Yeungnam Univ J Med.  2021 Jul;38(3):194-201. 10.12701/yujm.2021.00990.

Psychiatric understanding and treatment of patients with amputations

Affiliations
  • 1Department of Psychiatry, Yeungnam University Hospital, Daegu, Korea
  • 2Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea

Abstract

Amputation changes the lives of patients and their families. Consequently, the patient must adapt to altered body function and image. During this adaptation process, psychological problems, such as depression, anxiety, and posttraumatic stress disorder, can occur. The psychological difficulties of patients with amputation are often accepted as normal responses that are often poorly recognized by patients, family members, and their primary physicians. Psychological problems can interfere with rehabilitation and cause additional psychosocial problems. Therefore, their early detection and treatment are important. A multidisciplinary team approach, including mental health professionals, is ideal for comprehensive and biopsychosocial management. Mental health professionals could help patients set realistic goals and use adaptive coping styles. Psychiatric approaches should consider the physical, cognitive, psychological, social, and spiritual functions and social support systems before and after amputation. The abilities and limitations of physical, cognitive, psychological, and social functions should also be considered. To improve the patient’s adaptation, psychological interventions such as short-term psychotherapy, cognitive behavioral therapy, mindfulness meditation, biofeedback, and group psychotherapy can be helpful.

Keyword

Amputation; Psychiatric consideration; Psychological intervention; Psychological reaction

Reference

References

1. Han TR, Bang MS, Jeong SG, Kang EK, Ko MH, Ko YJ, et al. Rehabilitation medicine. 6th ed. Seoul: Koonja Publishing;2019.
2. Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008; 89:422–9.
Article
3. Kim SH, Lee YH, Oh WC, Hwang JH, Oh MA, Lee MK, et al. 2017 survey on disabled persons. Sejong: Ministry of Health and Welfare, Korean Institute for Health and Social Affairs;2017.
4. Block WE, Ventur PA. A study of the psychoanalytic concept of castration anxiety in symbolically castrated amputees. Psychiatr Q. 1963; 37:518–26.
Article
5. Perkins ZB, De’Ath HD, Sharp G, Tai NR. Factors affecting outcome after traumatic limb amputation. Br J Surg. 2012; 99(Suppl 1):75–86.
Article
6. Horgan O, MacLachlan M. Psychosocial adjustment to lower-limb amputation: a review. Disabil Rehabil. 2004; 26:837–50.
Article
7. Singh R, Ripley D, Pentland B, Todd I, Hunter J, Hutton L, et al. Depression and anxiety symptoms after lower limb amputation: the rise and fall. Clin Rehabil. 2009; 23:281–6.
Article
8. Melcer T, Walker GJ, Galarneau M, Belnap B, Konoske P. Midterm health and personnel outcomes of recent combat amputees. Mil Med. 2010; 175:147–54.
Article
9. Mckechnie PS, John A. Anxiety and depression following traumatic limb amputation: a systematic review. Injury. 2014; 45:1859–66.
Article
10. Pezzin LE, Dillingham TR, MacKenzie EJ. Rehabilitation and the long-term outcomes of persons with trauma-related amputations. Arch Phys Med Rehabil. 2000; 81:292–300.
Article
11. Armstrong DG, Lavery LA, van Houtum WH, Harkless LB. The impact of gender on amputation. J Foot Ankle Surg. 1997; 36:66–9.
Article
12. Kashani JH, Frank RG, Kashani SR, Wonderlich SA, Reid JC. Depression among amputees. J Clin Psychiatry. 1983; 44:256–8.
13. Atala KD, Carter BD. Pediatric limb amputation: aspects of coping and psychotherapeutic intervention. Child Psychiatry Hum Dev. 1992; 23:117–30.
Article
14. Tyc VL. Psychosocial adaptation of children and adolescents with limb deficiencies: a review. Clin Psychol Rev. 1992; 12:275–91.
Article
15. Cameron K, Tebbi MD, Janis C. Long-term psychosocial outcome among cancer amputees in adolescence and early adulthood. J Psychosoc Oncol. 1988; 5:69–82.
Article
16. Walters J. Coping with a leg amputation. Am J Nurs. 1981; 81:1349–52.
Article
17. Frank RG, Kashani JH, Kashani SR, Wonderlich SA, Umlauf RL, Ashkanazi GS. Psychological response to amputation as a function of age and time since amputation. Br J Psychiatry. 1984; 144:493–7.
Article
18. Williamson GM, Schulz R, Bridges MW, Behan AM. Social and psychological factors in adjustment to limb amputation. J Soc Behav Pers. 1994; 9:249–68.
19. Rybarczyk B, Szymanski L, Nicholas JJ. Limb amputation. In : Frank RG, Elliott TR, editors. Handbook of rehabilitation psychology. Washington, DC: American Psychological Association;2000. p. 29–47.
20. Cheung E, Alvaro R, Colotla VA. Psychological distress in workers with traumatic upper or lower-limb amputations following industrial injuries. Rehabil Psychol. 2003; 48:109–12.
21. Ramirez C, Menaker J. Traumatic amputations. Trauma Reports. 2017; 18:40–8.
22. Buchheit T, Van de Ven T, Hsia HL, McDuffie M, MacLeod DB, White W, et al. Pain phenotypes and associated clinical risk factors following traumatic amputation: results from Veterans Integrated Pain Evaluation Research (VIPER). Pain Med. 2016; 17:149–61.
Article
23. Richardson C, Glenn S, Nurmikko T, Horgan M. Incidence of phantom phenomena including phantom limb pain 6 months after major lower limb amputation in patients with peripheral vascular disease. Clin J Pain. 2006; 22:353–8.
Article
24. Schley MT, Wilms P, Toepfner S, Schaller HP, Schmelz M, Konrad CJ, et al. Painful and nonpainful phantom and stump sensations in acute traumatic amputees. J Trauma. 2008; 65:858–64.
Article
25. Arena JG, Sherman RA, Bruno GM, Smith JD. The relationship between situational stress and phantom limb pain: cross-lagged correlational data from six month pain logs. J Psychosom Res. 1990; 34:71–7.
Article
26. Schoppen T, Boonstra A, Groothoff JW, de Vries J, Göeken LN, Eisma WH. Employment status, job characteristics, and work-related health experience of people with a lower limb amputation in The Netherlands. Arch Phys Med Rehabil. 2001; 82:239–45.
Article
27. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002; 347:1924–31.
Article
28. Dougherty PJ. Long-term follow-up of unilateral transfemoral amputees from the Vietnam war. J Trauma. 2003; 54:718–23.
Article
29. Rybarczyk B, Nyenhuis DL, Nicholas JJ, Cash S, Kaiser J. Body image, perceived social stigma, and the prediction of psychosocial adjustment to leg amputation. Rehabil Psychol. 1995; 40:95–110.
Article
30. Badura-Brzoza K, Matysiakiewicz J, Piegza M, Rycerski W, Niedziela U, Hese RT. Sociodemographic factors and their influence on anxiety and depression in patients after limb amputation. Psychiatr Pol. 2006; 40:335–45.
31. Woods L, Hevey D, Ryall N, O’Keeffe F. Sex after amputation: the relationships between sexual functioning, body image, mood and anxiety in persons with a lower limb amputation. Disabil Rehabil. 2018; 40:1663–70.
Article
32. Carroll K, Edelstein JE. Prosthetics and patient management: a comprehensive clinical approach. Thorofare (NJ): Slack Inc.;2006.
33. Williams RM, Ehde DM, Smith DG, Czerniecki JM, Hoffman AJ, Robinson LR. A two-year longitudinal study of social support following amputation. Disabil Rehabil. 2004; 26:862–74.
Article
34. Bhuvaneswar CG, Epstein LA, Stern TA. Reactions to amputation: recognition and treatment. Prim Care Companion J Clin Psychiatry. 2007; 9:303–8.
Article
35. Burger H, Marincek C. The life style of young persons after lower limb amputation caused by injury. Prosthet Orthot Int. 1997; 21:35–9.
Article
36. Shukla GD, Sahu SC, Tripathi RP, Gupta DK. A psychiatric study of amputees. Br J Psychiatry. 1982; 141:50–3.
Article
37. Marshall M, Helmes E, Deathe AB. A comparison of psychosocial functioning and personality in amputee and chronic pain populations. Clin J Pain. 1992; 8:351–7.
Article
38. Fitzpatrick MC. The psychologic assessment and psychosocial recovery of the patient with an amputation. Clin Orthop Relat Res. 1999; (361):98–107.
Article
39. Cavanagh SR, Shin LM, Karamouz N, Rauch SL. Psychiatric and emotional sequelae of surgical amputation. Psychosomatics. 2006; 47:459–64.
Article
40. Breslau N. The epidemiology of posttraumatic stress disorder: what is the extent of the problem? J Clin Psychiatry. 2001; 62(Suppl 17):16–22.
41. Opalic P, Lesic A. Investigation of psychopathological state of patients depending on specific clinical characteristics of physical trauma. Panminerva Med. 2002; 44:11–7.
42. Keszler MS, Wright KS, Miranda A, Hopkins MS. Multidisciplinary amputation team management of individuals with limb loss. Curr Phys Med Rehabil Rep. 2020; 8:118–26.
Article
43. MacBride A, Rogers J, Whylie B, Freeman SJ. Psychosocial factors in the rehabilitation of elderly amputees. Psychosomatics. 1980; 21:258–61. 265
Article
44. Silander NC. Life-changing injuries: psychological intervention throughout the recovery process following traumatic amputations. J Health Serv Psychol. 2018; 44:74–8.
Article
45. Wald J, Alvaro R. Psychological factors in work-related amputation: considerations for rehabilitation counselors. J Rehabil. 2004; 70:6–15.
46. Desmond DM. Coping, affective distress, and psychosocial adjustment among people with traumatic upper limb amputations. J Psychosom Res. 2007; 62:15–21.
Article
47. Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York: Guilford Press;1991.
48. Mireau R, Inch R. Brief solution-focused counseling: a practical effective strategy for dealing with wait lists in community-based mental health services. Soc Work. 2009; 54:63–70.
Article
49. Bannink FP. Solution-focused brief therapy. J Contemp Psychother. 2007; 37:87–94.
Article
50. Gorenstein EE, Papp LA. Cognitive-behavioral therapy for anxiety in the elderly. Curr Psychiatry Rep. 2007; 9:20–5.
Article
51. Bhatnagar KA, Wisniewski L, Solomon M, Heinberg L. Effectiveness and feasibility of a cognitive-behavioral group intervention for body image disturbance in women with eating disorders. J Clin Psychol. 2013; 69:1–13.
Article
52. Weck F, Gropalis M, Hiller W, Bleichhardt G. Effectiveness of cognitive-behavioral group therapy for patients with hypochondriasis (health anxiety). J Anxiety Disord. 2015; 30:1–7.
Article
53. McGinn LK. Cognitive behavioral therapy of depression: theory, treatment, and empirical status. Am J Psychother. 2000; 54:257–62.
54. Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982; 4:33–47.
Article
55. Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. J Psychosom Res. 2010; 68:29–36.
Article
56. Berman RL, Iris MA, Bode R, Drengenberg C. The effectiveness of an online mind-body intervention for older adults with chronic pain. J Pain. 2009; 10:68–79.
Article
57. Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010; 78:169–83.
Article
58. Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000; 68:615–23.
Article
59. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006; 44:1–25.
Article
60. Wicksell RK, Olsson GL, Hayes SC. Mediators of change in acceptance and commitment therapy for pediatric chronic pain. Pain. 2011; 152:2792–801.
Article
61. McCracken LM, Vowles KE, Eccleston C. Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behav Res Ther. 2005; 43:1335–46.
Article
62. Vowles KE, McCracken LM, O’Brien JZ. Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process. Behav Res Ther. 2011; 49:748–55.
Article
63. Gallagher P, Maclachlan M. Adjustment to an artificial limb: a qualitative perspective. J Health Psychol. 2001; 6:85–100.
Article
64. Klerman GL, Weissman MM, Rounsaville BJ, Chevron ES. Interpersonal psychotherapy of depression. New York: Basic Books;1984.
65. Markowitz JC, Weissman MM. Interpersonal psychotherapy: principles and applications. World Psychiatry. 2004; 3:136–9.
66. Lee HK. Group psychotherapy: theory and practice. J Korean Neuropsychiatr Assoc. 2002; 41:189–200.
67. Rogers J, MacBride A, Whylie B, Freeman SJ. The use of groups in the rehabilitation of amputees. Int J Psychiatry Med. 1977-1978; 8:243–55.
Article
68. Mahlke CI, Krämer UM, Becker T, Bock T. Peer support in mental health services. Curr Opin Psychiatry. 2014; 27:276–81.
Article
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