Clinical syndromes during the hospital stay

The clinical syndromes requiring psychiatric attention are listed in Table...!.. In civilian life, confusion or psychotic responses appearing for the first time during a hospital stay almost always have an organic origin. They should be investigated, as should cases of delirium (see Cha.pt§L4.:1.2). Delirium with psychotic symptoms is associated with severe injuries, including major head injuries, caused by the accident. Impaired cognitive functions and drug or alcohol abuse prior to an accident may lead to subsequent withdrawal syndromes. Risk is greater over the age of 50 years.

Table 1 Psychiatric syndromes seen most frequently during hospital stay following accidental injury

The most frequent symptoms of anxiety are worrying intrusive thoughts about the accident or the injury, tension, startle reactions, and difficulty in concentrating. Sleep may be disturbed, but nightmares are uncommon. If present, they occur several days after the accident and usually disappear gradually. Nightmares persisting for more than 2 weeks are related to subsequent PTSD.

Depressed mood during the first few days and weeks following an accident is mostly due to guilt, shame, or grief related to real or imagined losses. The key to understanding the response is the meaning of the accident or the injury for the patient. However, premorbid causes of depression must be kept in mind. Depressive symptoms commonly occur in patients staying in hospital for an extended period, but major depression is probably no more frequent in accident victims than in patients undergoing surgery. Rarely, there are symptoms which cannot be explained medically.

Pain and pain control strongly influence psychological well being. Pain can restrict aeration of the lungs and movement, increasing the risk of muscle atrophy and bed sores. Poorly treated pain can demoralize patients, some of whom may regress or give up. Concern that trauma patients will become addicted if treated adequately with analgesics is not supported by clinical experience or empirical data.

Sometimes the patient may describe physical symptoms suggesting undetected injury. Such complaints should be taken seriously. About 25 per cent of such complaints relate to undetected injuries. Many of the remainder reveal undetected psychological distress.

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