Psych · Consultation-liaison — burns and critical illness psychiatry
Burns and critical illness psychiatry
Also known as Burns psychiatry · Burn unit psychiatry · Self-inflicted burns · Post-burn PTSD · Burn scar body image · Critical illness psychiatry · PICS after burns · Carbon monoxide delayed neuropsychiatric sequelae
Exam-exhaustive fellowship reference on consultation-liaison psychiatry after burn injury and critical illness: ASD/PTSD and depression trajectories, body-image distress, self-inflicted burns and suicide risk, burn-unit delirium, smoke/CO neuropsychiatric sequelae, capacity, pain–trauma coupling, and PICS/PICS-F. FRANZCP-primary, globally tagged.
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Red flags
- Treating self-inflicted burns as 'clearance only' without full suicide/self-harm risk assessment and ongoing psychiatric plan
- Missing hypoactive delirium during cooperative dressing changes — quiet is not safe
- Assuming body-image distress and social avoidance are cosmetic vanity rather than treatable morbidity
- Starting antipsychotics for agitation without pain control, cause hunt, and non-pharmacological measures
- Ignoring post-ICU PTSD and PICS-Family in survivors and caregivers after prolonged burn ICU stays
- Labelling delayed cognitive/affective change after smoke/CO exposure as purely functional without considering delayed neuropsychiatric sequelae
- Inventing mental health act section numbers or universal 'psych clearance' rules for intentional injury
Meet the patient
Day 6 in the burn unit. A 34-year-old man with 28 percent TBSA flame burns after a house fire is quiet, cooperative during dressings, and answers every question with a short, correct-sounding phrase. The nurses describe him as their easiest patient. His wife says he has not really followed a conversation since Tuesday, and that the fire started after he had been drinking heavily for three days.[10][11][12]
Three things are hiding in that paragraph: hypoactive delirium, an unasked question about intent, and a withdrawal timeline nobody has drawn. Quiet is not safe, and "easiest patient" is a warning, not a reassurance.[8][10][11]
References16ShowHide
- [1]Van Loey NE, Van Son MJ Psychopathology and psychological problems in patients with burn scars: epidemiology and management Am J Clin Dermatol, 2003.PMID 12680803
- [2]Thombs BD, Bresnick MG, Magyar-Russell G Depression in survivors of burn injury: a systematic review Gen Hosp Psychiatry, 2006.PMID 17088165
- [3]Fauerbach JA, McKibben J, Bienvenu OJ, et al. Psychological distress after major burn injury Psychosom Med, 2007.PMID 17585064
- [4]McKibben JB, Bresnick MG, Wiechman Askay SA, Fauerbach JA Acute stress disorder and posttraumatic stress disorder: a prospective study of prevalence, course, and predictors in a sample with major burn injuries J Burn Care Res, 2008.PMID 18182894
- [5]Wiechman SA, Ptacek JT, Patterson DR, et al. Rates, trends, and severity of depression after burn injuries J Burn Care Rehabil, 2001.PMID 11761394
- [6]Corry NH, Klick B, Fauerbach JA Posttraumatic stress disorder and pain impact functioning and disability after major burn injury J Burn Care Res, 2010.PMID 20061832
- [7]Fauerbach JA, Gehrke AK, Mason ST, et al. Cognitive Behavioral Treatment for Acute Posttrauma Distress: A Randomized, Controlled Proof-of-Concept Study in Burned Patients Arch Phys Med Rehabil, 2020.PMID 30776324
- [8]Atwell K, Bartley C, Cairns B, Charles A Incidence of self-inflicted burn injury in patients with Major Psychiatric Illness Burns, 2019.PMID 30429073
- [9]Smith JM, Fine JR, Romanowski KS, et al. Suicide by self-inflicted burns - A persistent psychiatric problem Burns, 2023.PMID 35810037
- [10]Stanley GHM, Barber ARJ, O'Brien AM, et al. Delirium in hospitalised adults with acute burns - A systematic review Burns, 2022.PMID 35701326
- [11]Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU) JAMA, 2001.PMID 11730446
- [12]Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Crit Care Med, 2018.PMID 30113379
- [13]Parker AM, Sricharoenchai T, Raparla S, et al. Posttraumatic stress disorder in critical illness survivors: a metaanalysis Crit Care Med, 2015.PMID 25654178
- [14]Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference Crit Care Med, 2012.PMID 21946660
- [15]Weaver LK, Hopkins RO, Chan KJ, et al. Hyperbaric oxygen for acute carbon monoxide poisoning N Engl J Med, 2002.PMID 12362006
- [16]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292