A Case For Coordination Of Care To Include Mental Health Professionals

I came upon this article written about a small research study performed at the University London College.  Upon completion of reading it, I was struck with the proverbial “AHA” moment…..thinking to myself that we should have looked into this before. How many of you have experienced a friend or loved one being hospitalized in the ICU?  My guess is that most of you have had this experience…..probably with an older member of your clan. Were they ever the same when they were released back home? If not, was it more of a mental health issue than a physical one? Were they depressed? Were they anxious, moody, or agitated easily? Did they suffer from sudden onset sleep disturbances or excess fatigue? Did you think to yourself…..well, maybe this is part of their physical ailment or this is part of aging and disease? I can tell you that those have been my thoughts in the past when faced with this issue.

After reading this article and looking at the study it was based on, I can’t believe I hadn’t thought of this before…..maybe they were suffering from mental illness brought on by their hospital stay. This certainly makes a strong case for the development of new standard practices in hospital settings. For so many, many years the fields of medicine and mental health have been separated…..or is the right word segregated?  This is especially true of our traditional Western health practices. We as consumers need to push for more integrative care…..not solely focusing on physical ailments, but treating the person as a whole including their mind. There are some truly amazing pioneers in this area such as Candace Pert and Bruce Lipton, but much more needs to be done. With that said, I have included the article here for all of you to read. I would love to hear your thoughts.

 

Can Psychological Interventions Help ICU Patients?

By  Associate News Editor
Reviewed by John M. Grohol, Psy.D. on October 20, 2012

Can Psychological Interventions Help ICU Patients?Psychological interventions may reduce the mental health problems experienced by many intensive care patients, according to University College London researchers.

The researchers in a new study found that more than half of those who were discharged from intensive care went on to suffer psychological problems.

Researchers further investigated the causes of poor mental health in certain intensive care unit (ICU) patients once they were back home and supposedly “well.”

The study looked at four groups of risk factors (clinical, acute psychological, socio-demographic and chronic health) during the ICU admissions of 157 patients.

Three months after hospital discharge, the patients were assessed to see if they had any symptoms of post traumatic stress disorder (PTSD), depression or anxiety.

While certain drug treatments were identified as clinical risk factors for psychological problems, it was discovered that having acute stress reactions while in intensive care was an even stronger risk factor.

“The research showed associations between sedative drugs such as benzodiazepines, the length of time a patient was sedated and the likelihood of them feeling depressed, anxious and traumatized in future.

“However we found that acute stress reactions felt by a patient in the ICU was an even stronger risk factor,” said Dr. David Howell, clinical director of critical care at University College Hospital.

“As well as looking at modifying our drug treatments, we may need to invest more time in the psychological care of a patient and find ways to prevent psychological suffering in the ICU which can affect the quality of their life in years to come.”

The study found that “level three” patients — those who received mechanical ventilation for over 24 hours or had had two or more organs supported — suffered considerable mental stress both during and after a general ICU admission.

Three months after a hospital discharge, 27 percent had probable PTSD, 46 percent had probable depression and 44 percent had anxiety.

The strongest risk factors were as follows: duration of sedation (for PTSD); use of benzodiazepines (for depression); use of inotropes and vasopressors (for anxiety) and use of steroids (predicting better physical quality of life).

The most notable finding, however, was that acute stress reactions in the ICU were stronger risk factors than clinical factors.

“Our hypothesis is that patients suffer stress and delirium in the ICU due to invasive treatments and powerful drugs received, and those who suffer those stress reactions are more likely to have adverse psychological outcomes in the long-term,” said Dr. Dorothy Wade, health psychologist in critical care at University College Hospital.

A short psychological questionnaire, called the I-PAT (Intensive Care Psychological Assessment Tool), which is used by nurses to assess any changes in the mental well-being of patients, is now being validated by Wade and her colleagues in the critical care unit.

Furthermore, a variety of methods including relaxation, breathing exercises and therapeutic approaches are used to help patients feel safe and more assured. Picture prompts, wearing eye masks and playing soft music can also diminish patients’ distress.

“These are all relatively simple interventions which staff can undertake at the bedside as part of holistic care,” said Wade.

More funding is needed, however, to investigate the effects of these techniques on a patient’s long-term mental wellbeing.

“Research into psychological recovery from critical care is vitally important and more needs to be done. We’re really proud of this study and our work developing the I-PAT, and excited about the next step, which is to examine the effects of psychological interventions while patients are in critical care,” said Howell.

The research is published in the journal Critical Care.

 

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9 thoughts on “A Case For Coordination Of Care To Include Mental Health Professionals

  1. Melanie says:

    It’s no wonder people leave the hospital depressed. Nurses and doctors talk over you, around you, and about you without talking to you. You become an object and that’s hard to recover from, even when the disease is expelled.

  2. I’d like to know why they were in the I.C.U.-I mean what illness did they have that put them in there? I have been in the I.C.U. three times for suicide attempts, each time more severe than the previous. My final attempt put me in critical condition for 4 days and stable for three days. I was in there because I was already depressed. When I got out I was still depressed! That was 12 years ago so I am better now but it wasn’t the time in the I.C.U. that made me have stress. The stress was already present.

  3. Jim Amos says:

    I appreciate the experiences of all those who have commented so far. However, I’d like to make a case for highlighting the importance of recognizing the most frequent neuropsychiatric challenge facing patients and caregivers in the intensive care unit–delirium. Delirium and PTSD associated with delirium in the ICU are getting a great deal of study, and most researchers and clinicians now agree that preventing delirium is the most important goal. It’s vital to treat the underlying medical causes of delirium when it occurs. Delirium is a mimic of many psychiatric disorders including depression, but it’s not a primary psychiatric issue per se. Delirium is a medical emergency and the occurrence rates of delirium in the ICU are around 80% or higher. I’m surprised there’s little mention of delirium in this study, which was published in Critical Care. If anyone wants to learn more about delirium in the ICU, one of the best web sites is http://www.mc.vanderbilt.edu/icudelirium/index.html. Another would be the site for the American Delirium Society (ADS) at http://americandeliriumsociety.org/.

    It’s ironic that there’s a call for more involvement of mental health care professionals regarding this issue when, in fact, delirium itself is caused by severe medical illness. I agree that we can do more in an effort to protect patients from the detrimental effects of stress on mental health, especially related to the ICU experience. I think being as specific as possible about what kind of stress patients suffer is necessary in order to protect people. Certainly more collaboration amongst mental health care providers and intensivists is needed.

    Jim Amos, MD
    The Practical Psychosomaticist

  4. WordsFallFromMyEyes says:

    I had a friend in Perth who was passenger in a car crash, had two broken legs, and a broken arm. SO STRIKING was his experience in the rehab after operations, how the doctors talked as if he were not in the room, he wrote about it all, and I typed it up for him. He wrote to the hospital after, to tell them of his experiences – you know, a year later – no response, nothing.

    Very very interesting study indeed – and just great you brought it out for all to see.

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