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The presence of nightmares as a screening tool for symptoms of posttraumatic stress disorder in burn survivors
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
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2006 (English)In: Journal of Burn Care and Research, ISSN 1559-047X, Vol. 27, no 5, 727-733 p.Article in journal (Refereed) Published
Abstract [en]

Recurrent nightmares can be a symptom of posttraumatic stress disorder (PTSD). This study evaluated the method of asking burn survivors about nightmares as a screening tool for the presence of PTSD symptomatology. The presence of nightmares in 85 individuals treated at the Burn Center in Uppsala, Sweden, between 1996 and 2000 (23 women, 62 men, average age 47 years, average burn size 17% TBSA, average time after burn 3.6 years) was evaluated by one question from the Burn Specific Health Scale (BSHS) and by using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria for nightmares. PTSD symptomatology was assessed with the Impact of Event Scale-Revised. Sensitivity, Specificity, Discriminant Ability, and Likelihood Ratios for a positive and a negative result were calculated to evaluate the screening questions. As many as 46% of the burn survivors reported nightmares of some frequency in the BSHS and as many as 28% when using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. Both approaches were useful tools for detecting or ruling out PTSD symptoms. The best Discriminant Ability was achieved with a screening test using the BSHS item "I have nightmares." Screening questions for presence of nightmares after burns can be useful in detecting PTSD symptomatology.

Place, publisher, year, edition, pages
2006. Vol. 27, no 5, 727-733 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95607DOI: 10.1097/01.BCR.0000238092.57817.7AISI: 000240885100024PubMedID: 16998407OAI: oai:DiVA.org:uu-95607DiVA: diva2:169895
Available from: 2007-03-23 Created: 2007-03-23 Last updated: 2011-06-01Bibliographically approved
In thesis
1. It’s Not Just a Burn: Physical and Psychological Problems after Burns
Open this publication in new window or tab >>It’s Not Just a Burn: Physical and Psychological Problems after Burns
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Survival after severe burns has improved in recent decades, but there is limited information on the course of recovery after surviving a burn and on factors that can affect recovery.

The aims of this thesis were to investigate the occurrence of physical and psychological problems after burns, and to examine the consequences of psychological problems for the clinical management of burn patients.

Three groups of consecutive patients who were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2005 were included in the studies. The Burn Specific Health Scale (BSHS) was used for self-report of burn-specific aspects of health. Personality traits and coping strategies as psychological factors during recovery were examined with the Swedish universities Scales of Personality (SSP) and the Coping with Burns Questionnaire (CBQ). Presence of symptoms of posttraumatic stress were assessed with the Impact of Event Scale-Revised (IES-R), and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used to determine the concurrent validity of the IES-R as a measure of Posttraumatic Stress Disorder (PTSD). Furthermore, the effect of pre-injury psychiatric morbidity on perceived health one year after injury was assessed.

Both pruritus and nightmares were common problems after burns; 59% of the individuals in the study reported pruritus and 43% reported nightmares. Neuroticism-related personality traits and avoidant coping strategies were associated with an increased risk of having pruritus or nightmares. The presence of nightmares could be used as a screening tool for high scores in the IES-R. The IES-R was in turn shown to be a good, although overly inclusive, test for the diagnosis of PTSD. Pre-injury psychiatric morbidity predicted perceived outcome in six out of nine burn-specific health domains.

These studies show that psychological factors and psychiatric morbidity affect outcome after burns.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 69 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 242
Keyword
Surgery, Burns, Injury, Trauma, Health Status, Rehabilitation, Outcome Assessment, Personality, Coping, Depression, Posttraumatic Stress Disorder, Impact of Event Scale, Nightmares, Pruritus, Itch, Skin, Psychiatric Disorders, Kirurgi
Identifiers
urn:nbn:se:uu:diva-7758 (URN)978-91-554-6832-3 (ISBN)
Public defence
2007-04-14, Enghoffsalen, Ing. 50, Akademiska sjukhuset Uppsala, Uppsala, 09:15 (English)
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Available from: 2007-03-23 Created: 2007-03-23 Last updated: 2009-05-07Bibliographically approved

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Kildal, MortenEkselius, LisaGerdin, BengtWillebrand, Mimmie

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