Intensive Care Unit (ICU) treatment involves a range of physical and psychological stressors including serious illness, invasive medical procedures, and prolonged incapacity. In addition to physical health problems, those that survive ICU often experience long term psychological difficulties such as cognitive impairment, depression, anxiety, and post-traumatic stress disorder. This review will first consider the types of psychological problems that can occur both during ICU treatment and following discharge and some of the factors involved in their development. Second, consideration is given to medical and psychological intervention strategies that can be provided both during treatment and in follow-up.
American Psychiatric Association.2000. Diagnostic and Statistical Manual of Mental Disorders (4th edition Text Revision). Washington DC: American Psychiatric Association.
2.
Backmän C.2002. Patient Diaries in ICU. In Griffiths RD, Jones C eds. Intensive Care AftercareOxford: Butterworth-Heinemann, 125—130.
3.
Bergbor-Engberg I., Haljamae H.1988. A retrospective study of patients recall of respirator treatment: nursing care factors and feelings of security/insecurity. Intens Care Nurs4: 95—101.
Biancofiore G., Bindi ML, Romanelli AM, et al. 2005. Stress inducing factors in ICU's: what liver transplant recipients experience and what care givers perceive. Liver Transplantation11: 967—972.
6.
Breslau N., Davis C., Andreski P., Peterson E.1991. Traumatic events and PTSD in an urban population of young adults. Arch Gen Psychiatry40: 216—22.
7.
Cohen R., Lohr I., Paul R., Boland R.2001. Impairments of attention and effort among patients with major affective disorders. J Neuropsychiatry Clin Neurosci13: 385—95.
8.
Curran PS, Bell P., Murray G., et al. 1990. Psychological consequences of the Enniskillen bombing. Brit J Psychiatry156: 478—82.
9.
Capuzzo M., Valpondi V., Cingolani E., et al. 2004. Application of the Italian version of the intensive care unit memory tool in the clinical setting. Crit Care8: 48—55.
10.
Deja M., Denker C., Weber Carstens S, et al. 2006. Social support during intensive care unit stay might improve mental impairment and consequently health related quality of life in survivors of severe acute respiratory distress syndrome. Crit Care10: 147—58.
11.
Dubois MJ, Bergeron N., Dumont M., Dial S., Skrobik Y.2001. Delirium in an intensive care unit: a study of risk factors . Intensive Care Med27: 1297—304.
12.
Eidelman LA, Putterman D., Putterman C., et al. 1996. The spectrum of septic encephalopathy: Definitions, etiologies and mortalities. JAMA275: 470—3.
13.
Ely EW, Shintani A., Truman B., et al. 2004. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA291: 1753—62.
14.
Ely EW, Inouye SK, Bernard GR, et al. 2001. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA286: 2703—10.
15.
Granja C., Lopes A., Moriera S., et al. 2005. Patients recollections of experiences in the intensive care unit may affect their quality of life. Crit Care9: 96—109.
16.
Helzer JE, Robins L., McEvoy L.1987. Post-traumatic stress disorder in the general population: Findings of the epidemiological catchment area survey. New Eng J Med317: 1630—4.
17.
Hopkins RO, Weaver LK, Pope D., et al. 1999. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med160: 50—56.
18.
Holstag HR, van Beeck EF, Lindeman E., Leenen LPH, et al. 2007. Determinants of long term functional consequences after major trauma. J Trauma62: 919—927.
19.
Hweidi IM2007. Jordanian patients' perception of stressors in critical care units: a questionnaire survey. Int J Nurs Stud44: 227—35.
20.
Jackson JC, Obremsky W., Bauer R., et al. 2007. Long term cognitive, emotuional and functional outcomes in trauma intensive care unit survivors without intracranial hemmorrrhage . J Trauma62: 80—8.
21.
Jackson JC, Hart RP, Gordon SM, et al. 2003. Six month neuropsychological outcome of medical intensive care unit patients. Crit Care Med31: 1226—34.
22.
Jelinek L., Jacobsen D., Kellner M., et al. 2006. Verbal and non-verbal memory functioning in posttraumatic stress disorder (PTSD). J Clin Exp Neuropsychol28: 940—8.
23.
Jones C.2002. Acute Psychological Problems. In Griffiths RD, Jones C eds. Intensive Care AftercareOxford : Butterworth-Heinemann, 19—26.
24.
Jones C., Griffiths RD, Slater T., Benjamin KS, Wilson S.2006. Significant cognitive dysfunction in non-delirious patients identified during and persisting following critical illness. Intensive Care Med32: 923—6.
25.
Jones C., Griffiths RD2002. Physical and Psychological Recovery. In Griffiths RD, Jones C eds Intensive Care AftercareOxford : Butterworth-Heinemann, 125—130.
26.
Jones C., Skirrow P., Griffiths RD, Humphris GH, Ingleby S., Eddleston J., Waldmann C., Gager M.2003. Rehabilitation after critical illness: a randomised controlled trial. Crit Care Med31: 2456—61.
27.
Jones C., Griffiths RD, Humphris GH, Skirrow P.2001. memory delusions and the development of acute post-traumatic stress disorder related symptoms after intensive care. Crit Care Med29: 573—7.
28.
Jones C., Griffiths RD, Humphris G.2000. Disturbed memory and amnaesia related to intensive care . Memory8: 79—94.
29.
Jones C., Humphris GM, Griffiths RD1998. Psychological morbidity following critical illness — the rationale for care after intensive care. Clin Intensive Care9: 199—205.
30.
Kapfhammer HP, Rothenhäuslern HB, Krauseneck T., Stoll C., Schelling G.2004. Post traumatic stress disorder and health related quality of life in long term survivors of acute respiratory distress syndrome . Am J Psychiatry161: 45—52.
31.
Kilpatrick DG, Resnik HS1993. PTSD associated with exposure to criminal victimisation in clinical and community populations. In Davidson JRT, Foa EB eds. PTSD in review: DSM-IV and beyond. Washington DC: American Psychiatric Association Press.
32.
Lin SM, Liu CY, Wang CH, et al. 2004. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med32: 2352—4.
33.
Lipowski ZJ1989. Delirium in the elderly patient. N Eng J Med320: 578—82.
34.
Malt UF, Olafsen OM1992. Psychological appraisal and emotional response to physical injury: a clinical phenomenological study of 109 adults. Psychiatr Med10: 117—34.
35.
McGuire BE, Basten CJ, Ryan CJ, Gallgher J.2000. Intensive care syndrome: a dangerous misnomer. Arch Intern Med160: 906—9.
36.
Mohta M., Sethi AK, Tyagi A., Mohta A.2003. Psychological care in trauma patients. Injury34: 17—25.
37.
Morgan L., Scourfield J., Williams D., Jasper A., Lewis G.2003. The Aberfan disaster; 33 year follow-up of survivors . Brit J Psychiatry182: 532—6.
38.
National Institute for Clinical Excellence.2007. Anxiety (amended): Management of anxiety (panic disorder with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. National Institute for Clinical Excellence.
39.
National Institute and Clinical Excellence, 2007a. Depression (amended) management of depression in primary and secondary care. National Institute for Clinical Excellence .
40.
National Institute for Clinical Excellence.2005. Posttraumatic stress disorder (PTSD) The management of PTSD in adults and children in primary and secondary care. National Institute for Clinical Excellence.
41.
Novaes MA, Knobel E., Bork AM, et al. 1999. Stressors in the ICU: perception of the patient, relatives and health care team. Int Care Med25: 1421—6.
42.
Novaes MA, Aronovich A., Ferraz MB, Knobel E.1997. Stressors in the ICU: patients evaluation. Int Care Med23: 1282—5.
43.
Paelecke-Habermann Y., Pohl J., Leplow B.2005. Attention and executive functions in remitted major depression patients. J Affect Disord89: 125—35.
44.
Papadopoulos MC, Davies DC, Moss RF, et al. 2000. Pathophysiology of septic encephalopathy: a review. Crit Care Med28: 3019—24.
45.
Poldemen KHSmit E.2005. Dealing with the delirium dilemma. Crit Care9: 335—6.
46.
Rattray JE, Johnston M., Wildsmith JAW.2005. Predictors of emotional outcomes of intensive care . Anaesthesia60: 1085—92.
47.
Rosene KA, Copass MK, Kastner LS, et al. 1982. Persistent neuropsychological sequelae of toxic shock. Ann Inter Med96: 865—70.
48.
Roth A., Fonagy P.2005. What Works for Whom? A Critical Review of Psychotherapy Research, 2nd edition. Guilford Press, New york.
49.
Rothenhausler HB, 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. Gen Hosp Psychiatry23: 90—6.
50.
Rotondi AJ, Celluri L., Sirio C., et al. 2002. Patients recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit . Crit Care Med30: 746—52.
51.
Samuelson KW, Neylan TC, Metzler TJ, et al. 2006. Neuropsychological functioning in posttraumatic stress disorder and alcohol abuse. Neuropsychology20: 716—26.
52.
Schelling G., Stoll C., Haller M., et al. 1998. Health related quality of life and post-traumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med26: 651—9.
Schnyder U., Morgeli H., Nigg C., et al. 2000. Early psychological reactions to life threatening injuries. Crit Care Med28: 86—91.
55.
Scragg P., Jones A., Fauvel N.2001. Psychological problems following ICU treatment . Anaesthesia56: 9—14.
56.
Skirrow P.2002. Delusional Memories of ICU. In Griffiths R.D, Jones C eds. Intensive Care AftercareOxford : Butterworth-Heinemann.
57.
Suave MJ, Doolittle N., Walker JA, Paul SM, Scheinman MM1996. Factors associated with cognitive recovery after cardiopulmonary resuscitation. Am J Crit Care5: 127—39.
58.
Sukantarat KT, Burgess PW, Williamson RCN, Brett SJ2005. Prolonged cognitive dysfunction in survivors of critical illness. Anaesthesia60: 847—853.
59.
Thomason JWW, Shintani A., Peterson JF, et al. 2005. Intensive care delirium an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients . Crit Care9: 375—81.
60.
Van de Leur JP, Van der Schans CP, Loef BG, et al. 2004. Discomfort and factual recollection in intensive care unit patients. Crit Care8: 467—73.
61.
Vles WJ, Steverburg EW, Essink-Bot ML, et al. 2005. Prevalence and determinants of disabilities and return to work after major trauma. J Trauma58: 126—35.
62.
Wilson BA1996. Cognitive functioning of adult survivors of cerebral hypoxia . Brain Inj10: 863—74.
63.
Yehuda R., Tischler L., Golier JA, et al. 2006. Longitudinal assessment of cognitive performance in holocaust survivors with and without PTSD. Biol Psychiatry60: 714—21.
