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Intensive Care Medicine

, 34:2136 | Cite as

Psychiatric disorders and the ICU: gaps and opportunities

  • Christoph PechlanerEmail author
  • Bruno Mégarbane
  • W. Wolfgang Fleischhacker
Editorial

One of three ICU patients has a pre-existing psychiatric disorder, according to a retrospective analysis presented in this issue of Intensive Care Medicine [1]. Suchyta and coworkers report substance dependence (alcohol or drug addiction) in one of five ICU patients, and an identical rate of other psychiatric disorders, predominantly depression.

Do you know the percentage of patients with psychiatric disorders on your ICU? We do not. A systematic search in Medline yields a remarkable dearth of evidence for psychiatric disorders on intensive care units. Epidemiologic data on the whole spectrum of psychiatric disease seem to be limited to a single small report, on 96 consecutive admissions to a coronary care unit in Colombia [2]. Of specific conditions, only alcohol dependence has been studied in more detail [3, 4, 5, 6, 7, 8, 9].

In contrast to ICUs, epidemiology in the general European population has been defined with notable detail. The 1-year prevalence of any psychiatric disorder...

References

  1. 1.
    Suchyta M, Beck C, Key C, Jephson A, Hopkins R (2008) Substance Dependence and Psychiatric Disorders are Related to Outcomes in a Mixed ICU Population. Intensive Care Med. doi: 10.1007/s00134-008-1263-9
  2. 2.
    Rincon HG, Granados M, Unutzer J, Gomez M, Duran R, Badiel M, Salas C, Martinez J, Mejia J, Ordonez C, Florez N, Rosso F, Echeverri P (2001) Prevalence, detection and treatment of anxiety, depression, and delirium in the adult critical care unit. Psychosomatics 42:391–396PubMedCrossRefGoogle Scholar
  3. 3.
    Jensen NH, Dragsted L, Christensen JK, Jorgensen JC, Qvist J (1988) Severity of illness and outcome of treatment in alcoholic patients in the intensive care unit. Intensive Care Med 15:19–22PubMedCrossRefGoogle Scholar
  4. 4.
    Marik P, Mohedin B (1996) Alcohol-related admissions to an inner city hospital intensive care unit. Alcohol Alcohol 31:393–396PubMedGoogle Scholar
  5. 5.
    Moss M, Parsons PE, Steinberg KP, Hudson LD, Guidot DM, Burnham EL, Eaton S, Cotsonis GA (2003) Chronic alcohol abuse is associated with an increased incidence of acute respiratory distress syndrome and severity of multiple organ dysfunction in patients with septic shock. Crit Care Med 31:869–877PubMedCrossRefGoogle Scholar
  6. 6.
    O’Brien JM Jr, Lu B, Ali NA, Martin GS, Aberegg SK, Marsh CB, Lemeshow S, Douglas IS (2007) Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients. Crit Care Med 35:345–350PubMedCrossRefGoogle Scholar
  7. 7.
    Saitz R, Ghali WA, Moskowitz MA (1997) The impact of alcohol-related diagnoses on pneumonia outcomes. Arch Intern Med 157:1446–1452PubMedCrossRefGoogle Scholar
  8. 8.
    Spies CD, Neuner B, Neumann T, Blum S, Muller C, Rommelspacher H, Rieger A, Sanft C, Specht M, Hannemann L, Striebel HW, Schaffartzik W (1996) Intercurrent complications in chronic alcoholic men admitted to the intensive care unit following trauma. Intensive Care Med 22:286–293PubMedCrossRefGoogle Scholar
  9. 9.
    Uusaro A, Parviainen I, Tenhunen JJ, Ruokonen E (2005) The proportion of intensive care unit admissions related to alcohol use: a prospective cohort study. Acta Anaesthesiol Scand 49:1236–1240PubMedCrossRefGoogle Scholar
  10. 10.
    Paykel ES, Brugha T, Fryers T (2005) Size and burden of depressive disorders in Europe. Eur Neuropsychopharmacol 15:411–423PubMedCrossRefGoogle Scholar
  11. 11.
    Alonso J, Lepine JP (2007) Overview of key data from the European study of the epidemiology of mental disorders (ESEMeD). J Clin Psychiatry 68(Suppl 2):3–9PubMedGoogle Scholar
  12. 12.
    Rehm J, Room R, van den Brink W, Kraus L (2005) Problematic drug use and drug use disorders in EU countries and Norway: an overview of the epidemiology. Eur Neuropsychopharmacol 15:389–397PubMedCrossRefGoogle Scholar
  13. 13.
    Baldwin WA, Rosenfeld BA, Breslow MJ, Buchman TG, Deutschman CS, Moore RD (1993) Substance abuse-related admissions to adult intensive care. Chest 103:21–25PubMedCrossRefGoogle Scholar
  14. 14.
    Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, Angermeyer MC, Bernert S, de Girolamo G, Morosini P, Polidori G, Kikkawa T, Kawakami N, Ono Y, Takeshima T, Uda H, Karam EG, Fayyad JA, Karam AN, Mneimneh ZN, Medina-Mora ME, Borges G, Lara C, de Graaf R, Ormel J, Gureje O, Shen Y, Huang Y, Zhang M, Alonso J, Haro JM, Vilagut G, Bromet EJ, Gluzman S, Webb C, Kessler RC, Merikangas KR, Anthony JC, Von Korff MR, Wang PS, Brugha TS, Aguilar-Gaxiola S, Lee S, Heeringa S, Pennell BE, Zaslavsky AM, Ustun TB, Chatterji S (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291:2581–2590PubMedCrossRefGoogle Scholar
  15. 15.
    Fleischhacker WW, Cetkovich-Bakmas M, De Hert M, Hennekens CH, Lambert M, Leucht S, Maj M, McIntyre RS, Naber D, Newcomer JW, Olfson M, Osby U, Sartorius N, Lieberman JA (2008) Comorbid somatic illnesses in patients with severe mental disorders: clinical, policy, and research challenges. J Clin Psychiatry 69:514–519PubMedGoogle Scholar
  16. 16.
    Leucht S, Burkard T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116:317–333PubMedCrossRefGoogle Scholar
  17. 17.
    Frasure-Smith N, Lesperance F (2008) Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry 65:62–71PubMedCrossRefGoogle Scholar
  18. 18.
    Moss M, Burnham EL (2003) Chronic alcohol abuse, acute respiratory distress syndrome, and multiple organ dysfunction. Crit Care Med 31:S207–S212PubMedCrossRefGoogle Scholar
  19. 19.
    Happel KI, Nelson S (2005) Alcohol, immunosuppression, and the lung. Proc Am Thorac Soc 2:428–432PubMedCrossRefGoogle Scholar
  20. 20.
    Broyles LM, Colbert AM, Tate JA, Swigart VA, Happ MB (2008) Clinicians’ evaluation and management of mental health, substance abuse, and chronic pain conditions in the intensive care unit. Crit Care Med 36:87–93PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Christoph Pechlaner
    • 1
    Email author
  • Bruno Mégarbane
    • 2
  • W. Wolfgang Fleischhacker
    • 3
  1. 1.Department of Internal MedicineInnsbruck Medical University, University HospitalInnsbruckAustria
  2. 2.Réanimation Médicale et Toxicologique, Hôpital LariboisièreINSERM U705, Université Paris-DiderotParisFrance
  3. 3.Department of Biological PsychiatryInnsbruck Medical UniversityInnsbruckAustria

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