psychological context els vandermeulen - thibaut deprez – leen braem – anne-sofie goemanne –...

PSYCHOLOGICAL CONTEXT

PSYCHOLOGICAL CONTEXT

Els Vandermeulen - Thibaut Deprez – Leen Braem – Anne-Sofie Goemanne – Marianne Verhaegen – Pascaline Gomez (Laëtitia De Wulf) Jean-Marc Hougardy – Virginie Deschamps – Koen Maertens

1. A Review

2. The Psychologist Today

3. Psychopathology and Psychological Problems

4. Research

5. Future

Psychological ContextPsychological Context

20 years ago: • burns : medical-somatical issue• psycho-social problems nurses

80-ies: explosion in UCL• many young victims• priority : medical survive• no time for psychological support

1. A Review1. A Review

• External psychologist• ‘Stranger’• Difficult to approach• ‘Competition’

1. A Review1. A Review

• Several disasters with burn injuries• Medical evolution and improvement• More victims survive burns• Quality of life and well-beingMore recognitio

n of psychological

support

More knowledge of psychological

impact

1. ACUTE STAGE

• Reduce anxiety during painful period• Inform about possible psychological responses that may be

experienced• Inform likely course of the injury and likely course of

recovery

2. SECUNDARY STAGE

• Independency and activity• Self-confidence and self-esteem• Body image concerns• Evaluate excessive avoidance tendencies (PTSD)• Conflict of interests staff – patient• Availability to staff members

2. The Psychologist Today2. The Psychologist Today

3. REHABILITATION STAGE

A new range of stressors develop after the patient returns home

• Identify patients requiring psychological intervention• Ongoing support for parents and family

family becomes the primary care giver

• Psychiatric disorders Depression Anxiety disorders (e.g. PTSD)

• Neuropsychological• Social interaction• Sexual and Marital• Generalized Anxiety• …

3. Psychopathology and Psychological Problems3. Psychopathology and Psychological Problems

1. Exposure to a traumatizing event2. The traumatic event is persistently re-experienced 3. Persistent avoidance of stimuli associated with the

trauma and numbing of general responsiveness4. Persistent symptoms of increased arousal 5. Duration of the disturbance (symptoms) is more than 1

month 6. The disturbance causes clinically significant distress or

impairment in social, occupational, or other important areas of functioning

1 American Psychiatric Association,Diagnostical and Statistical Manualof Mental Disorders (DSM-IV), 1994


POST-TRAUMATIC STRESS DISORDER:DSM-IV criteria1

POST-TRAUMATIC STRESS DISORDER:

Destruction of Basic Assumptions of Life:

•

feelings of predictability, controlability

and safety

•

illusion of being untouchable

Integration of the traumatic event• Post-trauma:

re-experiencing of the trauma avoidance of triggers related to the trauma

• Modify intern schemes (about self, others, world, future)

Prevention of PTSD• Adequate pain management• Creation of a predictable, controlable environment

• No evidence-based psychological interventions in acute

stage


Remarks• Physical harm is not necessary for PTSD• Witnessing an event with feelings of intense fear,

helplessness, or horror can lead to (symptoms of) PTSD• Initial stress-reaction is a ‘normal’ reaction in an ‘abnormal’

situation• Not every trauma causes PTSD• Not every trauma victim develops PTSD


Risk factors• Inadequate coping strategies• Psychiatric comorbidity• Neurotical personality structure• Localisation of burns (face, hands)• (Perception of) responsability • Extreme pain/anxiety during hospitalization• Women


• Prospective and logitudinal Dutch-Belgian research

Ghislenghien(n=30) Reference group(n=300)

Age 39,7 38# operations 4,9 1,3# days in BU 64,4 24TBSA 35,5 13% Men 86 76

Impact of Event Scale (IES): re-experience and avoidance

Incidence and Evolution of Trauma-Related Stress


05

101520253035404550

2wk 3md 6md 12md

PTS

AS

No PTS

Mean IES

Cut-off

67 %

18 %

15 %

Time post burn


0

5

10

15

20

25

30

35

40

2wk 3md 6md 12md 24md

Gellingen

Ref

Time Post Burn

Mean IES


CONCLUSIONS² :

Disaster: more psychological impact Need for psychological treatment: evident at 3 - 6 months

PB Delayed onset: onset of symptoms ≥ 6m after the stressor Psychosocial support at long term is indispensable


² Van Loey, N., Reynders, C., Faber, A. Posttraumatische stress-symptomen bij slachtoffers met ernstige brandwonden. ANPI-Magazine, september 2005, n° 176

Ongoing studies concerning PsychosocialConsequences of Burns in Children

1. Impact of Burn Camps on the psychosocial development of the

child and the experience of the parents4 in collaboration with NBC

2. Impact of Thermal Cures on scar formation4 in collaboration with Pinocchio

3. Vertical follow-up4 medical, psychological and functional screening from 2y PB until the age of 18 in collaboration with Greet Rouffaer Huis

4. Prospectif child study5 VSBN in collaboration with Belgian Burn Centers

4. Research4. Research

4 Maertens, K. – Scientist – VUB – in co-operation with the Belgian Burn Centers

5 Van Loey, N., Protocol kinder-onderzoek: gedragsproblemen en levenskwaliteit bij kinderen met brandwonden. 2007.

September 2006 : start workgroup psychologists of Belgian burn units meetings every 3 months discussion of items related to psychosocial issues in burn care

5. Future5. Future

Some goals• Standardized and structured approach in order to come to

uniform guidelines for psychosocial support for patient and family

• National network of psychologists• First-schoolday project• Return-to-work project

• Antwerpen: Leen Braem• Brussels: Els Vandermeulen Thibaut Deprez• Gent: Anne-Sofie Goemanne

Hanne Hendrickx (1/12/07)

• Leuven: Marianne Verhaegen• Liège: Jean-Marc Hougardy

Virginie Deschamps• Loverval: Pascaline Gomez

Laëtitia De Wulf• Scientist VUB: Koen Maertens

Psychologists Belgian Burn Centers

Psychologists Belgian Burn Centers

psychological context els vandermeulen - thibaut deprez – leen braem – anne-sofie goemanne –...

Documents

psychological interventions

review slide

untouchable slide

traumatic event posttrauma

trauma victim

trauma avoidance of

primary care giver slide

acute stage