The spectrum of psychocognitive morbidity in the critically ill: a review of the literature and call for improvement

Abstract

Objective: The objective of the study is to review the cognitive and psychiatric dysfunction experienced by critically ill patients during and after hospitalization.

Methods: A structured PubMed search identified studies and reports in English pertaining to intensive care unit (ICU)-related cognitive and psychological dysfunction, known risk factors, and treatment modalities.

Data synthesis: This article summarizes recent literature on psychological sequelae experienced by critically ill patients including delirium, cognitive impairment, acute stress disorder, posttraumatic stress disorder, anxiety, and depression. Known risk factors for cognitive dysfunction and psychological trauma are discussed, encompassing clinical, demographic, socioeconomic, and psychiatric domains as well as the memories of the ICU stay. Specific treatment and prevention modalities are discussed including post-ICU physical rehabilitation and psychotherapeutic interventions as well as interventions available to patients still in the ICU, including early mobilization, minimization of sedation, improved sleep hygiene, and available psychological interventions.

Conclusions: We propose a paradigm change highlighting the need for interventions focused on early psychological support applied in parallel with stabilization of physiologic status in the ICU.

Keywords: Anxiety; Critical illness; Depression; Post-ICU syndrome; Post-traumatic stress disorder; Psychological trauma.