Download after major physical trauma

today • Wednesday 4 May 2016
24
health
mental well-being A PRIORITY
Helping to heal the mind
after major physical trauma
S’pore hospitals provide psychological support in aftermath of falls, road accidents
Eveline Gan
[email protected]
Singapore —When
Mrs Mary Ann
Rodriguez was hospitalised after
sustaining serious injuries in a road
accident in January last year, doctors
did more than just mend her physical
health; they also paid special attention
to her mental well-being.
The 64-year-old secretary was
screened for signs of psychologi-
cal distress shortly after she was
admitted to Tan Tock Seng Hospital
(TTSH), and seen by a trauma psychologist who helped her cope with
the shock and grief of losing her husband, who was riding a motorcycle at
the time of the accident.
Mrs Rodriguez, who was riding pillion on the motorcycle, suffered facial
and leg injuries as well as fractures to
her pelvis and ribs.
“When someone you love just pass-
Photo: TTSH
When these psychological issues are not addressed early,
they may develop into something more severe, like posttraumatic stress disorder and depression ...
Ms Lanurse Chen (picture)
Senior Psychologist at Tan Tock Seng Hospital,
es on like that, your life changes completely. I’m very grateful the doctors
arranged for a psychologist to see me
during my hospital stay. Until today,
the same psychologist has been guiding me through this difficult period, one
step at a time,” said Mrs Rodriguez.
Trauma is currently the leading
diagnosis for hospital admissions in
Singapore.
Over the past decade, TTSH has
seen an increasing number of serious
trauma cases, most of which are due
to falls and motor vehicle accidents.
Last year, the hospital saw 1,633 serious trauma cases that required hospital admission — nearly double the 833
patients in 2005.
In addition to physical injuries,
traumatic events can also lead to psychological distress, which may persist
long after the body heals.
This has spurred some hospitals
here to provide early psychological
support and intervention to trauma
patients.
TTSH’s Trauma Service routinely
screens trauma patients for signs of
stress even before they start exhibiting any symptoms.
The screening is usually done
24 hours after admission using a
simple questionnaire and interview
by a team, which also observes the
behavioural patterns of patients during their hospital stay.
Approximately six in 10 trauma
patients admitted to TTSH and those
on follow-up visits with its trauma clinic
are screened for psychological issues,
said Dr Teo Li Tserng, chief of trauma and acute care surgery at TTSH’s
department of general surgery.
Those who skip the routine screening usually have medical reasons or
severe injuries that prevent them from
being assessed, added Dr Teo, who
spoke at the annual Singapore Trauma Conference 2016 organised by the
hospital last month.
At the Singapore General Hospital
(SGH), patients who sustain traumatic
injuries as a result of incidents such as
road traffic accidents and falls from
height are routinely referred to its
medical social workers, who also provide grief and bereavement support
when a death has occurred.
Patients whose acute stress symptoms persist are referred to the hospital’s psychiatrists, said Ms Esther
Lim, head of medical social services
at SGH.
The National University Hospital (NUH) is currently developing a
trauma screening programme and
expects to launch it in the second half
of this year.
Senior psychologist Ivena Clarissa
of NUH’s department of psychological medicine said patients under the
care of NUH’s trauma team will be
screened once they are out of intenContinued on page 25
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health
today • Wednesday 4 May 2016
Continued from page 24
Post-traumatic stress disorder: Red flags to look for after traumatic event
sive care and referred to a psychiatrist, psychologist, or psycho-education group so that they can pick up
relevant coping skills and resources.
According to Ms Ivena Clarissa, senior
psychologist at the National University
Hospital’s department of psychological
medicine, signs of post-traumatic stress
disorder after a traumatic event include:
Re-experiencing the trauma, such as
having recurrent memories or nightmares of
the trauma, flashbacks, intense distress and
physiological reactions (having difficulty
CatchING psychological
issues early
TTSH’s screening programme aims
to prevent and catch any early psychological issues before they become
“too complicated” in the long run, said
its senior psychologist, Ms Lanurse
Chen, who has been offering Mrs Rodriguez psychological support since she
was admitted to TTSH with serious
injuries.
According to Ms Chen, as many as
seven in 10 patients will experience
some form of acute stress reaction in
the aftermath of a traumatic incident.
NUH’s Ms Clarissa said it is not
uncommon for trauma victims to
display anxiety and depression, or
behavioural symptoms such as anger
or aggression, as they adjust to posttrauma life.
This initial reaction is “normal” and
for most people, the symptoms usually
subside over time, said Ms Chen.
“However, when these psychological issues are not addressed early,
they may develop into something more
severe, like post-traumatic stress disorder and depression in the longer
term. This is particularly so for those
who are hospitalised, who may experience other stressors such as concerns
about hospital bill, pain from their
injuries, and uncertainty, which can
all build up,” she added.
Without intervention and support,
these debilitating psychological symptoms can interfere with trauma victims’ everyday life.
“We have seen cases whereby
patients were not able to return to
work due to the association of work
with their injuries,” said Dr Teo.
One recent case he encountered
was a woman in her late 20s who was
hit by a car while crossing the road
on her way to work. Even after her
physical injuries healed, fear and
flashbacks of the traumatic event prevented her from returning to work for
three weeks, said Dr Teo. Her condition gradually improved with the help
of psychotherapy and her partner’s
support.
More than a year after the tragic
accident, Mrs Rodriguez’s physical
health is on the mend, but the psychological effects of her husband’s death
and stress from current financial
issues linger.
However, she is comforted by her
monthly follow-ups with her psychologist. While support from family and
friends is important, Mrs Rodriguez
believes it is crucial for trauma victims to seek professional counselling.
“Many friends have told me to forget and move on. They mean well but
sometimes, their advice is not right
because it is not easy for a person
who has gone through trauma to simply ‘move on’. I’m just glad my psychologist understands what I’m going
through and is helping me to cope,”
she said.
screening
for symptoms
In addition to
physical injuries,
traumatic events
can also lead to
psychological
distress, which may
persist long after
the body heals.
This has spurred
some hospitals
here to provide
early psychological
support and
intervention to
trauma patients.
TTSH’s Trauma
Service routinely
screens trauma
patients for signs of
stress even before
they start exhibiting
any symptoms.
breathing, rapid heartbeat, cold sweats,
dizziness) when exposed to things that
represent an aspect of the trauma
Efforts to avoid what is associated with
the trauma, such as people and situations
Negative thoughts and emotions, such as
difficulty remembering an important aspect
of the trauma, reduced interest or
participation in activities previously
enjoyed, feeling isolated from others,
difficulties experiencing positive emotions
Being more reactive, such as being
quick-tempered, reckless, jumpy, constantly
on the lookout for danger, and having
difficulty concentrating and sleeping
Seek professional help if you notice
these symptoms in yourself or your loved
ones after a traumatic event.