Increased risk of psychiatric diagnoses seen following ICU admission

Critically ill patients requiring mechanical ventilation in an intensive care unit (ICU) may be at increased risk of a new psychiatric illness and medication use following hospital release, according to a report published March 19 in JAMA.

The study of approximately 24,000 patients included critically ill patients in Denmark from 2006-2008, who were followed another year. These patients were compared with groups of hospitalized patients and the general population, according to Hannah Wunsch, MD, MSc, of Columbia University, New York, and colleagues.

US and Danish researchers found that the risk of new psychiatric diagnoses was low for critically ill patients with no prior history of psychiatric illnesses, however, it was higher than that of hospitalized patients and the general population within 3 months post-discharge.

Of 9,912 critically ill patients who didn’t have a prior history of mental problems-nearly 60% of the study patients, 0.5% were at increased risk for a new psychiatric diagnosis compared with 0.2% of hospitalized patients within the 3-month post-discharge period. The general population only had a risk of 0.02% within that time frame.

Anxiety and mood disorders were increased compared with the general population cohort during the 3-month post-discharge period (0.3% vs 0.01% and 0.2% vs 0.01%, respectively).

“The cumulative incidence of a new psychoactive medication prescription was increased in the cohort of patients receiving mechanical ventilation compared with the matched cohort in the first 3 months following discharge: 12.7% vs. 5.0% but decreased to a similar risk by the last 3 months: 1.6% vs. 1.5%,” the authors wrote. “The risk compared with the matched general population cohort was very high for the first 3 months of the year following discharge: 12.7% vs. 0.7% and remained higher in the last 3 months: 1.6% vs. 0.8%.”

Hypotic agents were prescribed at higher rates than other psychoactive drugs, yet new prescriptions for antidepressants also increased steadily over the 12-month follow-up period.

The researchers also found that prior psychiatric diagnoses were more common in the critically ill cohort than in the hospital and general population cohorts. Approximately 6% of critically ill patients had one or more psychiatric diagnoses five years before the ICU admission compared to 5.4% of the hospitalized patients and 2.4% in the general population.

“Our data suggest both a possible role of psychiatric disease in predisposing patients to critical illness and an increased but transient risk of new psychiatric diagnoses and treatment after critical illness,” the authors said.

“Discharge planning for these patients may require more comprehensive discussion of follow-up psychiatric assessment and provision of information to caregivers and other family members regarding potential psychiatric needs,” they noted.