ICU Treatment Linked to PTSD Symptoms
Nov. 4, 1999 (New Orleans) - A new study finds that treatment in the intensive care unit has a unique set of terrors -- painful enough to be a precipitating factor in the onset of posttraumatic stress disorder (PTSD). The conclusion comes from a German study of patients who spent at least one month in the intensive care unit (ICU) at the University of Munich and were evaluated for PTSD up to three years later.
"In our study on the PTSD patients, we found that the content of their intrusive memories, which is, of course, the integral part of PTSD, was related to both the initial trauma and the treatment," Jens Richter, MD, tells WebMD. Richter did the study as part of a thesis requirement for his medical degree at the University of Hamburg.
Of 41 patients who'd been in the ICU for severe multiple trauma between 1990 and 1994, 19% met the criteria of a standard psychiatric diagnostic manual for PTSD. The diagnosis was made following physical exams and a battery of mental tests, says Richter. Their fears were "revolving around themes like torture, being kept prisoner, [and] being subjected to painful procedures, as well as intrusive memories of the accident," he says.
It appears that about one-third of those in the ICU do well after discharge. Another third has problems but is able to cope, and the rest of the patients are prone to suffer from PTSD. But Richter acknowledges that it's not really possible to distinguish between the original trauma and the rigors of treatment in the ICU as the source of PTSD. In fact, the woman who'd been in the ICU for the longest period -- four months for a life-threatening infection that required painful treatments and even placement on a ventilator -- reported no mental problems. These patients had no precipitating trauma to cause their ICU stay, and it obviously played an important role in their subsequent mental well-being.
The PTSD phenomenon apparently has nothing to do with factors like age, sex, how severe the injury or the initial diagnosis. It's a complex psychological issue that wasn't revealed in the study.
Still, Richter believes his research has an important message for ICU physicians who need to look beyond the physical aspects of the trauma or illness. Among the ICU survivors, the study shows that nearly 60% had some kind of mental illness.
"Severe psychopathology can occur, can exist even years after discharge from the intensive care unit, and can thus endanger the efforts that have gone into saving that patient," says Richter.
He says that it may be important for patients to have psychiatrists serve as liaisons in intensive care units and monitor the progress patients make after being discharged from ICU.
Richter believes this is the first study to look at PTSD as it relates to prolonged intensive care. "It's terrible to see that there's such a high percentage," he says.