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).

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.

Childhood emotional abuse and posttraumatic stress symptoms in women: the mediating role of mindfulness

2017 ◽  
Vol 10 ◽  
pp. 105-116
Author(s):  
Stéphanie Laforte ◽  
Caroline Dugal ◽  
Claude Bélanger ◽  
Natacha Godbout
Keyword(s):  
Traumatic Stress ◽  
Emotional Abuse ◽  
Post Traumatic Stress ◽  
Mediating Role ◽  
Stress Symptoms ◽  
Post Traumatic ◽  
Childhood Emotional Abuse ◽  
The Relationship

More than one-third of adults report having experienced emotional abuse in childhood, which is one of the most common interpersonal traumas. Although survivors of interpersonal trauma are at risk of developing post-traumatic stress symptoms, few studies have specifically examined the links between childhood emotional abuse and symptoms of post-traumatic stress in adulthood. Recent studies highlight the role of mindfulness as a key variable in understanding how interpersonal traumas can be associated with long-term post-traumatic stress symptoms (Godbout, Dion, & Bigras, 2016). The purpose of this study is to examine the mediating role of mindfulness in the relationship between emotional abuse in childhood and post- traumatic stress symptoms. The sample consisted of 354 women from the community who responded to self -reported online questionnaires. The results of multiple regression analyses show that the relationship between emotional abuse in childhood and symptoms of post-traumatic stress is explained by a decrease in mindfulness capacities. Overall, the results highlight the role of mindfulness as a mechanism partially explaining the impacts of interpersonal traumas in childhood.

Introduction: Cognitive and Behavioural Disorders Following Critical Illness

2014 ◽  
Author(s):  
E Wesley Ely
Keyword(s):  
Cognitive Impairment ◽  
Critical Illness ◽  
Major Depression ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Behavioural Disorders ◽  
Post Traumatic

Chapter 18 provides an outline to cognitive and behavioural disorders following critical illness, and introduces topics that include a spectrum of acquired or exacerbated ‘neck-up’ disorders, such as ‘dementia-like’ long-term cognitive impairment, major depression, and post-traumatic stress disorder (PTSD).

Post-Traumatic Stress Disorder Following Critical Illness

2014 ◽  
Author(s):  
Christina Jones ◽  
Richard D Griffiths
Keyword(s):  
Critical Illness ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Early Recognition ◽  
Traumatic Event ◽  
Long Term Effects ◽  
Post Traumatic Stress ◽  
Post Traumatic

Post-traumatic stress disorder (PTSD) has been shown to be a significant problem for both patients and relatives after critical illness. For patients the recall of delusional memories from the period in ICU can be a powerful trigger for the development of PTSD. Such memories are described by patients as very vivid and difficult to separate from reality. Early recognition and treatment of PTSD, where needed, can reduce the long term effects. Chronic PTSD, where symptoms have been present for three months after the traumatic event, is associated with a number of long term health problems such as chronic pain. It can also have profound effects on relationships, financial status and overall wellbeing. The provision of an ICU diary has been shown to reduce the incidence of PTSD in patients and reduce the level of PTSD-related symptoms in family members. For the majority of patients this relatively simple intervention helps them to fill in memory gaps and combat any delusional memories they may recall.

Emotional Sequelae of Elective Abortion: The Role of Guilt and Shame

2017 ◽  
Vol 71 (2) ◽  
pp. 98-105 ◽  
Author(s):  
Donna Krupkin Whitney
Keyword(s):  
Healthcare Providers ◽  
Post Traumatic Stress ◽  
Elective Abortion ◽  
Effective Care ◽  
Interpersonal Difficulties ◽  
Post Traumatic ◽  
Post Abortion ◽  
Relationship Disturbances

Although estimates vary, many women experience long-term emotional, spiritual, psychological and interpersonal difficulties following abortion, including complicated grief, depression, post-traumatic stress disorder (PTSD) and relationship disturbances. Developmental, drive, object-relations and narcissism models for perinatal loss also illuminate the dynamics of post-abortion syndromes. Guilt and shame play important roles in generating and concealing post-abortion sequelae. Pastoral care and healthcare providers can increase their awareness of post-abortion sequelae and provide effective care for women experiencing these syndromes.

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