Psychological problems following ICU treatment*

Abstract

Treatment in an intensive care unit can be stressful and may leave patients with persisting psychological symptoms that impair quality of life. This postal questionnaire study of patients who had previously been treated in a general adult intensive care unit showed that 38 (47%) of 80 patients who returned fully completed questionnaires reported clinically significant anxiety and depression as measured by the Hospital Anxiety and Depression Scale. Thirty (38%) reported significant symptoms of post‐traumatic stress disorder, of whom 12 (15%) reached levels consistent with a diagnosis of full post‐traumatic stress disorder as measured by the Trauma Symptom Checklist 33 and the Impact of Events Scale. We describe a new measure of psychological distress specifically related to the experience of intensive care management, the Experience after Treatment in Intensive Care 7 Item Scale, and compare it to the other scales. The Experience after Treatment in Intensive Care 7 Item Scale shows that at least a proportion of the post‐traumatic stress reported was directly attributable to the experience of treatment in the intensive care unit.

What's Next After ARDS: Long-Term Outcomes

“…48 The etiology of ARDS-associated psychological disorders is unknown. 49,50 However, the severity of ARDS, defined as requiring extracorporeal lung assist, does not seem to influence the psychological impairment at 1 y in terms of symptoms of anxiety, depression, and risk of posttraumatic stress disorder. 27 Most of the literature concludes that physiopathological alterations related to the critical illness (hypoxemia, activation of the hypothalamicpituitary axis, elevated cytokines, organ dysfunction) and medications (epinephrine or norepinephrine, sedatives) contribute all together to the long-term psychological disorders.…”

The meaning of posttraumatic stress-reactions following critical illness or injury and intensive care treatment

“…Recognizing that a critical condition and ICU treatment can constitute a traumatic event, PTSD (or posttraumatic stress-reactions) in these patients has been studied, by reporting prevalence rates, for instance (Cuthbertson et al, 2004;Nickel et al, 2004;Schnyder et al, 2001;Scragg et al, 2001;Tedstone and Tarrier, 2003), or associating posttraumatic stress-reactions with traumatic memories, e.g. factual or delusional (Capuzzo et al, 2005;Jones et al, 2001;Schelling et al, 2003).…”

Memories and prevalence of posttraumatic stress disorder in intensive care units

“…Such differences may be attributed to the different instruments used to measure PTSD. However, there is a consensus among researchers about the risk factors for the development of symptoms (Cuthebertson, Stracham, & Seatt, 2003;Girard et al, 2007;Rattray, Johnston, & Wildsmith, 2005;Schelling, 2008;Scragg, A. Jones, & Fauvel, 2001), such as being female, going through psychological agitation in the ICU, being restrained mechanically, stopping benzodiazepines during hospitalization, use of opioids for sedation, septic shock, delirium, hypoxia, mechanical ventilation time and prior psychopathology. In these studies, there were no factors that could offer hope of being risk factors such as severity and complexity of neither illness nor hospitalization time.…”