Psychological care in trauma patients.
The clinician manages trauma patients in the emergency room, operation theatre, intensive care unit and trauma ward with an endeavour to provide best possible treatment for physical injuries. At the same time, it is equally important to give adequate attention to behavioural and psychological aspects associated with the event. Knowledge of the predisposing factors and their management helps the clinician to prevent or manage these psychological problems. Various causes of psychological disturbances in trauma patients have been highlighted. These include pain, the sudden and unexpected nature of events and the procedures and interventions necessary to resuscitate and stabilise the patient. The ICU and trauma ward environment, sleep and sensory deprivation, impact of injury on CNS, medications and associated pre-morbid conditions are also significant factors. Specific problems that concern the traumatised patients are helplessness, humiliation, threat to body image and mental symptoms. The patients react to these stressors by various defence mechanisms like conservation withdrawal, denial, regression, anger, anxiety and depression. Some of them develop delirium or even more severe problems like acute stress disorder or post-traumatic stress disorder. Physical, pharmacological or psychological interventions can be performed to prevent or minimise these problems in trauma patients. These include adequate pain relief, prevention of sensory and sleep deprivation, providing familiar surroundings, careful explanations and reassurance to the patient, psychotherapy and pharmacological treatment whenever required.
Mohta
Medha
M
Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi 110095, India. medhamohta@hotmail.com
Sethi
A K
AK
Tyagi
Asha
A
Mohta
Anup
A
D000223:Adaptation, Psychological; D000671:Amputation, Surgical / Q000523:psychology; D000928:Antidepressive Agents / Q000627:therapeutic use; D006259:Craniocerebral Trauma / Q000523:psychology / Q000628:therapy; D003674:Defense Mechanisms; D004644:Emotions; D005192:Family Health; D005260:Female; D006801:Humans; D008297:Male; D011613:Psychotherapy / Q000379:methods; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000523:psychology / Q000628:therapy; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D040701:Stress Disorders, Traumatic, Acute / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000523:psychology* / Q000628:therapy
D000928:Antidepressive Agents