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.

Genetic Risk Factors For Long-Term Cognitive Impairment After Critical Illness

2010 ◽  
Author(s):  
Max L. Gunther ◽  
James C. Jackson ◽  
Pratik Pandharipande ◽  
Alessandro Morandi ◽  
Maureen Hahn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Critical Illness ◽  
Genetic Risk ◽  
Genetic Risk Factors

scholarly journals Potentially Modifiable Risk Factors for Long-Term Cognitive Impairment After Critical Illness: A Systematic Review

2018 ◽  
Vol 93 (1) ◽  
pp. 68-82 ◽  
Author(s):  
Amra Sakusic ◽  
John C. O'Horo ◽  
Mikhail Dziadzko ◽  
Dziadzko Volha ◽  
Rashid Ali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cognitive Impairment ◽  
Critical Illness ◽  
Modifiable Risk Factors

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.

Treatment of Delirium During Critical Illness

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Niall T. Prendergast ◽  
Perry J. Tiberio ◽  
Timothy D. Girard
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Critical Illness ◽  
Medical Condition ◽  
Annual Review ◽  
Publication Date ◽  
Antipsychotic Medications ◽  
Acute Disturbance ◽  
Common Risk Factors

Delirium, an acute disturbance in mental status due to another medical condition, is common and morbid in the intensive care unit. Despite its clear association with multiple common risk factors and important outcomes, including mortality and long-term cognitive impairment, both the ultimate causes of and ideal treatments for delirium remain unclear. Studies suggest that neuroinflammation, hypoxia, alterations in energy metabolism, and imbalances in multiple neurotransmitter pathways contribute to delirium, but commonly used treatments (e.g., antipsychotic medications) target only one or a few of these potential mechanisms and are not supported by evidence of efficacy. At this time, the optimal treatment for delirium during critical illness remains avoidance of risk factors, though ongoing trials may expand on the promise shown by agents such as melatonin and dexmedetomidine. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Focus on long-term cognitive, psychological and physical impairments after critical illness

2019 ◽  
Vol 45 (10) ◽  
pp. 1466-1468 ◽  
Author(s):  
Thomas Bein ◽  
O. Joseph Bienvenu ◽  
Ramona O. Hopkins
Keyword(s):  
Critical Illness ◽  
Physical Impairments

Critical Illness and Long-Term Cognitive Impairment

2017 ◽  
Author(s):  
Ramona O. Hopkins ◽  
Maria E. Carlo ◽  
James C. Jackson
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Critical Illness ◽  
Processing Speed ◽  
Financial Management ◽  
Medication Management ◽  
Risks Factors ◽  
The Impact

Evidence from dozens of studies of thousands of individuals suggest that as many as half of critical illness survivors experience significant deficits in memory, executive functioning, attention, and processing speed that persist years after discharge from the intensive care unit (ICU). This chapter reviews the prevalence, characteristics, possible mechanisms, and risk factors for long-term cognitive impairment after critical illness. Some key risks factors—notably, delirium—may be modifiable, whereas others, such as genetic markers, are not. Cognitive impairments are associated with psychiatric disorders, including depression, anxiety, and posttraumatic stress disorder. The impact of critical illness–related cognitive impairment on individuals and society includes financial costs, inability to return to work, impairments in instrumental activities of daily living (financial management, medication management, shopping, home care), reduced quality of life, and caregiver burden. Efforts need to be directed not only at modifying risk factors but also at attempting to prevent, treat, and remediate deficits.

Neurocognitive impairment after critical illness

2016 ◽  
Author(s):  
Ramona O. Hopkins ◽  
James C. Jackson
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Critical Illness ◽  
Cognitive Rehabilitation ◽  
Acquired Brain Injury ◽  
Neurocognitive Impairment ◽  
Daily Functioning ◽  
Cognitive Domains ◽  
Over Time

More than 5 million individuals are admitted to intensive care units (ICUs) in North America annually. Due to improvements in treatment, increasing numbers of these individuals survive and go on to develop long-term neurocognitive impairment in a variety of cognitive domains. As evidence from over two dozen studies demonstrates, neurocognitive impairment occurs in up to two-thirds of individuals. While it may be particularly common in those with pre-existing vulnerabilities, even patients who are young with robust health prior to critical illness are at risk of post-ICU neurocognitive impairment. While neurocognitive impairment may improve over time and even dissipate in a subset of ICU survivors, neurocognitive impairment is often permanent and, in some cases may be progressive. As commonly occurs in the context of acquired brain injury, the neurocognitive impairment observed after critical illness is typically diffuse, although domains including memory, attention, and executive functioning are often particularly impaired. This impairment is sufficiently severe to negatively impact daily functioning. Although the risk factors and mechanisms undergirding neurocognitive impairment have yet to be fully elucidated, potential contributors include inflammation, hypoxia, and delirium. While one way to impact on the prevalence and incidence of cognitive impairment after critical illness is to attempt to modify key ‘in-hospital’ risk factors, another approach involves the use of post-ICU cognitive rehabilitation, which is increasingly being successfully employed with other impaired medical populations.

scholarly journals Risk Factors for Long-Term Brain Dysfunction after Chronic Critical Illness

2013 ◽  
Vol 10 (4) ◽  
pp. 315-323 ◽  
Author(s):  
Aluko A. Hope ◽  
R. Sean Morrison ◽  
Qingling Du ◽  
Sylvan Wallenstein ◽  
Judith E. Nelson
Keyword(s):  
Risk Factors ◽  
Critical Illness ◽  
Brain Dysfunction ◽  
Chronic Critical Illness

Outcome of psychiatric symptoms presenting at onset of multiple sclerosis: a retrospective study

2010 ◽  
Vol 16 (6) ◽  
pp. 742-748 ◽  
Author(s):  
Salvatore Lo Fermo ◽  
Rita Barone ◽  
Francesco Patti ◽  
Patrizia Laisa ◽  
Tiziana L Cavallaro ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Psychiatric Symptoms ◽  
Psychiatric Morbidity ◽  
Neurological Symptoms ◽  
Psychotic Symptoms ◽  
Psychiatric Disturbances ◽  
Multiple Sclerosis Diagnosis ◽  
Multiple Sclerosis Onset

Psychiatric disturbances may occur at the onset of multiple sclerosis. However, information on their outcome is lacking. Our objective was to document the characteristics of psychiatric symptoms at presentation of multiple sclerosis and to define the long-term evolution of psychiatric disturbances in these patients. Based on a clinical record analysis of patients with defined multiple sclerosis diagnosis and coming under the care of a university multiple sclerosis centre within the period 1997—2007, patients with both psychiatric and neurological symptoms at presentation were identified. Clinical data at onset and at last follow-up were considered. Among 682 evaluated patients, psychiatric disturbances were associated with multiple sclerosis onset in 16 cases (2.3%). Most patients (56%) presented with a mood disorder with clinical characteristics of a major depressive-like episode, five (32%) had psychotic symptoms. Initial psychiatric disturbances improved later than neurological symptoms, or never fully recovered, regardless of the concomitant use of psychotropic medications. In most of the subjects psychiatric disturbances tended to remain over the follow-up period and at last visit, after a mean follow-up of 7.6 years (±2.3), 14 subjects (87%) had a supplementary diagnosis of psychiatric illness. Psychiatric symptoms at onset of multiple sclerosis may be indicators of possible maintenance of psychiatric morbidity in a sizeable proportion of patients.

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