Increased psychiatric illness noted in intensive care unit patients

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1. Non-surgical intensive care unit (ICU) patients receiving mechanical ventilation demonstrated a higher prevalence of psychiatric diagnoses and psychoactive medication utilization in the five years prior to ICU admission

2. Non-surgical ICU patients with no prior psychiatric history demonstrated an increased incidence of new psychiatric diagnoses and psychoactive medication utilization 3 months post discharge.

Evidence Rating Level: 2 (Good)

Study Rundown: Patients admitted to intensive care units are subjected to impressive amounts of physiological stress. Comparing mechanically intubated ICU patients to both matched hospitalized patients and general population controls, this study demonstrated an increased burden of psychiatric illness prior to and following ICU admission. While this study did not account for variations in the severity of illness necessitating ICU admission, it does provide important information regarding the prevalence of psychiatric disease in this population. Recognition of this increased burden and subsequent risk may aid in planning for mental health follow up post-discharge and in organizing psychiatric treatment prior to potential future ICU admissions.

Click to read the study, published today in JAMA

Relevant Reading: Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care

In-Depth [retrospective cohort study]: This retrospective cohort study utilized data from a collection of Danish national medical databases from January 1, 2006 to December 31, 2008 to organize three comparative groups. A total of 24 179 adults admitted to the medical ICU for the first time and requiring mechanical ventilation were compared to non-ICU, hospitalized patients, and controls from the general population. Of ICU patients, 6.2% had one or more psychiatric diagnoses in the 5 years preceding admission, compared to 5.4% (P < 0.001, 95% CI: 1.22-1.42) in hospitalized patients and 2.4% in the general population (P < 0.001, 95% CI: 2.41-2.73). The 9912 adults admitted to the medical ICU with no prior psychiatric history who survived to discharge were subsequently analyzed, with a 0.5% risk of new psychiatric diagnoses noted 3 months post discharge in ICU patients and a .2% and .02% risk (P < 0.001) noted in hospitalized patients and the general population, respectively.

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