Cukor Judith, Wyka Katarzyna, Leahy Nicole, Yurt Roger, Difede JoAnn
From the *Department of Psychiatry, Weill Cornell Medical College, New York, New York; †NewYork Presbyterian Hospital, New York, New York; ‡Epidemiology and Biostatistics Program, City University of New York School of Public Health, New York, New York; §Department of Nursing, New York Presbyterian Hospital; and ‖Department of Surgery, Division of Burns, Critical Care and Trauma, Weill Cornell Medical College.
J Burn Care Res. 2015 Jan-Feb;36(1):184-92. doi: 10.1097/BCR.0000000000000177.
Burn injuries are unique in their medical and psychological impact, yet there has been little exploration of psychiatric treatment for this population. This uncontrolled pilot study assessed feasibility, acceptability, and preliminary efficacy of a treatment protocol designed to address posttraumatic stress disorder, depression, coping with scarring, and community integration among adult burn survivors. A 14-session, manualized treatment protocol was created using cognitive-behavioral interventions including imaginal exposure, behavioral activation, cognitive restructuring, modeling, and in vivo exposure. Responses were measured using the Clinician Administered PTSD Scale, Beck Depression Index, Community Integration Questionnaire, Oswestry Disability Questionnaire, and Burn Specific Health Scale. Nine of 10 enrolled patients (60% women; mean = 42 years old) completed treatment. Burn size was 0.5% to 65%; mechanism of injury included flame (4), scald (5), and contact (1) burns. Mean acute hospitalization was 30.1 days (range = 13-87); mean time from injury to treatment was 3.2 months (range = 1-7). Baseline mean posttraumatic stress score was 68 on the Clinician Administered PTSD Scale (severe); scores decreased by 36% to a mean of 45.3 at posttreatment, with a large effect size. Baseline self-reported depression was 21 (moderate) on the Beck Depression Index, decreasing by 47% to a mean of 12 posttreatment (nonclinical). Change in community reintegration score was significant and large, and body image showed significant improvement. The protocol showed promise in the treatment of posttraumatic stress disorder, depression, self-image, and community reintegration following burn injury. These findings suggest that coping may improve with treatment and symptoms should not be dismissed as unavoidable consequences of burn injury.
烧伤在医学和心理影响方面具有独特性，但针对这一群体的精神治疗探索却很少。这项非对照性试点研究评估了一种治疗方案的可行性、可接受性和初步疗效，该方案旨在解决成年烧伤幸存者的创伤后应激障碍、抑郁、应对疤痕以及融入社区等问题。使用认知行为干预措施创建了一个为期14节的标准化治疗方案，包括想象暴露、行为激活、认知重构、示范和现场暴露。使用临床医生管理的创伤后应激障碍量表、贝克抑郁量表、社区融入问卷、奥斯威斯残疾问卷和烧伤特异性健康量表来测量反应。10名登记患者中有9名（60%为女性；平均年龄42岁）完成了治疗。烧伤面积为0.5%至65%；受伤机制包括火焰烧伤（4例）、烫伤（5例）和接触性烧伤（1例）。平均急性住院时间为30.1天（范围 = 13 - 87天）；从受伤到治疗的平均时间为3.2个月（范围 = 1 - 7个月）。临床医生管理的创伤后应激障碍量表上的基线创伤后应激平均评分为68分（重度）；治疗后评分下降了36%，平均降至45.3分，效应量较大。贝克抑郁量表上的基线自我报告抑郁评分为21分（中度），治疗后下降了47%，平均降至12分（非临床）。社区重新融入得分的变化显著且幅度大，身体形象也有显著改善。该方案在治疗烧伤后的创伤后应激障碍、抑郁、自我形象和社区重新融入方面显示出前景。这些发现表明，通过治疗应对能力可能会提高，症状不应被视为烧伤不可避免的后果而被忽视。
