[The psychological and psychiatric care for the children after severe spinal cord injury in the framework of the combined early rehabilitative treatment]. / Psikhologicheskaia i psikhiatricheskaia pomoshch' detiam posle tiazheloi pozvonochno-spinnomozgovoi travmy v ramkakh kompleksnogo podkhoda k rannei reabilitatsii.

ABSTRACT

BACKGROUND: The number of children who have received severe spinal cord injury (SCI) is steadily increasing during the recent years. The clinical picture of the post-injury condition is characterized by psychological and psychiatric disorders of varying severity. The literature publications concern emotions experienced after SCI by the adult patients whereas the data on the emotional disorders in the children and the approaches to their medical treatment are virtually absent. Nor is enough information about the status of the children in the early period after the spinal trauma treated jointly by a psychiatrist and a psychologist. AIM: The objective of the present study was the evaluation of the emotions and motivations in the children following the severe spinal trauma in the course of the early rehabilitation period as well as the development of an algorithm for the interaction of a psychiatrist and a psychologist in their joint efforts to manage the emotional and motivational disorders. MATERIAL AND METHODS: The study included 35 children at the age from 8 to 18 years presenting with the severe spinal trauma who had been admitted for the treatment and rehabilitation based at the Research Institute of Emergency Pediatric Surgery and Traumatology, Moscow Health Department, during the period from 2016 to 2018. All the patients were examined by a psychiatrist and a psychologist in dynamics, viz. before the beginning of the rehabilitation course as well as within the 7-10th and 21-25th days after its initiation. The relevant diagnostic scales and questionnaires were used to detect depression and assess the severity of individual symptoms. RESULTS: Three groups of children who had experienced the severe spinal trauma were distinguished depending on the character of emotional disorders and their severity. Group 1 was comprised of the children with depression (n=6) including 2 boys and 4 girls at the age from 14 to17 years (17.2%). Group 2 consisted of the children with emotional disorders, such as high anxiety, impaired motivation with sub-depressive prerequisites (n=11) including 4 girls and 7 boys at the age from 12 to16 years (31.4%). Group 3 was composed of the children free from depression or depressive manifestations (n=18) including 15 boys, 3 girls at the age from 8 to17 years (51.4%). The algorithm for the combined rehabilitative treatment of the children during the early period after the severe spinal trauma with the participation of the psychiatrist and the psychologist has been developed. It was shown that the patients with a reduced intensity of emotional expression combined with a moderate or low level of anxiety and sufficient motivation needed the supervision by the psychologist alone. The children with a reduced intensity of emotional expression combined with a moderate or high level of anxiety and impaired motivation had to be supervised and treated by both the psychiatrist and the psychologist. The children with pronounced depression, high anxiety and low motivation required the supervision and treatment by a psychiatrist with simultaneous pharmacological correction of their condition. CONCLUSION: The results of this study give evidence that 48.6% of the children after severe spinal trauma suffer from the emotional and motivational disorders requiring specialized psychiatric care including the differentiated psychological and psychiatric treatment during the early rehabilitation period with the use of the algorithm for the combined treatment based on the joint efforts of the psychiatrist and the psychologist supplemented by the pharmacological correction.