RESUMO
The child with burns suffers severe pain at the time of the burn and during subsequent treatment and rehabilitation. Pain has adverse physiological and emotional effects, and research suggests that pain management is an important factor in better outcomes. There is increasing understanding of the private experience of pain, and how children benefit from honest preparation for procedures. Developmentally appropriate and culturally sensitive pain assessment, pain relief, and reevaluation have improved, becoming essential in treatment. Pharmacological treatment is primary, strengthened by new concepts from neurobiology, clinical science, and the introduction of more effective drugs with fewer adverse side effects and less toxicity. Empirical evaluation of various hypnotic, cognitive, behavioral, and sensory treatment methods is advancing. Multidisciplinary assessment helps to integrate psychological and pharmacological pain-relieving interventions to reduce emotional and mental stress, and family stress as well. Optimal care encourages burn teams to integrate pain guidelines into protocols and critical pathways for improved care.
Assuntos
Queimaduras/fisiopatologia , Dor/fisiopatologia , Dor/psicologia , Cuidados Paliativos , Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Anestésicos Dissociativos , Ansiolíticos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Benzodiazepinas , Criança , Pré-Escolar , Humanos , Hipnóticos e Sedativos/uso terapêutico , Lactente , Dor/tratamento farmacológico , Medição da Dor , Respiração Artificial , Expansão de Tecido , Desmame do RespiradorRESUMO
OBJECTIVE: This study attempted to determine the prevalence of somatic symptoms, somatization disorder, and medical interventions in patients with dissociative disorders. METHOD: Fourteen psychiatric inpatients with a DSM-III dissociative disorder were matched for age and gender with a comparison group of inpatients who reported few dissociative symptoms. All subjects were interviewed in a blind manner with the Dissociative Disorders Interview Schedule (this semistructured interview schedule includes a section on somatization disorder), and their hospital charts were reviewed to determine somatic symptoms and medical histories. RESULTS: Sixty-four percent of the patients with dissociative disorders met DSM-III criteria for somatization disorder and reported an average of 12.4 somatic symptoms. None of the comparison patients met DSM-III criteria for somatization disorder, and these patients reported an average of 3.1 somatic symptoms. These differences between the two groups were significant. Significant differences were also found in the number of medical hospitalizations and consultations between the two groups. A significant correlation was found between the degree of dissociation and degree of somatization in patients with dissociative disorders. CONCLUSIONS: The authors conclude that somatization disorder is a frequent and serious comorbid disorder among patients with dissociative disorders.
Assuntos
Transtornos Dissociativos/epidemiologia , Transtornos Somatoformes/epidemiologia , Adulto , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Abuso Sexual na Infância/epidemiologia , Comorbidade , Transtornos Dissociativos/diagnóstico , Transtornos Dissociativos/psicologia , Feminino , Hospitalização , Humanos , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologiaRESUMO
OBJECTIVE: This study attempted to determine 1) the prevalence of dissociative disorders in psychiatric inpatients, 2) the degree of reported childhood trauma in patients with dissociative disorders, and 3) the degree to which dissociative experiences are recognized in psychiatric patients. METHOD: A total of 110 patients consecutively admitted to a state psychiatric hospital were given the Dissociative Experiences Scale. Patients who scored above 25 were matched for age and gender with a group of patients who scored below 5 on the scale. All patients in the two groups were then interviewed in a blind manner, and the Dissociative Disorders Interview Schedule, the Traumatic Antecedent Questionnaire, and the posttraumatic stress disorder (PTSD) module of the Structured Clinical Interview for DSM-III-R, Nonpatient Version, were administered. Chart reviews were also conducted on all patients. RESULTS: Fifteen percent of the psychiatric patients scored above 25 on the Dissociative Experiences Scale; 100% of these patients met DSM-III criteria for a dissociative disorder. These patients had significantly higher rates of major depression, PTSD, substance abuse, and borderline personality than did the comparison patients, and they also reported significantly higher rates of childhood trauma. Chart review data revealed that dissociative symptoms were largely unrecognized. CONCLUSIONS: A high proportion of psychiatric inpatients have significant dissociative pathology, and these symptoms are underrecognized by clinicians. The proper diagnosis of these patients has important implications for their clinical course.
