Psychiatry of the medically ill in the burn unit.

Clinical experience and burn survivor testimony show that the experience of being burned can be associated with catastrophic stress and lead to drastic permanent body image changes from scarring and limb-function loss. Close relatives, if not killed in the fire, often also experience clinically significant bystander stress. Closeness of relationships may be lost, and self-image may suffer. Property damage and loss of crucial resources may be associated with fires. Although many burns result from accidents, most result from preventable causes associated with psychiatric disorders, which include mood disorders, psychoses, cognitive disorders, and substance-use disorders. Burns then result from: Deliberate self-harm Impaired judgment and poor coordination associated with substance intoxication Risk-taking behavior Poor supervision of children and impaired elderly persons Careless handling of flammable materials. Many clinical syndromes, such as delirium, ASD, acute psychosis, suicidality, and pain need to be addressed by the consulting psychiatrist to facilitate surgical treatment of the burn injury. Other psychiatric disorders, such as PTSD, major depression, and adjustment disorder, need to be treated to expedite long-term adjustment. Hospital length of stay and RTW/RTS are major outcome variables. The psychiatry consultant can positively affect both variables substantially using both pharmacologic and psychosocial measures. The important role of psychiatric issues both before and after burn injury support the need for more consistent and comprehensive medical insurance coverage for psychiatric consultation to burn units and clinics. Burn Support Groups are an invaluable asset.