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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. Psychological Context. A Review The Psychologist Today

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PSYCHOLOGICAL CONTEXT

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  1. 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

  2. Psychological Context • A Review • The Psychologist Today • Psychopathology and Psychological Problems • Research • Future

  3. 1. A Review 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

  4. 1. A Review • External psychologist • ‘Stranger’ • Difficult to approach • ‘Competition’ • More recognition of psychological support • More knowledge of psychological impact • Several disasters with burn injuries • Medical evolution and improvement • More victims survive burns • Quality of life and well-being

  5. 2. The Psychologist Today 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 • 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

  6. 3. Psychopathology and Psychological Problems • Psychiatric disorders • Depression • Anxiety disorders (e.g. PTSD) • Neuropsychological • Social interaction • Sexual and Marital • Generalized Anxiety • …

  7. 3. Psychopathology and Psychological Problems • Destruction of Basic Assumptions of Life: • feelings of predictability, controlability and safety • illusion of being untouchable POST-TRAUMATIC STRESS DISORDER: POST-TRAUMATIC STRESS DISORDER: DSM-IV criteria1 • Exposure to a traumatizing event • The traumatic event is persistently re-experienced • Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness • 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 Manual of Mental Disorders (DSM-IV), 1994

  8. 3. Psychopathology and Psychological Problems  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

  9. 3. Psychopathology and Psychological Problems • 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

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

  11. 3. Psychopathology and Psychological Problems Incidence and Evolution of Trauma-Related Stress • 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 24 TBSA 35,5 13 % Men 86 76  Impact of Event Scale (IES): re-experience and avoidance

  12. 3. Psychopathology and Psychological Problems Mean IES 15 % Cut-off 18 % 67 % Time post burn

  13. 3. Psychopathology and Psychological Problems Mean IES Time Post Burn

  14. 3. Psychopathology and Psychological Problems CONCLUSIONS² :  Disaster: more psychological impact  Need for psychological treatment: evident at3 - 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

  15. 4. Research Ongoing studies concerning Psychosocial Consequences 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 collaborationwith 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 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.

  16. 5. Future September 2006 : start workgroup psychologists of Belgian burn units  meetings every 3 months  discussion of items related to psychosocial issues in burn care • 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

  17. Psychologists Belgian Burn Centers • 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

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