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Simple interventions can help mental health of ICU patients

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More than 50% of patients discharged from intensive care go on to suffer adverse psychological problems, according to UK researchers.

Their study also showed that experiencing acute stress while in ICU was the greatest risk factor for post discharge mental health problems, rather than clinical causes like different drug types.

The researchers said this suggested psychological interventions while in critical care could reduce the risk of later psychological problems.

The study involved 157 ICU patients at University College London Hospitals NHS Foundation Trust, who were assessed three months after discharge to see if they had any signs of post-traumatic stress disorder, depression and anxiety.

The authors found “level three” patients – those that received mechanical ventilation for more than 24 hours or had had two or more organs supported – suffered considerable psychological distress both during and following ICU admission. Three months after being discharged, 27% had probable PTSD, 46% had probable depression and 44% had anxiety.

The biggest clinical risk factors for mental health problems were length of sedation and use of benzodiazepines, inotropes, vasopressors and steroids. However, the researchers said acute stress reactions in ICU, such as mood or intrusive memories, were stronger risk factors than clinical factors.

Study author Dr David Howell said: “The research showed associations between sedative drugs such as benzodiazepines, the length of time a patient was sedated and the likelihood of them feeling depressed, anxious and traumatised in future. However, we found that acute stress reactions felt by a patient in the ICU was an even stronger risk factor.

“As well as looking at modifying our drug treatments, we may need to invest more time in the psychological care of a patient and find ways to prevent psychological suffering in the ICU, which can affect the quality of their life in years to come.”

The authors have developed a short psychological questionnaire – an Intensive Care Psychological Assessment Tool (IPAT) – for use by nurses to assess changes in the mental wellbeing of patients. It is currently being validated.

In addition, they said a range of methods including relaxation, breathing exercises and therapeutic approaches were being tried out in the unit to help patients feel safe and more assured. Examples included eye masks for patients and softly playing music.

Lead study author Dr Dorothy Wade said: “These are all relatively simple interventions which staff can undertake at the bedside as part of holistic care.”


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