[Management of psychological trauma in primary care]. / Trauma psicológico en la atención primaria: orientaciones de manejo.

Exposure to traumatic events is frequent in the general population and psychiatric sequelae such as post-traumatic stress disorders are common. The symptoms of psychiatric sequelae after trauma are vague, with multiple psychological and physical symptoms, which can confuse the health care professional. This paper seeks to facilitate the work in primary care, providing practical information about the diagnosis, initial management and referral of patients who have suffered traumatic experiences. Some early interventions and treatments are suggested.

Trauma psicológico en la atención primaria: orientaciones de manejo / Management of psychological trauma in primary care

Exposure to traumatic events is frequent in the general population and psychiatric sequelae such as post-traumatic stress disorders are common. The symptoms of psychiatric sequelae after trauma are vague, with multiple psychological and physical symptoms, which can confuse the health care professional. This paper seeks to facilitate the work in primary care, providing practical information about the diagnosis, initial management and referral of patients who have suffered traumatic experiences. Some early interventions and treatments are suggested.

Post-traumatic symptoms in the staff of a mental health inpatient unit after the suicide of a patient: a case report in Chile / Síntomas postraumáticos en funcionarios de un servicio de hospitalización psiquiátrica luego del suicidio de un paciente: reporte de un caso en Chile

Multiple studies have shown that the suicide of a patient can produce posttraumatic and depressive symptoms among the mental health care providers, who typically have high levels of baseline burnout. OBJECTIVES: To measure posttraumatic, depressive and burnout symptoms in the staff of an inpatient psychiatric unit after the suicide of a patient. METHODS: Two months after the suicide all the employees were invited to answer, anonymously, the Posttraumatic Check-List (PCL), the Beck Depression Inventory (BDI), and the Maslach Burnout Inventory (MBI), for measuring posttraumatic, depressive, and burnout symptoms, respectively. RESULTS: Over 80% of the staff participated. A total of 17.1% had probable PTSD, 19.5% probable major depression, 24.4% and 14.6% high levels of emotional exhaustion and depersonalization, respectively, and 24.4% low levels of professional accomplishment. The group consisting of nurses, paramedic technicians, and nursing assistants ("nursing staff") had PTSD significantly greater than other workers (p < .001). CONCLUSIONS: Suicide in a psychiatric ward can produce posttraumatic and depressive symptoms among the staff, as high as another kind of traumas. The impact may be greater on the nursing staff. It is essential that organizations involved in the provision or teaching of mental health care incorporate this reality into their agenda, to prevent, mitigate and respond better to this phenomenon.

Múltiples estudios han mostrado que el suicidio de un paciente puede producir síntomas postraumáticos y depresivos en el personal de salud mental, quienes además presentan altos niveles de burnout basal. OBJETIVOS: Medir síntomas postraumáticos, depresivos y de burnout en los funcionarios de una unidad de hospitalización psiquiátrica luego del suicidio de un paciente. MÉTODOS: Dos meses después del suicidio, todos los funcionarios fueron invitados a contestar anónimamente el Postraumatic Check-List (PCL), el Inventario de Depresión de Beck (BDI), y el Inventario de Burnout de Maslach (MBI), para medir síntomas postraumáticos, depresivos, y de burnout, respectivamente. RESULTADOS: Más del 80% de los funcionarios contestaron los cuestionarios. Un total de 17,1% tenía probable Trastorno de Estrés Postraumático, 19,5% probable depresión mayor, 24,4% y 14,6% altos niveles de agotamiento emocional y despersonalización, respectivamente, y 24,4% bajos niveles de satisfacción profesional. El grupo compuesto por enfermeras universitarias, técnicos paramédicos, y asistentes de enfermería ("personal de enfermería") tuvo síntomas de Trastorno de Estrés Postraumático significativamente mayores que otros funcionarios (p < .001). CONCLUSIONES: El suicidio en una unidad de hospitalización psiquiátrica puede producir tantos síntomas postraumáticos y depresivos en los funcionarios de salud como otros tipos de traumas. El impacto podría ser mayor en el personal de enfermería. Es indispensable que las organizaciones involucradas en la provisión o enseñanza de salud mental incorporen esta realidad en sus agendas, para prevenir, mitigar y responder mejor a este fenómeno.

A personal perspective on the needs of the weight loss surgery patient.

Weight loss surgery (WLS) patients, such as those undergoing bileopancreatic diversions and other Roux-en-Y gastric bypass procedures, present a relatively new population for the health care system. WLS creates special needs for this population that health care providers may not be fully aware of. The author, a former WLS patient and health care quality assurance professional, presents observations from his unique personal perspective. He feels that WLS patients, and post-WLS patients receiving other health care services, can be inadvertently jeopardized by the lack of awareness of their special needs. These needs are the result of the permanent postsurgical malnutrition and malabsorption syndrome occurring after the Roux-en-Y gastric bypass. These needs include nutrition, management of electrolytes during surgery, and pain management. Additionally, the morbidly obese patients may possess low self-esteem to the degree that they may not actively and appropriately participate in their own care. The author also offers personal observations concerning his belief that there is discrimination against morbidly obese patients in the health care setting. The author presents a personal case study as a tool for better understanding of the WLS patient by caregivers.