title: Presence of pre-existing psychological comorbidity in a group of facially injured patients: a preliminary investigation.
abstract: OBJECTIVE
  To document the presence and demographics of an adult patient cohort who were identified as having a pre-existing psychiatric condition while being treated for a facial injury.
  
  
  METHODS
  A retrospective medical chart audit was conducted on 300 consecutive patients electing public treatment and subsequently admitted to a tertiary referral teaching hospital with a facial injury over a 21-month period from April 2006 to January 2008. Patients who were recruited into the study were identified as having features suggestive of psychological disturbance sufficient to confirm a pretraumatic psychiatric diagnosis as formally established by psychiatry trained staff.
  
  
  RESULTS
  Of the 300 patients initially included in the study, 16 were subsequently identified as having a psychiatric diagnosis. Most cases attracted dual diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for Axis I and II disorders. The most common were substance abuse/dependence (n = 10), followed by mood disorder (n = 6) and schizophrenia (n = 4). Four patients had a co-occurring personality disorder. No significant correlation between sociodemographic and clinical characteristics and psychological outcomes was identified in this study. Those at risk of psychological deterioration were referred to liaison psychiatry for formal intervention.
  
  
  CONCLUSIONS
  This preliminary study indicates that a small but significant number of patients (5%, n = 16) presented with a demonstrated pretraumatic psychiatric comorbidity. As such, they have some requirement for psychiatric input into their peri- and postoperative care. The broad spectrum of psychiatric disorders that we identified in this study highlights the need for vigilance by surgeons and other health care providers when dealing with facially injured patients and that, where appropriate, early referral to liaison psychiatry for management advice is desirable.
authors.affiliation: Department of General Surgery, Birmingham Heartlands Hospital, Bordesley Green, Birmingham, UK. drshafiqislam@hotmail.co.uk
authors.forename: Shofiq
authors.initials: S
authors.lastname: Islam
authors.forename: Helena
authors.initials: H
authors.lastname: Hooi
authors.forename: Gary R
authors.initials: GR
authors.lastname: Hoffman
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008446:Maxillofacial Injuries / Q000453:epidemiology* / Q000523:psychology*; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology*; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies; D012559:Schizophrenia / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*