Surgical and psychiatric profile of patients who self-harm by burning in a regional burn unit over an 11-year period.

INTRODUCTION: Patients admitted to hospital for deliberate self-harm by burning (DSHB) provide a challenge for medical, surgical and psychological management. We retrospectively reviewed all the patients admitted to a Scottish regional burn unit with DSHB over an 11-year period to assess demographics and outcome. METHODS: Ward admission data were used to identify DSHB patients admitted to the South East Scotland regional burn unit in Livingston, UK between 2002 and 2012, as well as a control group of accidental burn patients. Data were extracted concerning burn injury, psychiatric history and inpatient management. RESULTS: A total of 53 DSHB patients with 58 attendances over the 11-year period were compared to 49 accidental burns patients. Compared to controls, DSHB patients were more likely to be unemployed, live alone and have a previous psychiatric diagnosis (p < 0.01). DSHB patients had more severe burns, a longer hospital stay and were more likely to undergo surgery (p < 0.01). DSHB patients with previous self-harm, suicide attempts and diagnoses of personality and eating disorder all had significantly less severe burns than DSHB patients without these risk factors (p < 0.05). CONCLUSIONS: In our experience, DSHB patients have more severe burn injuries and require longer, resource-intensive hospital stays. Burn units should have an appropriate specialist psychologist/psychiatrist who works within the Burn multi-disciplinary team to help manage this complex group of patients' healthcare needs and reduce their risk of further self-harm.

Does the degree of ptosis predict the degree of psychological morbidity in bariatric patients undergoing reconstruction?

BACKGROUND: There is proven therapeutic benefit in bariatric surgery for obese patients. Successful bariatric surgery will result in massive weight loss and ptotic skin, which can cause significant functional and psychological problems. As the incidence of bariatric surgery increases, so will the demand for plastic surgery. Currently, there is no evidence-based indication for massive weight loss body contouring, and therefore there is no standardized provision. METHODS: A prospective, multicenter, observational study of outcomes in 75 patients undergoing bariatric and plastic surgery procedures at two clinical sites was performed to determine whether the degree of ptosis can be determined by the type (malabsorptive or restrictive) of bariatric surgery and if the extent of disfigurement has an impact on psychological morbidity. RESULTS: Massive weight loss body contouring is not purely aesthetic surgery, but it leads to functional and psychosocial benefits. This study has given preliminary data on which anthropometric measurements and their thresholds lead to the greatest benefit from massive weight loss body contouring. From this study, the fourth quartiles of the anthropometric measurements xiphisternum to pubic symphysis (≥91 cm), umbilicus to pubic symphysis (≥38 cm), and hip circumference (≥143 cm) were statistically significant in crossing the psychometric tolerances from within the normal range to pathological psychology. CONCLUSIONS: This study demonstrates that there is a statistically significant, quantifiable correlation among type of bariatric surgery, degree of ptosis, and psychological morbidity in patients who have undergone bariatric surgery. This pilot study could provide the basis for evidence-based guidelines for plastic surgery referral.

A preliminary report on the development of a validated tool for measuring psychosocial outcomes for massive weight loss patients.

AIM: To validate the newly developed patient report outcome measure (PROM): the Post Bariatric Outcome Tool (PBOT). The tool is designed and developed for massive weight loss patients seeking body contouring procedures. METHOD: The PBOT was piloted with three cohorts: massive weight loss patients seeking body contouring; massive weight loss patients who have had body contouring; and healthy, non-obese subjects as controls matched for age and gender. Each cohort completed two PROMS at week one, and then for a second time at week three. The PROMS used were the new Post Bariatric Outcome Tool (PBOT) and the Derriford Appearance Scale 24 (DAS24). CONCLUSION: The PBOT was shown to be reliable both in terms of its internal consistency and test-retest reliability. Comparison to the DAS24 demonstrated the PBOT to be valid. However, the cohorts were small and responsiveness was not tested. This needs to be tested in further larger validation studies, ideally, with comparison to functional scales such as the SF-36 or other validated massive weight loss body contouring PROMs; such as the Body Q.

Anoxic brain injury: Clinical patterns and functional outcomes. A study of 93 cases.

BACKGROUND: Anoxic brain injury (ABI) is a syndrome of diverse aetiology, most case series published to date being confined to ABI of a single aetiology or to a limited numbers of patients. METHODS: This study performed a retrospective analysis on all patients admitted for rehabilitation following ABI over a 14-year period. It identified 93 cases and presents a summary of their clinical patterns and functional and psychometric outcome measures. In addition a database involving 584 patients admitted for rehabilitation following traumatic brain injury (TBI) during the same time interval was used to compare demographic, functional and cognitive patterns. CONCLUSIONS: Relative to TBI, there was a peak frequency of ABI in males aged 60 years and in females in their late 20s. ABI patients were referred later for rehabilitation, had similar lengths of stay, but made slower progress, with poorer outcomes and were more likely to be transferred to residential care. Those with ABI had more severe impairments on cognitive assessment relative to those with TBI, being particularly susceptible to impairments in memory, especially visual memory or short-term memory. Neurological impairments of speech and language were present in 72 patients; visual field loss in eight and cortical blindness in 10; six suffered myoclonus and 10 late epilepsy.

The role of physical injury in motor and sensory conversion symptoms: a systematic and narrative review.

OBJECTIVES: Conversion symptoms are currently conceptualized as physical symptoms induced by psychological trauma, conflict, or stress. Historical accounts also included physical injury as an important precipitant. We aimed to determine (a) the frequency of reported physical injury prior to onset in published studies of patients with motor or sensory conversion symptoms and (b) the clinical characteristics of patients in whom onset was associated with physical injury. METHODS: Firstly, we employed a systematic review of all reports of adults with motor or sensory conversion symptoms published between 1965 and 2005. Secondly, we used a narrative review of the literature on this topic, especially possible mechanisms. RESULTS: A total of 133 eligible studies, which recorded precipitating factors, including 869 patients, were found. Physical injury prior to symptom onset was reported in 324 patients (37%). Clinical features associated with physical injury included younger age, weakness (vs. movement disorder), paraparesis (vs. hemiparesis), and neurological versus psychiatric study settings. CONCLUSIONS: Despite the current dominance of a psychological view of conversion symptoms, physical injury prior to onset has been frequently reported in papers published since 1965. While the data are of low quality, they nevertheless suggest that physical trauma has a role in many patients in the onset of motor and sensory conversion symptoms. We discuss possible mechanisms for this association.