
• Tricyclic antidepressants and MAO inhibitors
• Selective serotonin reuptake inhibitors (SSRIs)
  and serotonin antagonist and reuptake
  inhibitors(SARIs)

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Specific patient groups

• Head injured patients
• rehabilitation starts within first 6 months
• Patients with spinal cord injury
• kinetic therapy , regarding sexual relations and
  functioning should be dealt with honestly.
• Patients with amputated limbs
• Psycho-therapeutic interventions , vocational
  retraining

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• Thanks for your attention.

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Death and dying

• It becomes a demanding task on the part of the
  treating clinician to support a patient who is
  confounded by the fear of being alone and in
  pain.

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Families of trauma patients

• Intervention strategies
• Two-way commumication
• Honest information
• Regular meetings with family
• Message board can be provided outside ICU or
  trauma ward
• Written information
• Waiting area should be well-lit and comfortable
  with windows,telephone,coffee and vending
  machines

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Conclusions

• It is the responsibility of the treating
  personnel to comprehend the psychological effects
  of trauma in patients and their families, and to
  take necessary steps to prevent and treat these
  through knowledge, skill and understanding.