Understanding posttraumatic stress disorder-related symptoms after critical care: The early illness amnesia hypothesis*

Granja, Cristina; Gomes, Ernestina; Amaro, Augusta; Ribeiro, Orquídea; Jones, Christina; Carneiro, Antônio Fernando; Costa‐Pereira, Altamiro

doi:10.1097/ccm.0b013e318186a3e7

Cited by 153 publications

(107 citation statements)

References 15 publications

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“…The Memory Tool cannot be added in order to obtain an overall score, while the individual items developed to evaluate types of memories (delusional, affective, factual) are also not interconnected, therefore they cannot be considered parts of the same domain. In the present study, we used the version translated from English into Portu-guese by Granja et al (2008).…”

Section: Participantsmentioning

confidence: 99%

Memories and prevalence of posttraumatic stress disorder in intensive care units

Rovatti¹,

Teodoro²,

Castro³

2012

Psicol. Reflex. Crit.

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The present study evaluated the prevalence of PTSD indicators in patients who had to be hospitalized in ICU six months after being discharged and examined the relationship between PTSD and mnemonic memories. Participants were 41 adult patients with different diseases who answered questionnaires about PTSD, memory and clinical information. It was identified that 24.4% of the sample presented PTSD symptoms. These patients presented more affective memories than those without PTSD (t=2.29, p<.05). Affective memories correlated with total PTSD and with the dimensions 'reliving' (r=.443, p<.01) and 'excitability ' (r=.403, p<.01). Hierarchical regression analysis showed that sex (woman) and the presence of affective memories were PTSD predictors, explaining 38.2% of the variance. Keywords: Intensive care units, memory, posttraumatic stress disorder, quality of life.Resumo O estudo avaliou a prevalência de indicadores de TEPT em pacientes que foram internados em UTI seis meses após a alta hospitalar, e examinou a relação entre TEPT e recordações mnêmincas. Participaram 41 pacientes adultos com diferentes doenças, que responderam a questionários sobre TEPT, memórias e informações clínicas. Identificou-se que 24,4% da amostra possuía indicadores de TEPT. Estes pacientes apresentaram mais memórias afetivas que os pacientes sem TEPT (t=2,29, p<0,05). As memórias afetivas correlacionaram-se com o TEPT total (r=0,408, p<0,01) e com suas dimensões revivência (r=0,443, p<0,01) e excitabilidade (r=0,403, p<0,01). A análise de regressão hierárquica mostrou que o sexo (mulher) (β=0,44, p<0,01) e a presença de memórias afetivas (β=0,46, p<0,01) foram preditoras de TEPT, explicando 38,2% da sua variância. Palavras-chave: Unidades de terapia intensiva, memória, transtorno de estresse pós-traumático, qualidade de vida.

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Section: Participantsmentioning

confidence: 99%

Memories and prevalence of posttraumatic stress disorder in intensive care units

Rovatti¹,

Teodoro²,

Castro³

2012

Psicol. Reflex. Crit.

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“…3 Penilaian nyeri diperoleh dari laporan pasien sendiri merupakan "gold standard" dalam menilai intensitas nyeri, pasien biasanya akan memberitahu ketika merasakan nyeri, dan begitu juga apabila pasien tersebut tidak merasakan nyeri. 4 Nyeri merupakan salah satu gejala yang paling umum pada pasien sakit kritis dan dialami oleh setiap pasien dalam cara yang unik. Hal demikian tidak berarti pasien yang tidak dapat berkomunikasi atau dengan penggunaan ventilasi mekanik tidak dapat dilakukan penilaian nyeri, ekspresi wajah, gerakan tangan atau indikator perilaku lainnya dapat dijadikan sarana komunikasi untuk mengungkapkan rasa nyeri.…”

Section: 2unclassified

Perbandingan Proporsi Penilaian dan Reliabilitas Skala COMFORT dan CPOT dalam Menilai Intensitas Nyeri pada Pasien yang Menggunakan Ventilasi Mekanik di Instalasi Perawatan Intensif RSUP H. Adam Malik Medan

Marpaung¹,

Hanafie²,

Ihsan³

2017

jap

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AbstrakPain, agitation, delirium guidelines tahun 2013 menyatakan bahwa critical-care pain observation tool merupakan instrumen penilaian nyeri pada pasien tidak dapat berkomunikasi yang paling valid dan reliabel. Skala COMFORT merupakan standar instrumen penilaian intensitas nyeri di indstalasi rawat intensif RSUP Haji Adam Malik Medan. Tujuan penelitian ini membandingkan proporsi penilaian dan reliabilitas skala COMFORT dengan CPOT dalam menilai intensitas nyeri pada pasien yang menggunakan ventilasi mekanik di Instalasi Perawatan Intensif RSUP Haji Adam Malik, Medan. Penelitian ini menggunakan desain crosssectional pada 57 pasien di Instalasi Perawatan Intensif RSUP Haji Adam Malik Medan pada Maret-April 2016 yang memenuhi kriteria inklusi. Intensitas nyeri dinilai menggunakan skala COMFORT dan CPOT oleh 2 penilai yang berbeda pada saat istirahat dan saat stimulus noxious. Fisher's exact test, diperoleh nilai p=0,003 (p<0,05). Tidak terdapat perbedaan reliabilitas yang signifikan secara statistik pada saat stimulus noxious, nilai p = 0,13 (95% IK: -4-16%; p>0,05). Simpulan penelitian ini adalah CPOT merupakan instrumen penilaian nyeri yang lebih tepat dan cermat dibanding dengan skala COMFORT, namun tidak terdapat perbedaan reliabilitas CPOT dibanding dengan skala COMFORT dalam menilai intensitas nyeri pada pasien yang menggunakan ventilasi mekanik saat stimulus noxious. is the most valid and reliable pain assessment instrument for patients unable to communicate.

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“…ICU-related delusional memories are estimated to be present in around 30% to 70% of patients [10,12,13], are often persecutory in nature, and tend to be recalled with high vividness and in substantial detail [2].The direct cause of these delusional memories is unknown but is thought to be related to a combination of medication (including adrenaline, corticosteroids, opiates and sedative drugs such as propofol and benzodiazepine), sleep deprivation, and critical illness [12]. The literature surrounding the relationship between recall of absent, traumatic or delusional memories and psychological disorders is mixed, with different authors finding positive [10,12,14,15] and negative associations [7,16]. The association between delusional memories and the psychological distress of ICU survivors has been mainly attributed to the strong vividness with long duration and high emotional content of these memories when compared with memories of real events [13].…”

Section: Recovery From Critical Illnessmentioning

confidence: 99%

“…The aim of patient diaries is to provide ICU survivors with an accurate and informative collection of events, improving the memory recall of factual information. Delusional memories have been associated with anxiety, depression, post-traumatic stress symptomatology [9,12] and poor health-related quality of life [16].The aim of a diary is to provide a coherent narrative of the illness period, clarifying gaps in memory and diminishing the impact or dominance of imagined occurrences and hallucinations [18]. It has also been suggested that diaries can be used by relatives to encourage the healing process, after their own vicarious traumatic experience or as a basis for discussion about the patient's illness experience [10].…”

Section: Icu Diaries To Improve Recovery From Critical Illnessmentioning

confidence: 99%

Intensive care diaries to promote recovery for patients and families after critical illness: A Cochrane Systematic Review

Ullman

Aitken

Rattray

et al. 2015

International Journal of Nursing Studies

112

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Review methods: Studies evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU were included. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs. We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to pre-specified criteria. Permanent repository link Results:We identified three eligible studies; two describing ICU patients (N = 358), and one describing relatives of ICU patients (N = 30). No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, health-related quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (RR 0.29, 95% CI 0.07 to 1.19) or depression (RR 0.38, 95% CI 0.12 to 1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84 to 1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14 to 28), in comparison to no diary (median 28; range 14 to 38). Conclusions:Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members.

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Understanding posttraumatic stress disorder-related symptoms after critical care: The early illness amnesia hypothesis*

Abstract: Amnesia for the early period of critical illness (early amnesia) was positively associated with the level of posttraumatic stress disorder-related symptoms, which may be a proxy for severity of disease at the time of intensive care unit admission.

Cited by 153 publications

References 15 publications

Memories and prevalence of posttraumatic stress disorder in intensive care units

Memories and prevalence of posttraumatic stress disorder in intensive care units

Perbandingan Proporsi Penilaian dan Reliabilitas Skala COMFORT dan CPOT dalam Menilai Intensitas Nyeri pada Pasien yang Menggunakan Ventilasi Mekanik di Instalasi Perawatan Intensif RSUP H. Adam Malik Medan

Intensive care diaries to promote recovery for patients and families after critical illness: A Cochrane Systematic Review

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