Depressive Mood States Following Critical Illness

2014 ◽  
Author(s):  
O Joseph Bienvenu
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Critical Illness ◽  
Psychiatric Morbidity ◽  
Depressive Mood ◽  
Mood States ◽  
High Dose ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Depressive States

Patients with critical illnesses treated in intensive care units face severe physical and psychic stresses, and survivors often have financial and other burdens. The prevalence of depressive mood states in survivors varies by measure and follow-up time, but the median prevalence across >30 studies was 28% (mostly measured within a year of critical illness). Severe depressive states (e.g. major depressive episodes) are less common than minor depressive states. Risk factors include female sex, lesser educational attainment, unemployment, and medical and psychiatric comorbidity. Potential critical illness/intensive care-related risk factors include severity of organ failure, high-dose benzodiazepine administration, longer ICU stays, stressful ICU experiences, and early post-intensive care distress. Depressive symptoms in survivors are associated with impaired physical function, other psychiatric morbidity, cognitive and work difficulties, and lower health-related quality of life. Research is needed to evaluate the preventive or therapeutic role of psychological interventions during intensive care and psychological recovery programmes.

Psychological Morbidity After Critical Illness

2021 ◽  
pp. 101-121
Author(s):  
O. Joseph Bienvenu ◽  
Megan M Hosey
Keyword(s):  
Risk Factors ◽  
Critical Illness ◽  
Psychiatric Morbidity ◽  
Psychological Morbidity ◽  
Physical Impairments ◽  
New Approaches ◽  
Psychiatric Disturbances

Patients with critical illnesses face a number of severe psychic and physical stressors. Survivors often have long-term cognitive and physical impairments, as well as family, financial, and other stressors. These potential stressors increase the risk of psychiatric disturbances substantially. This chapter describes the burden of distress-related psychiatric morbidity in patients who survive critical illnesses, as well as risk factors for this morbidity. This knowledge serves as the motivation to develop new approaches that can ameliorate, or even prevent, long-term distress in survivors. The chapter also presents information about early attempts to reduce, prevent, and manage long-term psychological morbidity.

Incidence and Predictors of Suicide Attempts in Bipolar I and II Disorders: A Five-year Follow-up

2017 ◽  
Vol 41 (S1) ◽  
pp. S87-S87
Author(s):  
S. Pallaskorpi ◽  
K. Suominen ◽  
M. Ketokivi ◽  
H. Valtonen ◽  
P. Arvilommi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Models ◽  
Suicide Attempts ◽  
Incidence Rates ◽  
Personality Factors ◽  
Long Term Study ◽  
Major Depressive Episodes ◽  
Depressive Episodes

IntroductionAlthough suicidal behavior is very common in bipolar disorder (BD), few long-term studies have investigated incidence and risk factors of suicide attempts (SAs) specifically related to illness phases of BD.ObjectivesWe examined incidence of SAs during different phases of BD in a long-term prospective cohort of bipolar I (BD-I) and II (BD-II) patients and risk factors specifically for SAs during major depressive episodes (MDEs).MethodsIn the Jorvi bipolar study (JoBS), 191 BD-I and BD-II patients were followed using life-chart methodology. Prospective information on SAs of 177 patients (92.7%) during different illness phases was available up to five years. Incidence of SAs and their predictors were investigated using logistic and Poisson regression models. Analyses of risk factors for SAs occurring during MDEs were conducted using two-level random-intercept logistic regression models.ResultsDuring the five-year follow-up, 90 SAs per 718 patient-years occurred. Compared with euthymia the incidence was highest, over 120-fold, during mixed states (765/1000 person-years [95% confidence interval (CI) 461–1269]) and also very high in MDEs, almost 60-fold (354/1000 [95%CI 277–451]). For risk of SAs during MDEs, the duration of MDEs, severity of depression and cluster C personality disorders were significant predictors.ConclusionsIn this long-term study, the highest incidences of SAs occurred in mixed phases and MDEs. The variations in incidence rates between euthymia and illness phases were remarkably large, suggesting that the question “when” rather than “who” may be more relevant for suicide risk in BD. However, risk during MDEs is likely also influenced by personality factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of adult major depressive episodes: A systematic review and network meta-analysis of 113 randomised clinical trials

2018 ◽  
Author(s):  
Julian Mutz ◽  
Vijeinika Vipulananthan ◽  
Ben Carter ◽  
Rene Hurlemann ◽  
Cynthia H Y Fu ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Brain Stimulation ◽  
Acute Treatment ◽  
Meta Analysis ◽  
High Dose ◽  
Major Depressive ◽  
Treatment Protocols ◽  
Severity Scores ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Background: Non-surgical brain stimulation techniques have been applied as tertiary treatments in major depression. However, the relative efficacy and acceptability of individual protocols is uncertain. Our aim was to estimate the comparative clinical efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults. Methods: Embase, PubMed/MEDLINE and PsycINFO were searched up until May 8, 2018, supplemented by manual searches of bibliographies of recent reviews and included trials. We included clinical trials with random allocation to electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), accelerated TMS (aTMS), priming TMS (pTMS), deep TMS (dTMS), theta burst stimulation (TBS), synchronised TMS (sTMS), magnetic seizure therapy (MST) or transcranial direct current stimulation (tDCS) protocols or sham. Data were extracted from published reports and outcomes were synthesised using pairwise and network random-effects meta-analysis. Primary outcomes were response (efficacy) and all-cause discontinuation (acceptability). We computed odds ratios (OR) with 95% confidence intervals (CI). Remission and continuous post-treatment depression severity scores were also examined. Results: 113 trials (262 treatment arms) randomising 6,750 patients (mean age = 47.9 years; 59% female) with major depressive disorder or bipolar depression met our inclusion criteria. In terms of efficacy, 10 out of 18 treatment protocols were associated with higher response relative to sham in network meta-analysis: bitemporal ECT (OR=8.91, 95%CI 2.57-30.91), high-dose right-unilateral ECT (OR=7.27, 1.90-27.78), pTMS (OR=6.02, 2.21-16.38), MST (OR=5.55, 1.06-28.99), bilateral rTMS (OR=4.92, 2.93-8.25), bilateral TBS (OR=4.44, 1.47-13.41), low-frequency right rTMS (OR=3.65, 2.13-6.24), intermittent TBS (OR=3.20, 1.45-7.08), high-frequency left rTMS (OR=3.17, 2.29-4.37) and tDCS (OR=2.65, 1.55-4.55). Comparing active treatments, bitemporal ECT and high-dose right-unilateral ECT were associated with increased response. All treatment protocols were at least as acceptable as sham treatment. Conclusion: We found that non-surgical brain stimulation techniques constitute viable alternative or add-on treatments for adult patients with major depressive episodes. Our findings also highlight the need to consider other patient and treatment-related factors in addition to antidepressant efficacy and acceptability when making clinical decisions; and emphasize important research priorities in the field of brain stimulation.

scholarly journals Progression of Fibrinogen Decrease during High Dose Tigecycline Therapy in Critically Ill Patients: A Retrospective Analysis

2021 ◽  
Vol 10 (20) ◽  
pp. 4702
Author(s):  
Benedikt Treml ◽  
Sasa Rajsic ◽  
Tobias Hell ◽  
Dietmar Fries ◽  
Mirjam Bachler
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Time Course ◽  
Surgical Intensive Care Unit ◽  
High Dose ◽  
Coagulation Disorder ◽  
Surgical Intensive Care ◽  
Intensive Care Patients

Tigecycline is a novel glycylcycline broad-spectrum antibiotic offering good coverage for critically ill patients experiencing complicated infections. A known side effect is a coagulation disorder with distinct hypofibrinogenemia. To date, the information on possible risk factors and outcomes is sparse. Therefore, the aim of this study is to examine the time course of fibrinogen level changes during tigecycline therapy in critically ill patients. Moreover, we sought to identify risk factors for coagulopathy and to report on clinically important outcomes. We retrospectively reviewed all intensive care patients admitted to our General and Surgical Intensive Care Unit receiving tigecycline between 2010 and 2018. A total of 130 patients were stratified into two groups based on the extent of fibrinogen decrease. Patients with a greater fibrinogen decrease received a higher dose, a longer treatment and more dose changes of tigecycline, respectively. In regard to the underlying pathology, these patients showed higher inflammation markers as well as a slightly reduced liver synthesis capacity. We, therefore, conclude that such a fibrinogen decrease may be based upon further impairment of liver synthesis during severe inflammatory states. To decrease the risk of bleeding, cautious monitoring of coagulation in critically ill patients treated with high-dose tigecycline is warranted.

scholarly journals Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: systematic review and network meta-analysis

BMJ ◽  
2019 ◽  
pp. l1079 ◽  
Author(s):  
Julian Mutz ◽  
Vijeinika Vipulananthan ◽  
Ben Carter ◽  
René Hurlemann ◽  
Cynthia H Y Fu ◽  
...  
Keyword(s):  
Brain Stimulation ◽  
Meta Analysis ◽  
High Dose ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Major Depressive ◽  
Magnetic Seizure Therapy ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Theta Burst

AbstractObjectiveTo estimate the comparative clinical efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults.DesignSystematic review with pairwise and network meta-analysis.Data sourcesElectronic search of Embase, PubMed/Medline, and PsycINFO up to 8 May 2018, supplemented by manual searches of bibliographies of several reviews (published between 2009 and 2018) and included trials.Eligibility criteria for selecting studiesClinical trials with random allocation to electroconvulsive therapy (ECT), transcranial magnetic stimulation (repetitive (rTMS), accelerated, priming, deep, and synchronised), theta burst stimulation, magnetic seizure therapy, transcranial direct current stimulation (tDCS), or sham therapy.Main outcome measuresPrimary outcomes were response (efficacy) and all cause discontinuation (discontinuation of treatment for any reason) (acceptability), presented as odds ratios with 95% confidence intervals. Remission and continuous depression severity scores after treatment were also examined.Results113 trials (262 treatment arms) that randomised 6750 patients (mean age 47.9 years; 59% women) with major depressive disorder or bipolar depression met the inclusion criteria. The most studied treatment comparisons were high frequency left rTMS and tDCS versus sham therapy, whereas recent treatments remain understudied. The quality of the evidence was typically of low or unclear risk of bias (94 out of 113 trials, 83%) and the precision of summary estimates for treatment effect varied considerably. In network meta-analysis, 10 out of 18 treatment strategies were associated with higher response compared with sham therapy: bitemporal ECT (summary odds ratio 8.91, 95% confidence interval 2.57 to 30.91), high dose right unilateral ECT (7.27, 1.90 to 27.78), priming transcranial magnetic stimulation (6.02, 2.21 to 16.38), magnetic seizure therapy (5.55, 1.06 to 28.99), bilateral rTMS (4.92, 2.93 to 8.25), bilateral theta burst stimulation (4.44, 1.47 to 13.41), low frequency right rTMS (3.65, 2.13 to 6.24), intermittent theta burst stimulation (3.20, 1.45 to 7.08), high frequency left rTMS (3.17, 2.29 to 4.37), and tDCS (2.65, 1.55 to 4.55). Network meta-analytic estimates of active interventions contrasted with another active treatment indicated that bitemporal ECT and high dose right unilateral ECT were associated with increased response. All treatment strategies were at least as acceptable as sham therapy.ConclusionsThese findings provide evidence for the consideration of non-surgical brain stimulation techniques as alternative or add-on treatments for adults with major depressive episodes. These findings also highlight important research priorities in the specialty of brain stimulation, such as the need for further well designed randomised controlled trials comparing novel treatments, and sham controlled trials investigating magnetic seizure therapy.

scholarly journals Prospective study of risk factors for attempted suicide among patients with DSM–IV major depressive disorder

2005 ◽  
Vol 186 (4) ◽  
pp. 314-318 ◽  
Author(s):  
T. Petteri Sokero ◽  
Tarja K. Melartin ◽  
Heikki J. Rytsälä ◽  
Ulla S. Leskelä ◽  
Paula S. Lestelä-Mielonen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Structured Interviews ◽  
Major Depressive ◽  
Dsm Iv ◽  
Major Depressive Episodes ◽  
Depressive Episodes

BackgroundThere are few prospective studies on risk factors for attempted suicide among psychiatric out- and in-patients with major depressive disorder.AimsTo investigate risk factors for attempted suicide among psychiatric out- and in-patients with major depressive disorder inthe city of Vantaa, Finland.MethodThe Vantaa Depression Study included 269 patients with DSM–IV major depressive disorder diagnosed using semi-structured interviews and followed up at 6- and 18-month interviews with a life chart.ResultsDuring the 18-month follow-up, 8% of the patients attempted suicide. The relative risk of an attempt was 2.50 during partial remission and 7.54 during a major depressive episode, compared with full remission (P<0.001). Numerous factors were associated with this risk, but lacking a partner, previous suicide attempts and total time spent in major depressive episodes were the most robust predictors.ConclusionsSuicide attempts among patients with major depressive disorder are strongly associated with the presence and severity of depressive symptoms and predicted by lack of partner, previous suicide attempts and time spent in depression. Reducing the time spent depressed is a credible preventive measure.

Risk factors for onset of multiple or long major depressive episodes versus single and short episodes

2012 ◽  
Vol 48 (7) ◽  
pp. 1067-1075 ◽  
Author(s):  
Bauke T. Stegenga ◽  
Mirjam I. Geerlings ◽  
Francisco Torres-González ◽  
Miguel Xavier ◽  
Igor Švab ◽  
...  
Keyword(s):  
Risk Factors ◽  
Major Depressive ◽  
Major Depressive Episodes ◽  
Depressive Episodes

scholarly journals Suicide risk in systemic lupus erythematosus: A narrative review

2021 ◽  
Vol 8 (3) ◽  
pp. 9
Author(s):  
Solange Barros ◽  
Jozélio Freire De Carvalho
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Suicidal Behavior ◽  
Lupus Erythematosus ◽  
Suicide Risk ◽  
Narrative Review ◽  
Systemic Lupus ◽  
Suicide Risk Factors ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Introduction: Despite the medical and scientific advances, the disease’s restrictions and the perception of personal and social losses related to its course reinforce fear and generate intense suffering in lupus patients. Psychiatric comorbidities, especially major depressive episodes, are highly prevalent during systemic lupus erythematosus. Among them, suicide is a behavior that is much more common than we believe.Objective: To perform a narrative review on suicidal behavior associated with systemic erythematosus lupus (SLE).Results: Studies have shown an increased risk of suicide among patients with chronic diseases and psychiatric disorders, especially depression. However, suicide cannot be attributed only to a higher prevalence of depression and other mental illnesses. Therefore, it is necessary to learn more about the suicide risk factors present in patients with lupus to work on secondary prevention and avoid the premature loss of lives and the additional suffering of families and surrounding communities. The coordination between the studies on suicidal behavior and its intricate network of individual and sociocultural factors and the studies on this multisystem autoimmune disease with a broad manifestation spectrum, lupus, creates new and essential field research.Conclusions: Non-psychiatrist office-based physicians, health clinics, or wards dedicated to the treatment of SLE should recognize and handle the suicide risk factors on their patients to reduce the suffering caused by this disease.

scholarly journals Risk of a Diagnosis of Dementia for Elderly Medicare Beneficiaries after Intensive Care

2015 ◽  
Vol 123 (5) ◽  
pp. 1105-1112 ◽  
Author(s):  
Carmen Guerra ◽  
May Hua ◽  
Hannah Wunsch
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Critical Illness ◽  
General Population ◽  
Hospital Discharge ◽  
Medicare Beneficiaries ◽  
Risk Of Death ◽  
Increased Risk ◽  
Diagnosis Of Dementia

Abstract Background Critical illness is likely associated with an increased risk of dementia, but the magnitude remains uncertain. Methods The cohort was a random 2.5% sample of Medicare beneficiaries who received intensive care in 2005 and survived to hospital discharge. Patients were matched with general population controls (age, sex, and race) with 3 yr of follow-up. The authors used an extended Cox model to assess the risk of a diagnosis of dementia, adjusting for the known risk factors for dementia, and the competing risk of death. Results Among 10,348 intensive care patients who survived to hospital discharge, dementia was newly diagnosed in 1,648 (15.0%) over the 3 yr of follow-up versus 12.2% in controls (incidence per 1,000 person-years, 73.6; 95% CI, 70.0 to 77.1 vs. 45.8; 95% CI, 43.2 to 48.3; hazard ratio [HR], 1.61; 95% CI, 1.50 to 1.74; P &lt; 0.001). After accounting for the known risk factors in the year before the index hospitalization, the risk of receiving a diagnosis of dementia remained increased in patients who received intensive care (adjusted HR, 1.43; 95% CI, 1.32 to 1.54; P &lt; 0.001). Inclusion of identifiable risk factors accrued during the quarter of critical illness accounted for almost all of the increased risks (adjusted HR, 1.09; 95% CI, 1.00 to 1.20; P = 0.06). Conclusions Elderly critical care survivors have a 60% increased relative risk, but only 3% increased absolute risk, of receiving a diagnosis of dementia in the subsequent 3 yr compared with the general population. This increased risk is not accounted for by risk factors preexisting the critical illness. Surveillance bias, which increases the likelihood of receiving a diagnosis of dementia, could account for some or all of these additional risks.

scholarly journals Sleep and Delirium in Pediatric Critical Illness: What Is the Relationship?

2018 ◽  
Vol 6 (4) ◽  
pp. 90 ◽  
Author(s):  
Amy Calandriello ◽  
Joanna Tylka ◽  
Pallavi Patwari
Keyword(s):  
Risk Factors ◽  
Critical Care ◽  
Intensive Care ◽  
Critical Illness ◽  
Care Setting ◽  
Pediatric Intensive Care ◽  
Critical Care Setting ◽  
Pediatric Critical Care ◽  
Disturbed Sleep ◽  
Potential Risk Factors

With growing recognition of pediatric delirium in pediatric critical illness there has also been increased investigation into improving recognition and determining potential risk factors. Disturbed sleep has been assumed to be one of the key risk factors leading to delirium and is commonplace in the pediatric critical care setting as the nature of intensive care requires frequent and invasive monitoring and interventions. However, this relationship between sleep and delirium in pediatric critical illness has not been definitively established and may, instead, reflect significant overlap in risk factors and consequences of underlying neurologic dysfunction. We aim to review the existing tools for evaluation of sleep and delirium in the pediatric critical care setting and review findings from recent investigations with application of these measures in the pediatric intensive care unit.

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