A Biopsychosocial Approach With Traumatically Hospitalized Injured Soldiers . H. J. Wain Ph.D Chief, Psychiatry Consultation Liaison Service Department of Psychiatry, WRAMC Professor in Dept. of Psychiatry, USUHS. PCLS. Mission
H. J. Wain Ph.D
Chief, Psychiatry Consultation Liaison Service
Department of Psychiatry, WRAMC
Professor in Dept. of Psychiatry, USUHS
Explosives Injured Soldiers
Recognized body Losses
Comments of soldiers
Shooting or not?
Medical EventTrauma Stimuli
Fear Injured Soldiers
Concerns about families
Need to maintain alertness
AngerResponses to Injury
What Have We Learned To Attempt To Prevent or Decrease Chronic Disabling Psychiatric Stress Disorders Following Tauma?
Foster acceptance of MH Chronic Disabling Psychiatric Stress Disorders Following Tauma?
Some duplicity always looking for dx,symp.tx
Use biopsychosocial app
Develop Relationship with patients
Utilize TIPPS approach
Meet The Pt. Where They are:
- Facilitate medical tx
Advocate for pt. needs
Flexible eval. and tx.
Re enforce pts adaptive
< of disabling PTSD-chronic somatization and other psychiatric dx
Liaison with and educate medical staff
Support staff and families
All patients, are seen as early as possible
Sedated and ventilated patients see families
- Educate pts. and staff
. ResearchRole of PCLS (PMP)
Therapeutic Alliance conversational tone, empathy, Humor Chronic Disabling Psychiatric Stress Disorders Following Tauma?
Timing of Intervention
Mechanism of change
Meet The patient…....
Healthy DefensesComponents of Therapeutic Intervention and Prevention of Chronic Psychiatric Stress Disorders (TIPPS)
Flexibility is needed Chronic Disabling Psychiatric Stress Disorders Following Tauma?
Expect the unexpected
Be aware of transference issues
Be aware of counter transference issues
Think about their trauma
StabilizeApproaches That Facilitate T.I.P.P.S.
Families they left behind in Iraq-States
Reserves-Nat Guard-Active Duty
Changes, some warmer more responsive-critical
Pre morbid styles
Hierarchy of patients
Appreciation for treatmentsThemes in some groups
Individual Approaches Iraq-States
Groups for family
Groups for spouses
CAPS sees children
Meetings with administrators and hospital leadership
Questions about friends and kids
Change of shift grps
Suggestions for coping
Phone NumbersSupport For Medical Staff and Patient Families
H. Wain Ph.D, Chief Iraq-States
G. Grammer MD Asst Ch.
5 Housestaff MD
1 Psychology Resident
P. Martinez RN
C. Miller MSW
J. Stasinos MD##
D. Cotter MD##
E. McLaughlin RN ##
M. Oleshansky MD
I. Janke MD
S. Moran MD
R. Kogan MSW
C. DeboerPCLS STAFF
“therefore these results are very encouraging and suggests that the preventive psychiatry program (TIPPS) at WRAMC may be effective in preventing or decreasing long term severity and chronicity in this high risk group” (Hogue)