Mental Health in the Intensive Care Unit: The Need for Early Intervention

By Michael J. Young

A prospective cohort study recently published in the New England Journal of Medicine adds to a growing body of research illuminating the neurocognitive sequelae of critical illness requiring intensive care.  Researchers reported that “one out of four patients [treated in the ICU] had cognitive impairment 12 months after critical illness that was similar in severity to that of patients with mild Alzheimer’s disease, and one out of three had impairment typically associated with moderate traumatic brain injury.”  They underscore the possible role of delirium – a syndrome of disturbed consciousness commonly seen in critically ill patients treated in the ICU – in contributing to downstream cognitive impairments.  More broadly, these findings prompt intensivists to rethink the relative priority assigned to the mental health needs of patients during ICU stays.

When patients are admitted to the ICU with critical, life-threatening illnesses, it is sometimes all too easy to for clinicians to direct full medical attention to the physical ailments of patients to the occasional neglect of patients’ mental health or overall wellbeing.  Although issues relating to mental health might strike some as secondary when approaching patients in acute physical distress, optimal patient care requires clinicians to acknowledge the intimate nexus between the mental health and physical health.

Writing in BMJ, one patient vividly recounts her experiences in the ICU:

“Endless days and nights filled with strange broken sleep. A sea of fragmented menacing faces and shadows swimming through erratic beeps and bells. A large cackling face floating over me, constantly morphing and changing shape… Deafening, haunting laughter filling every space… My chest locked to the bed with wires and straps, as a plastic mask repeatedly smothered me. A strangling sensation around my neck. A warm metallic taste. An invisible force pinning my body down as a dark curtain was drawn closed.

These are my memories of intensive care. They formed the fabric of reality that I would take forward and recall vividly in my dreams for many months afterwards. Such fragmented delusional memories made it extremely difficult to understand and make sense of what really happened to me. This prevented my psychological recovery and led to the development of post-traumatic stress disorder (PTSD).”

Unfortunately, development of PTSD or other psychological problems following care in the ICU is not uncommon.  These realities indicate a tremendous need to identify risk factors and to craft early intervention strategies to mitigate deleterious neurocognitive sequelae of critical care.  Equipping doctors and nurses with guidelines and tools to facilitate expedient evaluation and efficient management of the unique mental health needs of patients during ICU stays can ultimately maximize the effectiveness of critical care and help to ensure the wellbeing of patients well beyond their stays in the ICU.

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