Journal Article Annotations
2022, 2nd Quarter
Annotations by O. Joseph Bienvenu, MD, PhD
The authors surveyed critical care and C-L psychiatry clinicians at Mayo Clinic on the potential benefits and risks of increasing the psychiatry (and/or psychology) presence in the ICU. The risks were minimal (e.g., potential workflow disruption or mixed messages to families), and the potential benefits more evident to providers than bedside nurses (who were more focused on burnout). To the authors’ and my knowledge, this is the first survey of its kind. The responses in “other” slots indicate more interest from critical care clinicians in having psychologists in the ICU, perhaps because of a perception that psychiatrists would be more interested in prescribing medications than facilitating communication and providing basic psychotherapies (perhaps we deserve this sentiment!).
Strength and weaknesses:
I applaud the authors for asking these important questions. The results fit with my C-L experience: e.g., in the past, our psychiatry residents assumed they should not be involved in the care of patients who are delirious or intubated. Notably, proactive psychiatric consultations are occurring and being investigated at institutions like Virginia Commonwealth University (Melissa Bui) and Brigham and Women’s Hospital (now Jordan Rosen), and our rehabilitation psychology colleagues are increasingly interested and involved in this work. This study comes from a single university hospital in the Midwest, and the authors were only able to get about a 1/3 response rate. Nevertheless, these results likely generalize to other ICUs where psychiatric consultations are relatively uncommon.
Psychiatrists and other mental clinicians could certainly make a difference in the outcomes of the critically ill. The current article illustrates some of the attitudinal challenges to making routine C-L psychiatry consults a reality.
The authors employed a Person-Task-Environment model when qualitatively appraising interviews with critical illness survivors. Though person-related barriers (e.g., depressed mood, physical weakness) have been a focus of prior observational and intervention studies, the authors cast a wider net and enhance our understanding of facilitators of recovery (e.g., matching tasks with patients’ abilities, managing expectations, and explicitly acknowledging progress).
Strength and weaknesses:
The data were collected in the mid-2000s; however, despite advances in critical care medicine, survivors still face the same issues they did at that time. Nevertheless, the original study was not designed to focus specifically on barriers and facilitators in interview. I believe the authors have done the field an immense favor in drawing attention to new variables to consider and address when designing interventions to enhance critical illness survivors’ recovery.
This work is relevant to any mental health clinician who addresses recovery from critical illness. Optimal treatments will likely require more attention to facilitators of recovery (e.g., reframing expectations, providing positive feedback), not simply using “antidepressants” and uninformed psychotherapeutic techniques to help mood and anxiety in this population.