Studies reveal post-traumatic stress disorder (PTSD) as a symptom after a patient has experienced an intensive care unit (ICU) stay. Often doctors, nurses, and caregivers overlook the psychiatric symptoms which may develop in patients after an intensive care unit experience. These symptoms can include, but are not limited to, intrusive thoughts, avoidant behaviors, mood swings, emotional numbness, sleep disturbances, and reckless behavior. Medical personnel are focused on the quality of a patient’s current condition often leaving PTSD symptoms undiagnosed.
ICU patients, even if comatose, still experience what is happening around them, and their brains find ways to rationalize what is occurring. These patients may experience flashbacks or dreams that they cannot explain. Other PTSD sufferers – victims of combat, sexual assault or natural disasters – also endure flashbacks, but theirs are grounded in episodes that can often be corroborated. What is unsettling for post-ICU patients is that no one can verify their seemingly real horrors; one patient described a food cart in the ICU selling strips of her flayed flesh.
ICU nurses have taken the lead in efforts to alleviate the trauma of stays and to shorten the duration of the subsequent mood disorders, for both families as well as patients. In Britain, Germany and some Scandinavian countries, nurses in many critical care units keep a diary of the care they provide to a patient, with contributions from the family, which they give to the patient upon discharge. The diaries function as a realistic counterpoint to patients’ hallucinations or amnesia.
Vanderbilt University Medical Center has been running a post-ICU clinic on Friday afternoons since last fall. Typically, the treatment team includes a critical care nurse-practitioner, a psychologist, a pharmacist, a pulmonologist and a nurse who functions in a social worker capacity. They evaluate patients for physical, cognitive, social and psychological impairments. James C. Jackson, a psychologist and assistant professor in the division of critical care medicine at Vanderbilt University School of Medicine, has worked with patients both in and out of studies making great contributions in this arena.
But whether patients or family members develop PTSD symptoms or the full disorder, persuading them to seek treatment poses unique challenges.