[Intensive care treatment of psychiatric patients]

In a retrospective analysis we studied the frequency and cause of intensive care measures for psychiatric patients. All inpatients seen in the Department of Psychiatry, University of Göttingen, between 1985 and 1990 who either were treated in an intensive care unit (ICU) or died during treatment were included. 218 patients fulfilled these criteria, representing 2.4% of all psychiatric inpatients. In the sample as a whole, addiction (29%) and neurotic disorder (27%) were the largest diagnostic groups, followed by organic psychoses (15%). In comparison with other psychiatric diagnoses, addictive and organic disorders were overrepresented. The patients originally seen in the Department of Psychiatry (n = 70) were admitted to the ICU for various reasons (24% alcoholic delirium, 17% electrolyte disturbances and dehydration, 16% pneumonia, 11% suicide attempts, 7% thrombosis, etc.). Reasons for admission directly to the ICU (n = 138) with subsequent referral to the Department of Psychiatry were generally either suicide attempts (53%) or complications of addiction (32%). Thirty-six per cent of all patients required tracheal intubation. Patients with endogenous psychoses required mechanical ventilation more often than patients with other psychiatric diagnoses. Sixteen deaths occurred in this period of time, most often in patients with organic psychoses (n = 6). These results illustrate a high incidence of severe medical disorders in psychiatric inpatients. They emphasize the necessity of intensive collaboration between psychiatrists and intensive care physicians.