Critical Care Psychiatry SIG

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Welcome to the Critical Care Psychiatry Special Interest Group!

We focus on issues that arise during or after critical illness, including detecting and managing delirium as well as more general psychiatric conditions. We will meet each year in November at the ACLP annual meeting and will hold regular virtual meetings throughout the year as well as maintain a listserver.


SIG Chair: José Maldonado, MD, FACLP

Executive Committee Members: Jordan Rosen, MD, Vice Chair, Yelizaveta Sher, MD, FACLP, Melissa Bui, MD

Critical Care Psychiatry Listserver

The primary means of communication among members of the Critical Care Psychiatry SIG is via listserv. Only members of the SIG may post and receive group messages, as well as view the archived postings. All ACLP members are welcome to join the Critical Care Psychiatry SIG. To join, edit your ACLP membership profile:

Log in to your profile.

On the “Account” tab, click “Personal Info” in the left menu.

Toward the bottom of the Personal Info page is the list of Special Interest Groups. Check the box for each SIG you wish to join. Or clear the checkbox to unsubscribe from a SIG.

Review/update your other profile information, and click the ”SAVE” button at the bottom of the page.

SIG Tracks

  1. Research Track lead by Jose Maldonado, MD, FACLP: Individuals within this track will be able to seek out mentorship opportunities to support the development of Quality Improvement and Research methodologies by which to create and evaluate Critical Care Psychiatry pilot programs within their own institutions. Collaboration among members across institutions will be strongly encouraged.
  2. Training Track lead by Melissa Bui, MD: designed to teach trainees, junior attendings and those wanting to start their own ICU services or liaisons, or to develop an expertise in the field (boot-camp style). This track will design and deliver advanced courses at the ACLP annual meeting, including the continuation of the Critical Care Reviews series which has been included in each of the past three annual meetings.
  3. Guidelines Track lead by Liza Sher, MD, FACLP: Members of this track will lend their expertise to develop protocols and guidelines. Systematic methodologies will be applied to develop consensus recommendations. Final statements will be submitted for approval to the ACLP’s Guidelines & Evidence-Based Medicine Subcommittee and to the ACLP Board. We hope to standardize our field’s evidence-based approach to care.
  4. Scholarly Track lead by Jordan Rosen, MD: members of this track will develop scholarly content, including the publication of peer-reviewed manuscripts, peer-reviewed website material including videos, webinars and other content, as well as reviews of new research. This content will also be posted on our SIG’s webpage through the ACLP. They may also have the opportunity to contribute to a book on Critical Care Psychiatry, its concept already having been pre-approved by the publisher.

Annual Meeting 2022 Workshop

Please do see the Workshop sponsored by the SIG at the recent Annual Meeting:


Abstract: Alterations in mental status (AMS) are a common presentation in the intensive care units (ICUs). Diagnosing a patient with a change in mental status can be a daunting challenge. Some presentations are clear; a patient who is postictal after a seizure or a diabetic patient who is hypoglycemic. At times, the clinical picture is more subtle and not easily identified. Altered mental status (AMS) is not a disease: it is a symptom. Causes run the gamut from easily reversible conditions (e.g., hypoglycemia, hypoxemia, delirium) to permanent (intracranial hemorrhage) and from the relatively benign (e.g., medication toxicity, non-convulsive status) to life threatening conditions (e.g., meningitis or encephalitis). Developing a structured and systematic approach to these cases will help you develop and streamline the diagnostic workup and management of these patients with AMS. This presentation is intended to provide physicians with the background and tools to assess and differentiate among the most common neuropsychiatric conditions constituting the differential diagnosis for AMS among CCU patients, including hypoactive delirium, non-convulsive status, psychoactive substance effects, and other alterations in awareness, such as coma, minimally conscious states and akinetic mutism).

Dr Maldonado will discuss the particulars of hypoactive delirium, its causes, and consequences, and will discuss the best assessments and treatment modalities. Hypoactive delirium is the most difficult to recognize and accurately diagnose, and by far the most common motoric type of delirium. It also has the greatest morbidity and mortality rate. This presentation will serve as the basis for all the other disorders included in this presentation, representing the differential diagnosis for each other’s condition.

Dr Zabinski will discuss Nonconvulsive status epilepticus (NCSE), a complex disorder with multiple subtypes that can present a vexing challenge in neurologic and psychiatric evaluation of altered mental status, particularly in cases with notable psychiatric comorbidity in the inpatient setting. This review will look at the range of neuropsychiatric presentations with approaches to differential, evaluation, and treatment from the perspective of a consultation psychiatrist.

Dr. Rosen will describe the pathophysiology and issues that present with accumulation of common sedatives and analgesics that can lead to delayed awakening and ICU-acquired neuropathy and myopathy. He will then address common questions that arise once these conditions are present.

Dr. Durga Roy will review alterations in mental state that may arise from coma, minimally conscious state, post-traumatic confusional state and akinetic mutism. She will present the phenomenology, diagnostic workup as well as challenges and dilemmas in managing these patients. A focus on neurocircuitry, functional resting-state networks and other neuroimaging findings will be discussed along with an evidence-based review of pharmacologic and behavioral interventions used in these scenarios.

ACLP Critical Care Psychiatry Selected Bibliography

Bhattacharyya S, Darby RR, Raibagkar P, Gonzalez Castro LN, Berkowitz AL. Antibiotic-associated encephalopathy. Neurology. 2016 Mar 8;86(10):963-71.

Reade MC, Finfer S. Sedation and delirium in the intensive care unit. N Engl J Med. 2014 Jan 30;370(5):444-54. 

Martyn JAJ, Mao J, Bittner EA. Opioid Tolerance in Critical Illness. N Engl J Med. 2019 Jan 24;380(4):365-378.

Wang EH, Mabasa VH, Loh GW, Ensom MH. Haloperidol dosing strategies in the treatment of delirium in the critically ill. Neurocrit Care. 2012 Feb;16(1):170-83.

Smith BS, Yogaratnam D, Levasseur-Franklin KE, Forni A, Fong J. Introduction to drug pharmacokinetics in the critically ill patient. Chest. 2012 May;141(5):1327-1336. 

Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008 Jan 12;371(9607):126-34.

Pandharipande P, Shintani A, Peterson J, Pun BT, Wilkinson GR, Dittus RS, Bernard GR, Ely EW. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006 Jan;104(1):21-6.

Pun BT, Balas MC, Barnes-Daly MA, Thompson JL, Aldrich JM, Barr J, Byrum D, Carson SS, Devlin JW, Engel HJ, Esbrook CL, Hargett KD, Harmon L, Hielsberg C, Jackson JC, Kelly TL, Kumar V, Millner L, Morse A, Perme CS, Posa PJ, Puntillo KA, Schweickert WD, Stollings JL, Tan A, D’Agostino McGowan L, Ely EW. Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults. Crit Care Med.2019 Jan;47(1):3-14.

More to come!

Other Resources