Psychotropic medication use in former ICU patients with mental health problems: A prospective observational follow-up study

Janssen, Debbie G. A.; Jonker, Joep; Dijk, Diederik van; Heerdink, Eibert R.; Egberts, Toine C. G.; Slooter, Arjen J. C.

doi:10.1016/j.jcrc.2020.06.002

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…15 Lastly, a survey sent to 1-year survivors who had a critical care stay in one hospital in the Netherlands found that 15% of respondents reported psychotropic medicine use within 1 year after hospital discharge. 16 Focusing on antipsychotics, a single-centre prospective study of ICU patients in the US treated for acute respiratory failure or shock found that 10% (42/412) of antipsychotic-naïve survivors were discharged from the hospital on antipsychotics - all after initiation in the ICU. 17 This is substantially higher than our finding of 1.1% of antipsychotic-naïve critical care survivors prescribed antipsychotics or mania medicines after hospital discharge and the recent published findings from Canada.…”

Section: Discussionmentioning

confidence: 99%

“…However, past studies report severe underestimates of mental health disorders based on diagnosis codes when compared to psychotropic prescriptions. 16,30,31 As our study was centred on a region of Scotland, prescribing information on patients who moved into Lothian shortly before hospitalisation or left Lothian after hospitalisation could be misclassified; however, this is likely a small portion of the study population (e.g. in 2019, 87,400 people (1.6%) moved to Scotland and 57,100 people (1.0%) emigrated).…”

Section: Discussionmentioning

confidence: 99%

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Psychotropic prescribing after hospital discharge in survivors of critical illness, a retrospective cohort study (2012–2019)

Mansi,

Rentsch,

Bourne

et al. 2024

Journal of the Intensive Care Society

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Background: Many people survive critical illness with the burden of new or worsened mental health issues and sleep disturbances. We examined the frequency of psychotropic prescribing after critical illness, comparing critical care to non-critical care hospitalised survivors, and whether this varied in important subgroups. Methods: This retrospective cohort study included 23,340 critical care and 367,185 non-critical care hospitalised adults from 2012 through 2019 in Lothian, Scotland, who survived to discharge. Results: One-third of critical care survivors (32%; 7527/23,340) received a psychotropic prescription within 90 days after hospital discharge (25% antidepressants; 14% anxiolytics/hypnotics; 4% antipsychotics/mania medicines). In contrast, 15% (54,589/367,185) of non-critical care survivors received a psychotropic prescription (12% antidepressants; 5% anxiolytics/hypnotics; 2% antipsychotics/mania medicines). Among patients without psychotropic prescriptions within 180 days prior to hospitalisation, after hospital discharge, the critical care group had a higher incidence of psychotropic prescription (10.3%; 1610/15,609) compared with the non-critical care group (3.2%; 9743/307,429); unadjusted hazard ratio (HR) 3.39, 95% CI: 3.22–3.57. After adjustment for potential confounders, the risk remained elevated (adjusted HR 2.03, 95% CI: 1.91–2.16), persisted later in follow-up (90–365 days; adjusted HR 1.38, 95% CI: 1.30–1.46), and was more pronounced in those without recorded comorbidities (adjusted HR 3.49, 95% CI: 3.22–3.78). Conclusions: Critical care survivors have a higher risk of receiving psychotropic prescriptions than hospitalised patients, with a significant proportion receiving benzodiazepines and other hypnotics. Future research should focus on the requirement for and safety of psychotropic medicines in survivors of critical illness, to help guide policy for clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Psychotropic prescribing after hospital discharge in survivors of critical illness, a retrospective cohort study (2012–2019)

Mansi,

Rentsch,

Bourne

et al. 2024

Journal of the Intensive Care Society

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“…However, symptom screening is rare, access to mental health care is limited and geographically inconsistent, and treatment typically includes medications or in-person therapist visits . Yet patients often prefer therapy that is accessible from home because of physical disability and travel barriers, approaches relevant to their unique illness experiences, and nonpharmacological strategies because of baseline polypharmacy …”

Section: Discussionmentioning

confidence: 99%

Mobile Mindfulness Intervention for Psychological Distress Among Intensive Care Unit Survivors

Cox,

Gallis,

Olsen

et al. 2024

JAMA Intern Med

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ImportanceAlthough psychological distress is common among survivors of critical illness, there are few tailored therapies.ObjectiveTo determine the optimal method for delivering a mindfulness intervention via a mobile app for critical illness survivors.Design, Setting, and ParticipantsThis randomized clinical trial used a 2 × 2 × 2 factorial design and was conducted at 3 sites among survivors of critical illness with elevated postdischarge symptoms of depression. The study was conducted between August 2019 and July 2023.InterventionsParticipants were randomized to 1 of 8 different groups as determined by 3 two-level intervention component combinations: intervention introduction method (mobile app vs therapist call), mindfulness meditation dose (once daily vs twice daily), and management of increasing symptoms (mobile app vs therapist call).Main Outcomes and MeasuresThe primary outcome was the 9-item Patient Health Questionnaire (PHQ-9) depression scale score (range, 0-27) at 1 month. Secondary outcomes included anxiety (7-item Generalized Anxiety Disorder) and posttraumatic stress disorder (Posttraumatic Stress Scale) symptoms at 1 and 3 months, adherence, and feasibility. General linear models were used to compare main effects and interactions of the components among intervention groups. A formal decisional framework was used to determine an optimized intervention version.ResultsA total of 247 participants (mean [SD] age, 50.2 [15.4] years; 104 [42.1%] women) were randomized. Twice-daily meditation compared with once-daily meditation was associated with a 1.2 (95% CI, 0.04-2.4)–unit lower mean estimated PHQ-9 score at 1 month and a 1.5 (95% CI, 0.1-2.8)–unit lower estimated mean score at 3 months. The other 2 intervention components had no main effects on the PHQ-9. Across-group adherence was high (217 participants [87.9%] using the intervention at trial conclusion) and retention was strong (191 [77.3%] and 182 [73.7%] at 1 and 3 months, respectively).Conclusions and RelevanceA mindfulness intervention for survivors of critical illness that included an app-based introduction, twice-daily guided meditation, and app-based management of increasing depression symptoms was optimal considering effects on psychological distress symptoms, adherence, and feasibility.Trial RegistrationClinicalTrials.gov Identifier: NCT04038567

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“…De acuerdo con lo reportado en esos estudios, el internamiento repetido en una UCI es un factor de riesgo para una alteración mental, y tal riesgo es mayor en jóvenes, en mujeres y en pacientes con comorbilidades preexistentes (Sareen et al, 2020), mientras que la nutrición enteral es el factor de mayor riesgo para el desarrollo de depresión posterior al internamiento (Kang et al, 2019). Janssen et al (2020) señalan asimismo que la baja ventilación está asociada con deterioro mental a los tres meses, en comparación con una ventilación más alta.…”

Section: Discusión Y Conclusionesunclassified

Factores psicosociales en personas egresadas de unidades de cuidados intensivos: una revisión narrativa de la literatura

Flores-Constantino,

Juárez-García,

Quintana-Sánchez

et al. 2024

Psic. y Sal.

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Antecedentes: Las personas sobrevivientes de una Unidad de Cuidados Intensivos (UCI) experimentan con frecuencia deterioro cognitivo y alteraciones de la salud mental que pueden empeorar más allá del alta hospitalaria, por lo que es necesario identificar la evidencia que existe respecto a la presencia y prevalencia de dichas variables psicosociales en este grupo poblacional después de su alta, las que repercuten en su calidad de vida. Objetivo: Identificar los factores psicosociales más prevalentes en personas egresadas de una UCI. Método: Se realizó una búsqueda empleando los términos MeSh y text Word mediante los boleanos “AND” y “NOT” en las bases de datos PubMed y PsycINFO. Resultados: Se identificaron 770 artículos, de los cuales se utilizaron únicamente 21 para esta revisión. La mayoría de las personas estuvieron en la UCI más de siete días, varones de entre 40 y 65 años que habían ingresado a la UCI por enfermedades cardiovasculares, principalmente. Las variables psicosociales más reportadas fueron síntomas de trastorno de estrés postraumático, deterioro cognitivo, síntomas de ansiedad y depresión, todos ellos derivados de su estancia en la UCI. La ventilación mecánica, la nutrición enteral, la estancia prolongada y el ingreso en más de una ocasión a la UCI, así como presencia de comorbilidad, ser personas jóvenes y mujeres son factores de riesgo para la presencia de estas variables en tales pacientes. Discusión y conclusiones: Las recomendaciones abonan al desarrollo de intervenciones psicoterapéuticas preventivas al alta y mediante programas de psicología hospitalaria que mitiguen el impacto psicológico negativo de esta unidad de atención, tomando en cuenta el tipo de tratamiento recibido y sus recursos sociales y económicos. Recibido: 31/07/2022 Aceptado: 19/09/2023

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Psychotropic medication use in former ICU patients with mental health problems: A prospective observational follow-up study

Cited by 6 publications

References 29 publications

Psychotropic prescribing after hospital discharge in survivors of critical illness, a retrospective cohort study (2012–2019)

Psychotropic prescribing after hospital discharge in survivors of critical illness, a retrospective cohort study (2012–2019)

Mobile Mindfulness Intervention for Psychological Distress Among Intensive Care Unit Survivors

Factores psicosociales en personas egresadas de unidades de cuidados intensivos: una revisión narrativa de la literatura

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