Psychiatry of the medically ill in the burn unit

Clinical experience and burn survivor testimony show that the experience of being burned can be associated with catastrophic stress and can lead to drastic permanent body image changes from scarring, limb, and function loss. Closeness of relationships may be lost; close relatives often suffer psychological damage, and self-image may suffer. Although many bums result from accidents, the majority result from preventable causes associated with psychiatric disorders, including mood disorders, psychoses, cognitive disorders, and substance use disorders. Many clinical syndromes, such as delirium, acute stress disorder, acute psychosis, suicidality, and pain need to be addressed by the consulting psychiatrist to facilitate surgical treatment of the burn injury. Other psychiatric disorders, such as post-traumatic stress disorder, major depression, and adjustment disorders, need to be treated to expedite long-term adjustment.