Ingles 2
American Journal of Clinical Dermatology
April 2003, Volume 4,
Issue 4
, pp 245272
Psychopathology and Psychological
Problems in Patients with Burn Scars
●
Nancy E. E. Van Loey
,
●
Maarten J. M. Van Son
Abstract
Burn injury is often a devastating event with longterm physical and psychosocial effects. Burn scars after deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in
body appearance. In addition, the traumatic nature of the burn accident and the painful treatment may
induce psychopathological responses.
Depression and posttraumatic stress disorder (PTSD), which are prevalent in 13–23% and 13–45% of
cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are preburn depression and female gender in combination with facial disfigurement. Risk factors
related to PTSD are preburn depression, type and severity of baseline symptoms, anxiety related to pain,
and visibility of burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social problems include difficulties in sexual life and social interactions. Quality of life
initially seems to be lower in burn patients compared with the general population. Problems in the mental
area are more troublesome than physical problems. Over a period of many years, quality of life was reported
to be rather good. Mediating variables such as low social support, emotion and avoidant coping styles, and personality traits such as neuroticism and low extraversion, negatively affect adjustment after burn injury.
Few studies of psychological treatments in burn patients are available. From general trauma literature, it is
concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors)
interventions have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement reprocessing and desensitization are successful. Psychological debriefing aiming to prevent
chronic posttrauma reactions has not, thus far, shown a positive effect in burn patients. Treatment of
problems in the social area includes cognitivebehavioral therapy, social skills training, and community
interventions. Sexual health promotion and counseling may decrease problems in sexual life. In conclusion, psychopathology and psychological problems are identified in a significant minority of burn
patients. Symptoms of mood and anxiety disorders (of which PTSD is one) should be the subject of
screening in the postburn phase and treated if indicated. A profile of the patient at risk, based on preinjury
factors such as premorbid psychiatric disorder and personality characteristics, peritraumatic factors and postburn factors, is presented. Finally, objective characteristics of disfigurement appear to play a minor role,
although other factors, such as proneness to shame, body image problems, and lack of selfesteem, may be
of significance.
Problemas Psicopatología y Psicología
en pacientes con cicatrices de quemaduras
Abstracto Lesiones por quemadura es a menudo un evento devastador con efectos físicos y psicosociales a largo
plazo. Grabar cicatrices después de una lesión dérmica profunda son cosméticamente desfigurando y
obligar a la persona marcada para hacer frente a una alteración en la apariencia del cuerpo. Además, la
naturaleza traumática del accidente quemadura dolorosa y el tratamiento puede inducir respuestas
psicopatológicos. La depresión y el trastorno de estrés postraumático (TEPT), que son frecuentes en 1323% y el 1345% de
los casos, respectivamente, han sido las áreas más comunes de la investigación en pacientes con
quemaduras. Los factores de riesgo relacionados con la depresión son la depresión preburn y el sexo
femenino en combinación con desfiguración facial. Los factores de riesgo relacionados con el trastorno de ...
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