03254nas a2200289   4500000000100000008004100001653003900042653002600081653002500107100001700132700001600149700001900165700001800184700001800202700001900220700001700239700001500256700001300271700001300284700001300297245011400310856007800424300001300502490000600515520242900521022001402950       2015                            d10aNeglected tropical diseases (NTDs)10aPsychological aspects10aSnakebite envenoming1 aWijesinghe C1 aWilliams SS1 aKasturiratne A1 aDolawaththa N1 aWimalaratne P1 aWijewickrema B1 aJayamanne SF1 aIsbister G1 aDawson A1 aLalloo D1 aSilva JH00aA randomized controlled trial of a brief intervention for delayed psychological effects in snakebite victims.  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532481/pdf/pntd.0003989.pdf  ae00039890 v93 a<p><strong>BACKGROUND: </strong>Snakebite results in delayed psychological morbidity and negative psycho-social impact. However, psychological support is rarely provided to victims.</p>

<p><strong>AIM: </strong>To assess the effectiveness of a brief intervention which can be provided by non-specialist doctors aimed at reducing psychological morbidity following snakebite envenoming.</p>

<p><strong>METHOD: </strong>In a single blind, randomized controlled trial, snakebite victims with systemic envenoming [n = 225, 168 males, mean age 42.1 (SD 12.4) years] were randomized into three arms. One arm received no intervention (n = 68, Group A), the second received psychological first aid and psychoeducation (dispelling prevalent cultural beliefs related to snakebite which promote development of a sick role) at discharge from hospital (n = 65, Group B), while the third received psychological first aid and psychoeducation at discharge and a second intervention one month later based on cognitive behavioural principles (n = 69, Group C). All patients were assessed six months after hospital discharge for the presence of psychological symptoms and level of functioning using standardized tools.</p>

<p><strong>RESULTS: </strong>At six months, there was a decreasing trend in the proportion of patients who were positive for psychiatric symptoms of depression and anxiety from Group A through Group B to Group C (Chi square test for trend = 7.901, p = 0.005). This was mainly due to a decreasing trend for symptoms of anxiety (chi-square for trend = 11.256, p = 0.001). There was also decreasing trend in the overall prevalence of disability from Group A through Group B to Group C (chi square for trend = 7.551, p = 0.006), predominantly in relation to disability in family life (p = 0.006) and social life (p = 0.005). However, there was no difference in the proportion of patients diagnosed with depression between the three groups (chi square for trend = 0.391, p = 0.532), and the intervention also had no effect on post-traumatic stress disorder.</p>

<p><strong>CONCLUSIONS: </strong>A brief psychological intervention, which included psychological first aid and psychoeducation plus cognitive behavioural therapy that can be provided by non-specialist doctors appeared to reduce psychiatric symptoms and disability after snakebite envenoming, but not depression or post-traumatic stress disorder.</p>
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