Psychopharmacology in the intensive care unit

The task of the psychopharmacologist in the ICU does not stop with a recommendation of the best drug and dosage. The clinical course of patients in ICUs is often stormy. With each change, the appropriateness of the chosen psychopharmacologic treatment may be questioned. Is the patient experiencing a side effect? Should the drug be discontinued or the dosage altered? Nonpsychiatrists are often unfamiliar and uncomfortable with psychotropic medications and are not as likely to accurately assess side effects or therapeutic progress. Try to anticipate the more likely complications in the progress notes without being too lengthy, and attempt to verbally communicate impressions and recommendations. Finally, stay abreast of the patient's progress, and make it clear that you are available for consultation and advice. In this way you may assure that the patient will be best able to tolerate and benefit from ICU treatment.