March 15, 2013
A stay in an intensive care unit (ICU) may actually cause post-traumatic stress disorder (PTSD), according to a study conducted by researchers from Johns Hopkins University and published in the journal Psychological Medicine.
“We usually think of PTSD as something you develop if you go to war, are sexually assaulted or suffer a similar emotional trauma,” senior author Dale Needham said. “Instead, it may be as common, or more common, in ICU patients as in soldiers, but it’s something many doctors – including psychiatrists – don’t fully appreciate.”
PTSD is an anxiety disorder characterized by three kinds of symptoms: reliving trauma through nightmares or flashbacks; physical or emotional avoidance (including through numbness and detachment) of reminders of the trauma; and hyperarousal in response to such reminders (including irritability, difficulty sleeping and being easily startled). PTSD can significantly damage sufferers’ quality of life and slow recovery from related or unrelated health problems.
For the current study, researchers focused on patients with acute lung injury (ALI), which is considered the archetype of the critical illnesses that send patients to ICUs. Follow-up interviews were conducted with 183 ALI patients who had been confined to 13 ICUs at four separate Baltimore hospitals between October 2004 and 2007.
35 percent of patients interviewed demonstrated clinically significant PTSD symptoms at some point after their hospital stays, most of them within three months. Two years after leaving the hospital, 62 percent of those patients were still suffering from those symptoms. 50 percent were taking psychiatric drugs, and 40 percent had seen a psychiatrist in the prior two years.
The longer patients had spent in the ICU, the more likely they were to suffer from PTSD.
Flashbacks to hospital delirium
Unlike most PTSD sufferers, the ICU survivors regularly experienced flashbacks to delusions they have had or events they had hallucinated during their hospital stay, rather than to real-life occurrences.
“One woman thought her husband and the nurse were plotting to kill her,” lead researcher O. Joseph Bienvenu said.
Delirium and hallucinations are relatively common in ALI patients in ICUs. Such patients are given heavy doses of sedatives and narcotics, which may induce hallucination. ICU patients are at particular risk of this because the complication known as sepsis (blood poisoning) may weaken the blood-brain barrier, allowing drugs to cross more freely into the brain and leading to delusions.
Although the researchers looked only at ALI patients, they suspect that PTSD is equally common in other ICU survivors. This points to the importance of addressing the conditions that cause PTSD, and helping to counsel survivors after their hospital stays to reduce their symptoms, the researchers said.
“Physical weakness usually gets better, but these mental symptoms often just linger,” Bienvenu said. “We need to pay more attention to preventing and treating PTSD in these patients.”
One recent study found that PTSD symptoms in ICU survivors were reduced when they had a phone debrief with a nurse a month after their hospital release, and were allowed to see a diary that hospital staff and family members had made about their ICU stay.