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28 - The intensive care unit

from Part III - Working with specific units

Published online by Cambridge University Press:  10 December 2009

By
Simon Turner ,
Daniel Conway ,
Jane Eddleston  and
Elspeth Guthrie
Edited by
Geoffrey Lloyd  and
Elspeth Guthrie
Geoffrey Lloyd
Affiliation:
Priory Hospital, London
Elspeth Guthrie
Affiliation:
University of Manchester
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Summary

Introduction

Intensive care medicine is a relatively new speciality made possible by technological advances in artificial life support. Intensive care unit (ICU) development took its first steps at Copenhagen in 1952, with treatment using positive pressure ventilation of poliomyelitis cases. This success was copied worldwide during similar epidemics and now intensive care units are integral parts of most major acute hospital services.

In the UK there are over 200 ICUs admitting around 80 000 patients per year. Intensive care medicine is able to offer support for those suffering acute multiple organ failure, including pulmonary, haematological, hepatic, cardiovascular and renal replacement therapy. Data derived from the Case Mix Programme of the Intensive Care National Audit and Research Centre (www.icnarc.org) suggest that ICU mortality is high, with only 70% of admissions surviving to hospital discharge. Technological advances have created unique ethical dilemmas for those involved in the ICU, particularly regarding the withdrawal of life-supporting therapy in patients often unable to speak for themselves.

From the 1960s, increasing interest has developed in the psychological impact of the ICU environment. Research and clinical input has been provided by several disciplines: nursing, psychology and psychiatry.

One of the first reviews of the issues from a psychiatric perspective was by Kornfeld in 1969. He categorized the problems into four areas:

  • psychiatric reactions to the conditions that led to ICU admission

  • psychiatric reactions provoked by the unusual environment of the ICU

  • psychiatric reactions that develop post-discharge

  • the psychological welfare of staff working on ICUs.

In this chapter, the issues are categorized in the same way, but the impact on relatives and approaches to liaison with the ICU are also discussed.

Keywords

artificial life supportdepressionintensive care unitpatientpsychiatric disorder
Type
Chapter
Information
Handbook of Liaison Psychiatry , pp. 673 - 696
Publisher: Cambridge University Press
Print publication year: 2007

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References

Anderson, I. M., Nutt, D. J. and Deakin, J. F. W. (2000). Evidence based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology, 14, 3–20.Google Scholar
Azoulay, E., Pochard, F., Chevret, S., et al. (2001). French FAMIREA group meeting the needs of intensive care unit patient families: a multicenter study. American Journal of Respiratory and Critical Care Medicine, 163, 135–9.Google Scholar
Baxter, S. (1974). Psychological problems of intensive care. British Journal of Hospital Medicine, 11, 875–85.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., et al. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–71.Google Scholar
Bijttebier, P., Vanoost, S., Delva, D., et al. (2001). Needs of relatives of critical care patients: perceptions of relatives, physicians and nurses. Intensive Care Medicine, 27, 160–5.Google Scholar
Billig, N. (1981). Liaison psychiatry: a role on the medical intensive care unit. The International Journal of Psychiatry in Medicine, 11, 379–86.Google Scholar
Capuzzo, M., Valpondi, V., Cingolani, E., et al. (2005). Post-traumatic stress disorder-related symptoms after intensive care. Minerva Anesthesiologica, 71, 167–79.Google Scholar
Chelluri, L., Im, K., Belle, S., et al. (2004). Long-term mortality and quality of life after prolonged mechanical ventilation. Critical Care Medicine, 32, 61–9.Google Scholar
Cheng, E. Y. (1996). Recall in the sedated ICU patient. Journal of Clinical Anaesthesia, 8, 675–8.Google Scholar
Conway, D. H., Turner, S. J., Eddleston, J., et al. (2001). Sedation on intensive care: a pathway into dependence. Care of the Critically Ill, 17, 170–1.Google Scholar
Cutler, L. and Garner, M. (1995). Reducing relocation stress after discharge from the intensive therapy unit. Intensive and Critical Care Nursing, 11, 333–5.Google Scholar
Eddleston, J. M., White, P. and Guthrie, E. (2000). Survival, morbidity, and quality of life after discharge from intensive care. Critical Care Medicine, 28, 2293–9.Google Scholar
First, M., Spitzer, R., Gibbon, M., et al. (1998). Structured Clinical Interview for DSM-IV Axis I Disorders – non-patient edition (SCID-I/NP, Version 2.0). Arlington VA: American Psychiatric Press.
Fish, D. N. (1991). Treatment of delirium in the critically ill patient. Clinical Pharmacy, 10, 456–66.Google Scholar
Gipson, W. T. (1991). Fatigue and depression in the patient in the intensive care unit. Primary Care, 18, 359–67.Google Scholar
Granberg, A., Engberg, I. B. and Lundberg, D. (1996). Intensive care syndrome: a literature review. Intensive and Critical Care Nursing, 12, 173–82.Google Scholar
Green, A. (1996). An exploratory study of patients' memory recall of their stay in an adult intensive therapy unit. Intensive and Critical Care Nursing, 12, 131–7.Google Scholar
Halm, M. A., Titler, M. G., Kleiber, C., et al. (1993). Behavioral responses of family members during critical illness. Clinical Nursing Research, 2, 414–37.Google Scholar
Hay, D. and Oken, D. (1972). The psychological stresses of intensive care nursing. Psychosomatic Medicine, 34, 109–18.Google Scholar
Henderson, A., Wright, M. and Pond, S. M. (1993). Experience with 732 acute overdose patients admitted to an intensive care unit over six years. Medical Journal of Australia, 158, 28–30.Google Scholar
Hopkins, R. O. and Brett, S. (2005). Chronic neurocognitive effects of critical illness. Current Opinion in Critical Care, 11, 369–75.Google Scholar
Hopkins, R. O., Weaver, L. K., Pope, D., et al. (1999). Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 160, 50–65.Google Scholar
Hopkins, R. O., Weaver, L. K., Chan, K.J., et al. (2004). Quality of life, emotional, and cognitive function following acute respiratory distress syndrome. Journal of the International Neuropsychological Society, 10, 1005–17.Google Scholar
Hopkins, R. O., Weaver, L. K., Collingridge, D., et al. (2005a). Two year neurocognitive, emotional and quality of life in acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 171, 340–7.Google Scholar
Hopkins, R. O., Jackson, J. C. and Wallace, C. J. (2005b). Neurocognitive impairments in ICU patients with prolonged mechanical ventilation. Program and Abstracts of the International Neuropsychology Society, 33rd Annual Meeting, 61. 1–5 February, St Louis, Missouri, USA.
Jackson, J., Hart, R., Gordon, S., et al. (2003). Six-month neuropsychological outcomes of medical intensive care unit patients. Critical Care Medicine, 31, 1226–34.Google Scholar
Jones, C., Griffiths, R. D., Macmillan, R., et al. (1994). Psychological problems occurring after intensive care. British Journal of Intensive Care, 4, 46–53.Google Scholar
Jones, C., Griffiths, R. D. and Humpris, G. (2000a). Disturbed memory and amnesia related to intensive care. Memory, 8, 79–94.Google Scholar
Jones, C., Skirrow, P., Griffiths, R. D., et al. (2000b). Predicting intensive care relatives at risk of post traumatic stress disorder. British Journal of Anaesthesia, 84, 666–7.Google Scholar
Jones, C., Griffiths, R. D., Humphris, G., et al. (2001). Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Critical Care Medicine, 29, 687–8.Google Scholar
Kam, P. C. A. and Chang, G. W. M. (1997). Selective serotonin inhibitors: pharmacology and clinical implications in anaesthesia and critical care. Anaesthesia, 52, 982–8.Google Scholar
Keenan, S. P., Busche, K. D., Chen, L. M., et al. (1997). A retrospective review of a large cohort of patients undergoing the process of withholding or withdrawal of life support. Critical Care Medicine, 25, 1324–31.Google Scholar
Kleck, H. (1984). ICU syndrome: onset, manifestations, treatment, stressors and prevention. Critical Care Quarterly, 6, 21–8.Google Scholar
Kleiber, C., Halm, M., Titler, M., et al. (1994). Emotional responses of family members during a critical care hospitalization. American Journal of Critical Care, 3, 70–6.Google Scholar
Kornfeld, D. S. (1969). Psychiatric view of the intensive care unit. British Medical Journal, 1, 108–10.Google Scholar
Koumans, A. J. R. (1965). Psychiatric consultation in an intensive care unit. Journal of the American Medical Association, 194, 163–7.Google Scholar
Kress, J., Gehlbach, B., Lacy, M., et al. (2003). Long-term psychological effects of daily sedative interruption on critically ill patients. American Journal of Respiratory and Critical Care Medicine, 168, 1457–61.Google Scholar
Kutz, I., Shabtai, H., Solomon, Z., et al. (1994). Post-traumatic stress disorder in myocardial infarction patients: prevalence study. Israel Journal of Psychiatry and Related Sciences, 31, 48–56.Google Scholar
Leith, B. A. (1999). Patients' and family members' perceptions of transfer from intensive care. Heart and Lung, 28, 210–18.Google Scholar
Lyness, J. M., Noel, T. K., Cox, C., et al. (1997). Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriatric Depression Scale. Archives of Internal Medicine, 157, 449–54.Google Scholar
MacKenzie, T. B. and Popkin, M. K. (1980). Stress response syndrome occurring after delirium. American Journal of Psychiatry, 137, 1433–5.Google Scholar
Mayou, R., Bryant, B. and Duthie, R. (1993). Psychiatric consequences of road traffic accidents. British Medical Journal, 307, 647–51.Google Scholar
McGuire, B., Basten, C., Ryan, C., et al. (2000). Intensive care syndrome: a dangerous misnomer. Archives of Internal Medicine, 160, 906–9.Google Scholar
McKegney, F. P. (1966). The intensive care syndrome: the definition, treatment and prevention of a new ‘disease of medical progress’. Connecticut Medicine, 30, 633–6.Google Scholar
Mendel, J. G. and Khan, F. A. (1980). Psychological aspects of weaning from mechanical ventilation. Psychosomatics, 21, 465–71.Google Scholar
Menza, M. A., Murray, G. B., Holmes, V. F., et al. (1987). Decreased extrapyramidal symptoms with intravenous haloperidol. Journal of Clinical Psychiatry, 48, 278–80.Google Scholar
Molter, N. C. (1979). Needs of relatives of critically ill patients. Heart and Lung, 8, 332–9.Google Scholar
Nelson, B. J., Weinart, C. R., Bury, C. L., et al. (2000). Intensive care unit drug use and subsequent quality of life in acute lung injury patients. Critical Care Medicine, 28, 3626–30.Google Scholar
Paratz, J., Thomas, P. and Adsett, J. (2005). Re-admission to intensive care: identification of risk factors. Physiotherapy Research, 10, 154–63.Google Scholar
Pearson, A., Robertson-Malt, S., Walsh, K., et al. (2001). Intensive care nurses' experiences of caring for brain dead organ donor patients. Journal of Clinical Nursing, 10, 132–9.Google Scholar
Pochard, F., Azoulay, E., Chevret, S., et al. The French FAMIREA group. (2001). Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Critical Care Medicine, 29, 1893–7.Google Scholar
Power, B. M., Pinder, M., Hackett, L. P., et al. (1995). Fatal serotonin syndrome following a combined overdose of moclobemide, clomipramine and fluoxetine. Anaesthesia and Intensive Care, 23, 499–522.Google Scholar
Radloff, L. S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.Google Scholar
Rothenhausler, H. B., Ehrentraut, S., Stoll, C., et al. (2001). The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: results of an exploratory study. General Hospital Psychiatry, 23, 90–6.Google Scholar
Russell, S. (1999). An exploratory study of patients' perceptions, memories and experiences of an intensive care unit. Journal of Advanced Nursing, 29, 783–91.Google Scholar
Schelling, G., Stoll, C., Haller, M., et al. (1998). Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Critical Care Medicine, 26, 651–9.Google Scholar
Scragg, P., Jones, A. and Fauvel, N. (2001). Psychological problems following ICU treatment. Anaesthesia, 56, 9–14.Google Scholar
Skirrow, P., Jones, C., Griffiths, R. D., et al. (2002). The impact of current media events on hallucinatory content: the experience of the intensive care unit (ICU) patient. British Journal of Clinical Psychology, 41, 87–91.Google Scholar
Strom, J., Thisted, B., Krantz, T., et al. (1986). Self-poisoning treated in an ICU: drug pattern, acute mortality and short-term survival. Acta Anaesthesiologica Scandinavica, 30, 148–53.Google Scholar
Suchtya, M. R., Hopkins, R. O., White, J., et al. (2004). The incidence of cognitive dysfunction after ARDS. American Journal of Respiratory Critical Care Medicine, 169, A18.Google Scholar
Turner, S. J., Ingleby, S. E., Eddleston, J. M., et al. (2002). Psychiatric perspectives on intensive care follow-up. British Journal of Intensive Care, 12, 6–10.Google Scholar
Emmerik, A. A., Kamphuis, J. H., Hulsbosch, A. M., et al. (2002). Single session debriefing after psychological trauma: a meta-analysis. The Lancet, 360, 766–71.Google Scholar
Vreeland, R. and Ellis, G. (1969). Stresses on the nurse in the intensive-care unit. Journal of the American Medical Association, 208, 332–4.Google Scholar
Wagner, B. K. J., O'Hara, D. A. and Hammond, J. S. (1997). Drugs for amnesia in the ICU. American Journal of Critical Care, 6, 192–201.Google Scholar
Wehler, M., Geise, A., Hadzionerovic, D., et al. (2003). Health-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population. Critical Care Medicine, 31, 1094–101.Google Scholar
Weinert, C. (2005). Epidemiology and treatment of psychiatric conditions that develop after critical illness. Current Opinion in Critical Care, 11(4), 376–80.Google Scholar
Weinert, C., Groom, J., Stibbe, C., et al. (2003). Depression and antidepressant therapy during recovery from acute respiratory failure. American Journal of Respiratory Critical Care Medicine, 167, A437.Google Scholar
Wilson, L. M. (1972). Intensive care delirium: the effect of outside deprivation in a windowless unit. Archives of Internal Medicine, 130, 225–6.Google Scholar
Winship, G. (1998). Intensive care psychiatric nursing – psychoanalytic perspectives. Journal of Psychiatric and Mental Health Nursing, 5, 361–5.Google Scholar
Young, E., Eddleston, J., Ingleby, S., et al. (2005). Returning home after intensive care: a comparison of symptoms of anxiety and depression in ICU and elective cardiac surgery patients and their relatives. Intensive Care Medicine, 31, 86–91.Google Scholar
Youngner, S., Jackson, D. L. and Allen, M. (1979). Staff attitudes towards the care of the critically ill in the medical intensive care unit. Critical Care Medicine, 7, 35–40.Google Scholar
Zigmond, A. S. and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–70.Google Scholar

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