ABSTRACT
Major electrical injury causes widespread tissue destruction. Slow and incomplete functional recovery after electrocution-type injury has led clinicians to suspect residual brain damage. One hundred and one consecutive patients who were admitted to the hospital because of electrical injury were studied. Forty-eight had electric-current injury. The other 53 had flash, contact, or arcing burns (electrical injury without passage of current). A primary study cohort of 16 patients with electric-current injury and 18 patients who had electrical injury without passage of current received specialized trauma-based psychiatric treatment, which was coordinated with serial auditory and neurologic studies. This strategy served to highlight discrepancies between preinjury and postinjury performance. Twelve of 16 patients with electric-current injury showed neurobehavioral (organic) dysfunction after 1 year, which implied brain damage; eight showed persistent auditory changes. Four of 18 patients who had electrical injury without passage of current met criteria for post-traumatic stress disorder after 1 year; none had neurobehavioral or auditory dysfunction. These findings indicate that patients with electric-current injury are at risk for permanent auditory dysfunction and brain damage, whereas those with other types of electrical burns are not.
Subject(s)
Brain Damage, Chronic/etiology , Burns, Electric/psychology , Tinnitus/etiology , Adult , Brain Damage, Chronic/diagnosis , Brain Damage, Chronic/epidemiology , Burns, Electric/epidemiology , Cohort Studies , Female , Follow-Up Studies , Hearing Tests , Humans , Male , Middle Aged , Neuropsychological Tests , Risk Factors , Time Factors , Tinnitus/diagnosis , Tinnitus/epidemiologyABSTRACT
Volitional collapse, or loss of the will to live, remains one of the most vexing of the various system failures complicating serious illness or injury. It resembles, but is distinguishable from, major depression. Two features of volitional collapse may sometimes be turned to therapeutic advantage: it releases the patient from a struggle that may be dissipating already depleted energy reserves, and it transfers survival responsibility from one who has given up to others who have not. Preferred treatment involves carefully orchestrated initiatives from the patient's physician, closest friend, and spouse; their leverage derives from traditional sources, most importantly psychologic transference, bonding, and conjugal commitment. A burn unit provides an ideal environment in which to study the disorder and its response to treatment.
Subject(s)
Burns/psychology , Mood Disorders/therapy , Volition , Adult , Burns/complications , Humans , Interpersonal Relations , Male , Marriage , Mood Disorders/etiologySubject(s)
Burns/psychology , Multiple Organ Failure , Volition , Attitude to Health , Counseling , Humans , Physician-Patient RelationsABSTRACT
Major burn trauma is ordinarily associated with psychological regression, which regularly assumes either an immature, dependent (childlike), or primitive (animal-like) form. Also, the severely burned patient is exquisitely responsive, both constructively and destructively, to behavioral nuances in his or her "significant other," typically, the spouse. Two variables, type of regression and marital status, provide an empirically derived rationale for the psychiatric treatment of behavioral problems affecting patient management, including especially (1) pain-related behavior, (2) intrusive reexperiencing of the trauma, (3) depletion/despair phenomena, and (4) problems related to scarring. Results are more favorable when regression is of the dependent type rather than primitive type. Treatment is enhanced when the partner in a committed relationship is included in the treatment program.
Subject(s)
Burns/psychology , Marriage , Regression, Psychology , Adolescent , Adult , Aged , Burns/therapy , Cicatrix/psychology , Depression/psychology , Humans , Male , Pain/psychology , Psychotherapy, Multiple/methodsABSTRACT
Three instances of inappropriate ADH syndrome following craniofacial operations are reported. The cornerstone to diagnosis is careful fluid and electrolyte monitoring. Treatment consists of fluid restrictions in the acute phase and demeclocycline for refractory cases. Seizures should be symptomatically treated. Surgeons involved in the care of craniofacial anomalies must be aware of this syndrome because the symptoms closely mimic those commonly observed following intracranial procedures. If unrecognized, the consequence is potentially lethal.
