CHEST Guidelines-Critical-Care-Psychiatry

Critical-Care-Psychiatry_chest

Pdf Summary

The document explores the integration of psychiatry into critical care settings, particularly in the ICU, through the lens of Dr. Melissa P. Bui's experiences. It begins with the case of Mr. X, a patient recovering from critical illness, who exhibited delusional memories despite having no prior psychiatric history. This highlights the often overlooked psychological aftermath in patients experiencing severe medical trauma, particularly in intensive care units.<br /><br />Dr. Bui discusses the fluctuation of psychiatry's role in critical care, noting that advancements in internal medicine and critical care have sometimes diminished psychiatry's presence. However, a shift occurred in the early 2000s with the adoption of proactive psychiatric consultation models that use early screening and intervention. This model improves patient outcomes, reduces ICU stays, and enhances resource distribution and staff satisfaction. Dr. Bui's involvement in setting up an embedded psychiatric consult service in an ICU highlighted its benefits, including a significant reduction in hospital stay lengths.<br /><br />The document underscores that psychiatric intervention in the ICU can address issues like anxiety, agitation, and delusional memories, which are common among ICU survivors. Up to 68% of these patients may experience delusional memories, drawing attention to the need for psychiatric expertise in such settings. These delusional beliefs, often persecutory, blend factual memories with fictional narratives, as seen in Mr. X's case.<br /><br />The article advocates for the recognition of the mental health challenges ICU patients face, highlighting the value psychiatry offers in managing complex psychiatric manifestations that arise from critical illnesses. The document concludes by emphasizing the continuous learning required in medicine and the valuable insights patients like Mr. X provide, shaping more empathetic and effective psychiatric care approaches in critical care environments.

Keywords

psychiatry

critical care

ICU

psychological aftermath

psychiatric consultation

delusional memories

patient outcomes

mental health

Dr. Melissa P. Bui

hospital stay reduction