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[Classification of mental disorders in the Intensive Care Unit]
1Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lérida, España.
Purpose:
To determine the incidence and characteristics of mental disorders (MD) in the Intensive Care Unit (ICU), and to define a classification system adapted to the ICU environment.
Design:
A retrospective, descriptive analysis.
Setting:
Intensive Care Unit, Arnau de Vilanova Hospital in Lérida (Spain).
Patients:
All patients with MD admitted during 5-year period (January, 1 2004 to December 31, 2008).
Main Variables:
General variables included clinical-demographic data, diagnostic variables, procedures, severity score, length of stay and mortality. Specific variables included psychiatric history, screening for substance abuse, psychiatric assessment, monitoring and transfer to a psychiatric center. Classification of the MD was as follows: 1) acute substance intoxication (SI); 2) suicide attempts (SA); and 3) MD associated with the main diagnosis (AMD).
Results:
A total of 146 patients had MD (7.8%); they were predominantly male (74%) and were younger than the general ICU population (43.9 vs. 55.3 years, p<0.001). The ICU stays of the patients with MDs were shorter (4 days vs. 7 days, p<0.001), and there was less hospital mortality (17.1 vs. 25%, p<0.05). They also showed a higher incidence of pneumonia (19.9 vs. 13.8%, p<0.05), but no differences in the level of severity were observed. The SI group (24.7%) contained the highest number of young people; the SA group (36.3%) showed a predominance of women; and the AMD (39%) group had the longest stays and the highest mortality. Psychiatric consultation was carried out mainly in the SA group (62.3%).
Conclusions:
MD is a relatively common problem in the ICU. Collaboration with the Psychiatry Department seldom occurs, but must be encouraged to develop fully integrated management of critical patients with MD.
Insights
Mental disorders (MD) affect nearly 8% of Intensive Care Unit (ICU) patients, with specific types like substance intoxication and suicide attempts presenting unique characteristics. Improved collaboration between ICU and psychiatry is crucial for patient care.
Area of Science:
- Critical Care Medicine
- Psychiatry
- Epidemiology
Context:
- Mental disorders (MD) represent a significant, yet often overlooked, patient population within Intensive Care Units (ICUs).
- Understanding the specific incidence, demographics, and clinical trajectories of these patients is essential for optimizing care.
- The study addresses the need for a tailored classification system for MD within the unique ICU environment.
Purpose:
- To determine the incidence and characteristics of mental disorders (MD) in the Intensive Care Unit (ICU).
- To establish a classification system for MD specifically adapted to the ICU setting.
- To analyze the clinical-demographic data, management, and outcomes of ICU patients with MD.
Summary:
- A retrospective analysis of 146 patients with MD (7.8% of ICU admissions) revealed distinct patterns: acute substance intoxication (24.7%) skewed younger, suicide attempts (36.3%) predominated in females, and associated MD (39%) had longer stays and higher mortality.
- Patients with MD were younger and had shorter ICU stays but a higher incidence of pneumonia compared to the general ICU population.
- Psychiatric consultation was primarily utilized in suicide attempt cases.
Impact:
- Mental disorders are a common comorbidity in ICUs, necessitating specialized management strategies.
- Current collaboration between ICU and Psychiatry departments is limited, highlighting a critical gap in patient care.
- Fostering interdisciplinary collaboration is vital for the comprehensive management of critically ill patients with mental disorders.
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