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Los diagnósticos psiquiátricos y el uso de medicamentos psicoactivos entre los pacientes críticos no quirúrgicos que
Hannah Wunsch1, Christian F Christiansen2, Martin B Johansen3
1Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
JAMA
|March 20, 2014
Resumen
Los pacientes críticamente enfermos tienen tasas más altas de diagnósticos psiquiátricos previos. Los sobrevivientes se enfrentan a un aumento transitorio del riesgo de nuevos diagnósticos psiquiátricos y el uso de medicamentos después del alta.
Área de la Ciencia:
- Medicina de cuidados críticos Medicina de cuidados críticos.
- La psiquiatría es la psiquiatría.
- Epidemiología La epidemiología.
Sus antecedentes:
- El vínculo entre la enfermedad crítica y los trastornos psiquiátricos no se entiende bien.
- Investigar la salud psiquiátrica antes y después de una enfermedad crítica es crucial para la atención al paciente.
Objetivo del estudio:
- Para evaluar los diagnósticos psiquiátricos y las recetas de medicamentos psicoactivos en los años anteriores a la enfermedad crítica.
- Evaluar la incidencia de nuevos diagnósticos psiquiátricos y el uso de medicamentos en el año siguiente a la enfermedad crítica.
Principales métodos:
- Un estudio de cohorte basado en la población en Dinamarca (2006-2009) incluyó pacientes en estado crítico (admisión a la unidad de cuidados intensivos con ventilación mecánica) y cohortes de comparación emparejadas.
- Los diagnósticos psiquiátricos previos a la enfermedad y el uso de medicamentos se compararon utilizando ratios de prevalencia ajustados (PR).
- Los nuevos diagnósticos y el uso de medicamentos para la enfermedad postcrítica se evaluaron utilizando la incidencia acumulada y los ratios de riesgo ajustados (HR) a través de la regresión de Cox.
Principales resultados:
- Los pacientes en estado crítico tenían tasas más altas de diagnósticos psiquiátricos previos (6.2%) en comparación con las cohortes hospitalizadas (5.4%) y la población general (2.4%).
- Después del alta, los sobrevivientes críticamente enfermos sin antecedentes psiquiátricos previos mostraron un mayor riesgo de nuevos diagnósticos (0,5% frente a 0,2%) y recetas de medicamentos (12,7% frente a 5,0%) dentro de los 3 meses.
- Estos riesgos aumentados se resolvieron en gran medida de 9 a 12 meses después de la aprobación de la gestión.
Conclusiones:
- Las condiciones psiquiátricas preexistentes son más frecuentes en individuos críticamente enfermos.
- Los sobrevivientes de enfermedades críticas experimentan un aumento temporal en los nuevos diagnósticos psiquiátricos y el uso de medicamentos psicoactivos.
- Los hallazgos sugieren un potencial papel predisponente de la enfermedad psiquiátrica y un riesgo psiquiátrico transitorio posterior a la enfermedad.
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