From the Guidelines
For a 37-year-old patient with a high SASH score and significant psychological distress post-orthopaedic procedure, a comprehensive interdisciplinary treatment plan is crucial, incorporating both physical and psychological interventions to optimize recovery and minimize morbidity and mortality risks. The patient's treatment should begin with a thorough psychiatric evaluation to assess the severity of psychological distress, as recommended by the American Academy of Orthopaedic Surgeons in their 2022 guideline summary for evaluation of psychosychosocial factors influencing recovery from orthopaedic trauma 1.
Given the high SASH score, indicating significant psychological distress as measured by the Kessler Psychological Distress Scale (K10), medication management should include non-opioid analgesics for pain control, such as acetaminophen and NSAIDs, to minimize the risk of opioid addiction. For psychological distress, initiating an SSRI like sertraline or escitalopram is recommended, with short-term anxiolytics used judiciously due to their potential for addiction.
Key components of the treatment plan should include:
- Psychiatric evaluation to assess distress severity and substance use patterns
- Medication management with non-opioid analgesics and SSRIs for psychological distress
- Brief use of anxiolytics for acute anxiety
- Cognitive behavioral therapy sessions focusing on pain coping strategies and substance use triggers
- Physical therapy sessions as soon as medically appropriate to promote physical recovery
- Regular interdisciplinary team meetings to monitor progress and adjust the treatment plan as necessary
This approach is supported by the 2022 guideline summary from the American Academy of Orthopaedic Surgeons, emphasizing the importance of an interdisciplinary team in evaluating and treating psychosocial factors influencing recovery from orthopaedic trauma 1. By prioritizing a comprehensive and multimodal treatment plan, healthcare providers can effectively address the patient's physical and psychological needs, ultimately reducing morbidity, mortality, and improving quality of life.
From the Research
Treatment Plan for Patient with High SASH Score and Psychological Distress
The patient's high SASH score, as measured by the Kessler Psychological Distress Scale (K10), indicates significant psychological distress post-orthopaedic procedure.
- The K10 scale has been shown to be a reliable tool for assessing psychological distress, with good internal consistency and strong inter-item correlation 2.
- A study on the Japanese version of the K6 and K10 found that these scales performed excellently in detecting DSM-IV mood and anxiety disorders, with areas under the receiver operating characteristic curves (AUCs) as high as 0.94 3.
- Another study found that the K10 is suitable for assessing morbidity in the population and may be appropriate for use in clinical practice 4.
- In terms of treatment, anxiety disorders, which are often associated with high psychological distress, should be treated with psychological therapy, pharmacotherapy, or a combination of both 5.
- Cognitive behavioral therapy is regarded as the psychotherapy with the highest level of evidence, and first-line drugs include selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors 5.
- When developing a treatment plan, efficacy, adverse effects, interactions, costs, and the preference of the patient should be considered 5.
Recommended Treatment Approach
Based on the evidence, a recommended treatment approach for the patient with a high SASH score and significant psychological distress post-orthopaedic procedure may include:
- Psychological therapy, such as cognitive behavioral therapy, to address underlying anxiety and depression
- Pharmacotherapy, such as selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors, to manage symptoms of anxiety and depression
- A combination of both psychological therapy and pharmacotherapy for optimal treatment outcomes
- Regular monitoring and assessment of the patient's psychological distress and treatment response, using tools such as the K10 scale 2, 3, 4, 6.