Rehabilitation Psychology Insights for Treatment of Critical Illness Survivors

2017 ◽  
Author(s):  
Jennifer E. Jutte ◽  
James C. Jackson ◽  
Ramona O. Hopkins
Keyword(s):  
Critical Illness ◽  
Critically Ill Patient ◽  
Post Traumatic Stress ◽  
Rehabilitation Psychology ◽  
Acute Distress ◽  
Post Traumatic ◽  
Anxiety Depression

This chapter discusses the role of rehabilitation psychologists in the care of the critically ill patient during and after a stay in intensive care unit (ICU). Since post-ICU cognitive impairments and psychiatric difficulties such as anxiety, depression, acute distress disorder, and post-traumatic stress disorder may not be preventable altogether, it is important to attempt to minimize long-term impairment and distress. Because of the thorough training rehabilitation psychologists receive in assessment and intervention practices in patients with a variety of complex medical conditions, rehabilitation psychologists are particularly well-suited to identify and address the complex post-ICU morbidities faced by critical illness survivors across the continuum of care environments. Interventions across settings to minimize delirium, reduce psychological distress, and shore up cognitive deficits could positively influence patients’ recovery trajectories and quality of life.

scholarly journals Glucocorticoids and the brain after critical illness

Endocrinology ◽  
2021 ◽  
Author(s):  
Alice R Hill ◽  
Joanna L Spencer-Segal
Keyword(s):  
Critical Illness ◽  
Structural Integrity ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Post Traumatic Stress ◽  
Free Cortisol ◽  
Acute Elevation ◽  
Post Traumatic

Abstract Treatment for critical illness typically focuses on a patient’s short-term physical recovery; however, recent work has broadened our understanding of the long-term implications of illness and treatment strategies. In particular, survivors of critical illness have significantly elevated risk of developing lasting cognitive impairment and psychiatric disorders. In this review, we examine the role of endogenous and exogenous glucocorticoids in neuropsychiatric outcomes following critical illness. Illness is marked by acute elevation of free cortisol and adrenocorticotropic hormone (ACTH) suppression, which typically normalize after recovery; however, prolonged dysregulation can sometimes occur. High glucocorticoid levels can cause lasting alterations to the plasticity and structural integrity of the hippocampus and prefrontal cortex, and this mechanism may plausibly contribute to impaired memory and cognition in critical illness survivors, though specific evidence is lacking. Glucocorticoids may also exacerbate inflammation-associated neural damage. Conversely, current evidence indicates that glucocorticoids during illness may protect against the development of post-traumatic stress disorder (PTSD). We propose future directions for research in this field, including determining the role of persistent glucocorticoid elevations after illness in neuropsychiatric outcomes, the role of systemic vs. neuroinflammation, and probing unexplored lines of investigation on the role of mineralocorticoid receptors and the gut-brain axis. Progress toward personalized medicine in this area has the potential to produce tangible improvements to the lives patients after a critical illness, including Coronavirus Disease 2019 (COVID-19).

Palliative Care

2015 ◽  
pp. 105-123
Author(s):  
May Hua
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Intensive Care ◽  
Critical Illness ◽  
Serious Illness ◽  
Surgical Units ◽  
Potential Benefits

Palliative care is a specialty of medicine that focuses on improving quality of life for patients with serious illness and their families. As the limitations of intensive care and the long-term sequelae of critical illness continue to be delimited, the role of palliative care for patients that are unable to achieve their original goals of care, as well as for survivors of critical illness, is changing and expanding. The purpose of this chapter is to introduce readers to the specialty of palliative care and its potential benefits for critically ill patients, and to present some of the issues related to the delivery of palliative care in surgical units.

scholarly journals Neuropharmacology of the Neuropsychiatric Symptoms of Dementia and Role of Pain: Essential Oil of Bergamot as a Novel Therapeutic Approach

2019 ◽  
Vol 20 (13) ◽  
pp. 3327 ◽  
Author(s):  
Damiana Scuteri ◽  
Laura Rombolà ◽  
Luigi Antonio Morrone ◽  
Giacinto Bagetta ◽  
Shinobu Sakurada ◽  
...  
Keyword(s):  
Essential Oil ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Term Treatment ◽  
Long Term Treatment ◽  
Anxiety Depression ◽  
Cognitive Disturbance

Aging of the population makes of dementia a challenge for health systems worldwide. The cognitive disturbance is a serious but not the only issue in dementia; behavioral and psychological syndromes known as neuropsychiatric symptoms of dementia remarkably reduce the quality of life. The cluster of symptoms includes anxiety, depression, wandering, delusions, hallucinations, misidentifications, agitation and aggression. The pathophysiology of these symptoms implicates all the neurotransmitter systems, with a pivotal role for the glutamatergic neurotransmission. Imbalanced glutamatergic and GABAergic neurotransmissions, over-activation of the extrasynaptic N-methyl-D-aspartate (NMDA) receptors and alterations of the latter have been linked to the development of neuropsychiatric symptoms experienced by almost the entire demented population. Drugs with efficacy and safety for prevention or long term treatment of these disorders are not available yet. Aromatherapy provides the best evidence for positive outcomes in the control of agitation, the most resistant symptom. Demented patients often cannot verbalize pain, resulting in unrelieved symptoms and contributing to agitation. Bergamot essential oil provides extensive preclinical evidence of analgesic properties. Incidentally, the essential oil of bergamot induces anxyolitic-like effects devoid of sedation, typical of benzodiazepines, with a noteworthy advantage for demented patients. These data, together with the reported safety profile, form the rational basis for bergamot as a neurotherapeutic to be trialed for the control of behavioral and psychological symptoms of dementia.

Quality of life and depression during hospitalization for hematopoietic stem cell transplantation to predict quality of life and post-traumatic stress disorder symptoms at 6 months post-transplant.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 215-215
Author(s):  
Areej El-Jawahri ◽  
Harry VanDusen ◽  
Lara Traeger ◽  
Joel Fishbein ◽  
Tanya Keenan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Stem Cell ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Ptsd Symptoms ◽  
Post Traumatic Stress ◽  
Post Traumatic

215 Background: Patients undergoinghematopoietic stem cell transplantation (HCT) experience a steep deterioration in quality of life (QOL) and mood during hospitalization for HCT. The impact of this deterioration on patients’ long-term QOL and post-traumatic stress disorder (PTSD) symptoms is unknown. Methods: We conducted a prospective longitudinal study of patients hospitalized for HCT. At baseline (day-6), day+1, day+8, and 6 months post-HCT, we assessed QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation [FACT-BMT]) and mood (Hospital Anxiety and Depression Scale [HADS]). We used the PTSD Checklist to assess for PTSD symptoms at 6 months. We used multivariable linear regression models to identify predictors of QOL and PTSD symptoms at 6 months post-HCT. Results: We enrolled 97% (90/93) of consecutively eligible patients undergoing autologous (n = 30), myeloablative allogeneic (n = 30), or reduced intensity allogeneic (n = 30) HCT. Overall, patients’ QOL at 6 months (mean FACT-BMT: 110, 95%CI [104-116]) recovered to baseline pre-transplant values (mean FACT-BMT: 110, 95% CI [107-115]). At 6 months, 28.4% of participants met provisional diagnostic criteria for PTSD, and 43.3% had clinically significant depression. In multivariable regression analyses adjusting for baseline QOL, mood, other covariates, change in QOL and depression scores during hospitalization for HCT predicted impaired QOL (DQOL β = 1.13, P < 0.0001, D HADS-depression β = 2.51, P = 0.001) and PTSD symptoms (DQOL β = 0.50, P < 0.0001, DHADS-depression β = 1.22, P < 0.0001) at 6 months post-HCT. Conclusions: While patients’ overall QOL at 6 months post-HCT returned to baseline values, a significant proportion met provisional diagnostic criteria for PTSD and depression. The decline in QOL and increase in depressive symptoms during hospitalization for HCT were the most important predictors of long-term QOL impairment and PTSD symptoms. Future studies should evaluate whether interventions to improve QOL and reduce psychological distress during HCT may improve long-term QOL and reduce the risk of PTSD symptoms.

scholarly journals Factors associated with impaired quality of life three months after being diagnosed with COVID-19

2021 ◽  
Author(s):  
Verena Rass ◽  
Bogdan-Andrei Ianosi ◽  
Laura Zamarian ◽  
Ronny Beer ◽  
Sabina Sahanic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Physical Health ◽  
Traumatic Stress ◽  
Post Traumatic Stress ◽  
Factors Associated ◽  
Sf 36 ◽  
Post Traumatic ◽  
Anxiety Depression

Abstract Purpose To assess patient characteristics associated with health-related quality of life (HR-QoL) and its mental and physical subcategories 3 months after diagnosis with COVID-19. Methods In this prospective multicentre cohort study, HR-QoL was assessed in 90 patients using the SF-36 questionnaire (36-item Short Form Health Survey), which consists of 8 health domains that can be divided into a mental and physical health component. Mental health symptoms including anxiety, depression, and post-traumatic stress disorders were evaluated using the Hospital Anxiety and Depression Scale (HADS) and Post-traumatic Stress Disorder Checklist-5 (PCL-5) 3 months after COVID-19. Using descriptive statistics and multivariable regression analysis, we identified factors associated with impaired HR-QoL 3 months after COVID-19 diagnosis. Results Patients were 55 years of age (IQR, 49–63; 39% women) and were classified as severe (23%), moderate (57%), or mild (20%) according to acute disease severity. HR-QoL was impaired in 28/90 patients (31%). Younger age [per year, adjOR (95%CI) 0.94 (0.88–1.00), p = 0.049], longer hospitalization [per day, adjOR (95%CI) 1.07 (1.01–1.13), p = 0.015], impaired sleep [adjOR (95%CI) 5.54 (1.2–25.61), p = 0.028], and anxiety [adjOR (95%CI) 15.67 (3.03–80.99), p = 0.001) were independently associated with impaired HR-QoL. Twenty-nine percent (n = 26) scored below the normal range on the mental health component of the SF-36 and independent associations emerged for anxiety, depression, and self-reported numbness. Impairments in the physical health component of the SF-36 were reported by 12 (13%) patients and linked to hypogeusia and fatigue. Conclusion Every third patient reported a reduction in HR-QoL 3 months after COVID-19 diagnosis and impairments were more prominent in mental than physical well-being.

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