Psychological Distress After Major Burn Injury

Abstract

Objective-To track the prevalence and stability of clinically significant psychological distress and to identify potentially modifiable inhospital symptoms predictive of long-term distress (physical, psychological, and social impairment).Method-We obtained data from the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The Brief Symptom Inventory (BSI) was used to assess symptoms in-hospital (n = 1232) and at 6 (n = 790), 12 (n = 645), and 24 (n = 433) months post burn. Distress was examined dimensionally (BSI's Global Severity Index (GSI)) and categorically (groups formed by dichotomizing GSI: T score ≥63). Attrition was unrelated to inhospital GSI score.Results-Significant in-hospital psychological distress occurred in 34% of the patients, and clinically significant and reliable change in symptom severity by follow-up visits occurred infrequently. Principal components analysis of in-hospital distress symptoms demonstrated "alienation" and "anxiety" factors that robustly predicted distress at 6, 12, and 24 months, controlling for correlates of baseline distress.Conclusions-This is the largest prospective, multisite, cohort study of patients with major burn injury. We found that clinically significant in-hospital psychological distress was common and tends to persist. Two structural components of in-hospital distress seemed particularly predictive of long-term distress. Research is needed to determine if early recognition and treatment of patients with in-hospital psychological distress can improve long-term outcomes.

Puerarin alleviates burn-related procedural pain mediated by P2X3 receptors

“…This rapid response is brought about by sudden increases in sympathetic nervous system activity and endogenous stress hormone levels [14,50]. It has been reported that the secretions of plasma cortisol, adrenocorticotropic hormone, and aldosterone are significantly increased immediately after severe burns, and the extent of this is associated with intensity of stress [14,40].…”

“…Furthermore, the levels of blood glucose, insulin, and cortisol in burn patients are enhanced. In patients with large areas of burn, particularly thirddegree burns, lasting hyperglycemia and hypermetabolism promote secretion from Islets of Langerhans to accelerate glycogenolysis, which elevate blood glucose [14,25,40,51]. Increased levels of cortisols are further associated with enhanced hepatic gluconeogenesis and a reduced insulinmediated glucose uptake into skeletal muscle and adipose tissue [20,44].…”

“…Pain accompanies burns and involves emotion and physical stress and dysregulation of the hypothalamicpituitary-adrenocortical axis and immune system [14,40]. This rapid response is brought about by sudden increases in sympathetic nervous system activity and endogenous stress hormone levels [14,50].…”

“…P2 purinoceptors responding to ATP are divided into ionotropic receptors (P2X, seven types; P2X 1 -7 ) coupled to ion channels and metabotropic receptors (P2Y, eight types; P2Y 1,2,4,6,11,12,13,14 ) coupled to intracellular secondmessenger systems through heterotrimeric G-proteins [6]. P2 receptors expressed in blood cells regulate responses such as cell proliferation, differentiation, chemotaxis, cytokine release, and immune and inflammatory responses [8,11].…”

“…Burn injuries are frequent and disabling problems in most areas of the world [14]. Pain is a major problem after burns [49] and is one of the patients' most serious and persisting complaints.…”