Challenges in Management of Hand Injuries in Psychiatric Patients

Managing hand injuries in patients with concurrent psychiatric illness poses a significant challenge in patient care. An increasing segment of literature has also linked worse surgical and nonsurgical outcomes to patients with underlying psychiatric disease. As a result, the goal of this case series is to highlight the common themes seen in psychiatric patients who experience hand injuries and the factors that challenge the recovery, treatment, and overall outcome.The study was conducted in our hand therapy clinic. Outpatient clinic records were scanned from December 2023 to March 2024. Patients who had hand injuries with psychiatric history were identified in the health record retrospectively. Data on patient demographics, psychiatric condition, mechanism of injury, hospital course, and insurance status were collected.Seven patients with hand injury and psychiatric history were identified. Among the 7 patients in this study, 6 of them had depression, 4 had bipolar disorder, 4 had polysubstance use disorder, 3 had suicidal ideation with self-harm behaviors, 2 had anxiety, 2 had borderline personality disorder, and 2 had ADHD. Four patients self-discharged against medical advice on their initial admission. Five patients were lost to follow-up prior to completing their course of treatment, 3 of which were indicated for further plastic surgery. These patients also either had public insurance or were uninsured. Charts were reviewed and various barriers to health care were identified.This study showcases the obstacles to patient care continuity associated with psychiatric comorbidities and how they impact the management of hand injuries. Patients in this population face significant barriers in access to care. This leads to an increase in nonadherence to treatment protocols and delays their recovery. Management of patients with opioid use disorder or uninsured status was further complicated by the limitation of treatment options and loss to follow-up. Patients with psychiatric comorbidities compounded by hand trauma not only need a multidisciplinary approach but also integrated care. This may reduce the number of patients lost to follow-up and improve patient outcomes.