Psychische Störungen in der Intensivmedizin – Teil 1: Grundlagen, Störungsbilder und Diagnostik

Alexander Wolf; Frank-Gerald B Pajonk

doi:10.1055/s-0032-1307462

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2012; 47(3): 150-157
DOI: 10.1055/s-0032-1307462

Fachwissen

Intensivmedizin

Psychische Störungen in der Intensivmedizin – Teil 1: Grundlagen, Störungsbilder und Diagnostik

Mental Disorders in Intensive Care Medicine – Part 1: Principles and Diagnostics

Alexander Wolf

,

Frank-Gerald B Pajonk

Abstract

Zusammenfassung

Der zweiteilige Artikel ”Psychische Störungen in der Intensivmedizin“ stellt die häufigsten psychischen Störungen und Erkrankungen dar, mit denen der Intensivmediziner konfrontiert ist. Teil 1 wird sich mit Grundlagen, Störungsbildern und Diagnostik befassen und Teil 2 mit der Prävention und Therapie dieser Erkrankungen. Die häufigsten psychischen Störungen auf der Intensivstation sind Delir, Substanzabusus bzw. -intoxikation, Suizidversuche, Angststörung, Depression oder Psychosen. Psychische Störungen können Grund für die Aufnahme sein oder sich im Rahmen der intensivmedizinischen Behandlung entwickeln, wie z.B. eine posttraumatische Belastungsstörung. Die Folge davon: eine erhöhte Morbidität, Mortalität und Liegedauer. Eine frühzeitige Einbindung eines Psychiaters in die Diagnostik ist empfehlenswert.

Abstract

This two-part article on mental disorders in intensive care medicine aims to provide an understanding of the most frequent mental disorders in critical care medicine. Part 1 highlights the basic principles, disturbances and diagnostics and part 2 deals with prevention and therapeutic approaches. The most frequent mental disorders in the intensive care unit are delirium, substance abuse or, respectively, intoxication, suicide attempts, anxiety disorders, depression or psychosis. Mental disorders may be the reason for admission or can develop in the course of intensive care treatment, such as, for example, a post-traumatic stress disorder. The consequences thereof include increased morbidity, mortality, and duration of hospitalization. The early participation of a psychiatrist in the diagnostic process is to be recommended.

Schlüsselwörter

psychische Störungen - ITS - Intensivmedizin - Diagnostik - Delir - Suizid - Angststörung - Depression - Substanzabusus

Key words

mental disorders - psychic disorders - ICU - critical care - delirium - suicide - anxiety disorder - depression - drug abuse

Full Text

References

Literatur
1 Tanimoto S, Takayanagi K, Yokota H et al. The psychological and physiological effects of an intensive-care unit environment on healthy individuals. Clin Perform Qual Health Care 1999; 7: 77-82
2 Samuelson KA. Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patients – findings from 250 interviews. Intensive Crit Care Nurs 2011; 27: 76-84
3 Hofhuis JG, Spronk PE, van Stel HF et al. Experiences of critically ill patients in the ICU. Intensive Crit Care Nurs 2008; 24: 300-313
4 Hansen MS, Fink P, Frydenberg M et al. Mental disorders among internal medical inpatients: prevalence, detection, and treatment status. J Psychosom Res 2001; 50: 199-204
5 Martucci M, Balestrieri M, Bisoffi G et al. Evaluating psychiatric morbidity in a general hospital: a two-phase epidemiological survey. Psychol Med 1999; 29: 823-832
6 Rincon HG, Granados M, Unutzer J et al. Prevalence, detection and treatment of anxiety, depression, and delirium in the adult critical care unit. Psychosomatics 2001; 42: 391-396
7 Hale M, Koss N, Kerstein M et al. Psychiatric complications in a surgical ICU. Crit Care Med 1977; 5: 199-203
8 Anderson WG, Arnold RM, Angus DC et al. Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. J Gen Intern Med 2008; 23: 1871-1876
9 Davidson JE, Jones C, Bienvenu OJ. Family response to critical illness: Postintensive care syndrome-family. Crit Care Med 2012; 40: 618-624
10 Mealer ML, Shelton A, Berg B et al. Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. Am J Respir Crit Care Med 2007; 175: 693-697
11 Meagher DJ, O'Hanlon D, O'Mahony E et al. Relationship between symptoms and motoric subtype of delirium. J Neuropsychiatry Clin Neurosci 2000; 12: 51-56
12 Meagher DJ, O'Hanlon D, O'Mahony E et al. The use of environmental strategies and psychotropic medication in the management of delirium. Br J Psychiatry 1996; 168: 512-515
13 Pandharipande P, Cotton BA, Shintani A et al. Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med 2007; 33: 1726-1731
14 Peterson JF, Pun BT, Dittus RS et al. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc 2006; 54: 479-484
15 Yang FM, Marcantonio ER, Inouye SK et al. Phenomenological subtypes of delirium in older persons: patterns, prevalence, and prognosis. Psychosomatics 2009; 50: 248-254
16 Robinson TN, Raeburn CD, Tran ZV et al. Motor subtypes of postoperative delirium in older adults. Arch Surg 2011; 146: 295-300
17 Engel GL, Romano J. Delirium, a syndrome of cerebral insufficiency. J Chronic Dis 1959; 9: 260-277
18 Maclullich AM, Ferguson KJ, Miller T et al. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res 2008; 65: 229-238
19 Trzepacz PT. Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 2000; 5: 132-148
20 Cerejeira J, Firmino H, Vaz-Serra A et al. The neuroinflammatory hypothesis of delirium. Acta Neuropathol 2010; 119: 737-754
21 Sharshar T, Carlier R, Bernard F et al. Brain lesions in septic shock: a magnetic resonance imaging study. Intensive Care Med 2007; 33: 798-806
22 Reichenberg A, Yirmiya R, Schuld A et al. Cytokine-associated emotional and cognitive disturbances in humans. Arch Gen Psychiatry 2001; 58: 445-452
23 Shigeta H, Yasui A, Nimura Y et al. Postoperative delirium and melatonin levels in elderly patients. Am J Surg 2001; 182: 449-454
24 Uchida K, Aoki T, Ishizuka B. Postoperative delirium and plasma melatonin. Med Hypotheses 1999; 53: 103-106
25 Schmitt TK, Pajonk FG. Postoperatives Delir beim Intensivpatienten. Anaesthesist 2008; 57: 403-429
26 Dasgupta M, Dumbrell AC. Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc 2006; 54: 1578-1589
27 Ely EW, Gautam S, Margolin R et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med 2001; 27: 1892-1900
28 Van Rompaey B, Elseviers MM, Schuurmans MJ et al. Risk factors for delirium in intensive care patients: a prospective cohort study. Crit Care 2009; 13
29 Dubois MJ, Bergeron N, Dumont M et al. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med 2001; 27: 1297-1304
30 Pandharipande P, Shintani A, Peterson J et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 2006; 104: 21-26
31 Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. Jama 1990; 263: 1097-1101
32 Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. Jama 1996; 275: 852-857
33 Ely EW, Inouye SK, Bernard GR et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). Jama 2001; 286: 2703-2710
34 Ely EW, Shintani A, Truman B et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Jama 2004; 291: 1753-1762
35 McNicoll L, Pisani MA, Zhang Y et al. Delirium in the intensive care unit: occurrence and clinical course in older patients. J Am Geriatr Soc 2003; 51: 591-598
36 Lat I, McMillian W, Taylor S et al. The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Crit Care Med 2009; 37: 1898-1905
37 Van Eijk MM, Kesecioglu J, Slooter AJ. Intensive care delirium monitoring and standardised treatment: a complete survey of Dutch Intensive Care Units. Intensive Crit Care Nurs 2008; 24: 218-221
38 Ely EW, Stephens RK, Jackson JC et al. Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals. Crit Care Med 2004; 32: 106-112
39 Lütz A, Heymann A, Radtke FM et al. Was wir nicht messen, detektieren wir meist auch nicht. Anasthesiol Intensivmed Notfallmed Schmerzther 2010; 45: 106-111
40 Lin SM, Liu CY, Wang CH et al. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 2004; 32: 2254-2259
41 Pisani MA, Kong SY, Kasl SV et al. Days of delirium are associated with 1–year mortality in an older intensive care unit population. Am J Respir Crit Care Med 2009; 180: 1092-1097
42 Milbrandt EB, Deppen S, Harrison PL et al. Costs associated with delirium in mechanically ventilated patients. Crit Care Med 2004; 32: 955-962
43 DGAI, DIVI. Analgesie, Sedierung und Delirmanagement in der Intensivmedizin –Langfassung. Im Internet: http://www.awmf.org/uploads/tx_szleitlinien/001-012l.pdf
44 Luetz A, Heymann A, Radtke FM et al. Different assessment tools for intensive care unit delirium: which score to use?. Crit Care Med 2010; 38: 409-418
45 Ely EW, Putensen C. Die "Confusion Assessment Method (CAM)" für Intensivstation (CAM-ICU) Übungsleitfaden. Im Internet: http://www.mc.vanderbilt.edu/icudelirium/docs/CAM_ICU_training_German.pdf
46 Granacher RP, Baldessarini RJ. Physostigmine. Its use in acute anticholinergic syndrome with antidepressant and antiparkinson drugs. Arch Gen Psychiatry 1975; 32: 375-380
47 Link J, Papadopoulos G, Dopjans D et al. Distinct central anticholinergic syndrome following general anaesthesia. Eur J Anaesthesiol 1997; 14: 15-23
48 De Keulenaer BL, Philpot S, Wilkinson M et al. Central anticholinergic syndrome in the intensive care unit. Eur J Anaesthesiol 2004; 21: 499-501
49 Schneck HJ, Rupreht J. Central anticholinergic syndrome (CAS) in anesthesia and intensive care. Acta Anaesthesiol Belg 1989; 40: 219-228
50 Torline RL. Central anticholinergic syndrome – the forgotten diagnosis. Anesthesiology Review 1993; 20: 47-50
51 Holzgrafe RE, Vondrell JJ, Mintz SM. Reversal of postoperative reactions to scopolamine with physostigmine. Anesth Analg 1973; 52: 921-925
52 Brown DV, Heller F, Barkin R. Anticholinergic syndrome after anesthesia: a case report and review. Am J Ther 2004; 11: 144-153
53 Cardoso G, Alexandre J, Rosa A. Depression, anxiety and alcohol abuse in a gastroenterology intensive care unit: prevalence and detection. Clin Pract Epidemiol Ment Health 2010; 6: 47-52
54 Treggiari-Venzi M, Borgeat A, Fuchs-Buder T et al. Overnight sedation with midazolam or propofol in the ICU: effects on sleep quality, anxiety and depression. Intensive Care Med 1996; 22: 1186-1190
55 Pirraglia PA, Peterson JC, Williams-Russo P et al. Depressive symptomatology in coronary artery bypass graft surgery patients. Int J Geriatr Psychiatry 1999; 14: 668-680
56 Lenzi GL, Altieri M, Maestrini I. Post-stroke depression. Rev Neurol (Paris) 2008; 164: 837-840
57 Jubran A, Lawm G, Kelly J et al. Depressive disorders during weaning from prolonged mechanical ventilation. Intensive Care Med 2010; 36: 828-835
58 Bernhard P. Angst und Angstbewältigung von Patient und Personal einer medizinischen Intensivstation. Psychother Psychosom Med Psychol 1984; 34: 50-55
59 Johnson MM, Sexton DL. Distress during mechanical ventilation: patients' perceptions. Crit Care Nurse 1990; 10: 48-57
60 Statistisches Bundesamt Deutschland. Gesundheit, Todesursachen in Deutschland 2009. Im Internet: http://www.destatis.de/jetspeed/portal/cms/Sites/destatis/Internet/DE/Content/Publikationen/Fachveroeffentlichungen/Gesundheit/Todesursachen/Todesursachen2120400097004,property=file.pdf
61 Pajonk FG, D'Amelio R. Psychosozialer Notfall – Suizidalitat und Suizid in der Rettungsmedizin. Anasthesiol Intensivmed Notfallmed Schmerzther 2009; 44: 720-727
62 Sverrisson KO, Palsson SP, Sigvaldason K et al. Clinical aspects and follow up of suicide attempts treated in a general intensive care unit at Landspitali University Hospital in Iceland 2000–2004. Laeknabladid 2010; 96: 101-107
63 Ruchholtz S, Pajonk FG, Waydhas C et al. Long-term results and quality of life after parasuicidal multiple blunt trauma. Crit Care Med 1999; 27: 522-530
64 Maier R, Stieglitz RD, Marsch SC et al. Patienten mit intensivpflichtigen medikamentosen Suizidversuchen – Risikoprofil und Verlauf. Fortschr Neurol Psychiatr 2011; 79: 283-289
65 Statistisches Bundesamt Deutschland. Pressemitteilung Nr.039 vom 28.01.2011, Diagnose Alkoholmissbrauch: 2,8% mehr junge Krankenhauspatienten im Jahr 2009. Im Internet: http://www.destatis.de/jetspeed/portal/cms/Sites/destatis/Internet/DE/Presse/pm/2011/01/PD11__039__231,templateId=renderPrint.psml
66 Die Drogenbeauftragte der Bundesregierung. Drogen- und Suchtbericht. Im Internet: http://www.drogenbeauftragte.de/fileadmin/dateien-dba/Service/Publikationen/Drogen_und_Suchtbericht_2011_110517_Drogenbeauftragte.pdf
67 Lam SM, Lau AC, Yan WW. Over 8 years experience on severe acute poisoning requiring intensive care in Hong Kong, China. Hum Exp Toxicol 2010; 29: 757-765
68 Furst S, Habscheid W. Akute Intoxikationen bei Patienten einer medizinischen Intensivstation. Dtsch Med Wochenschr 1993; 118: 849-853
69 Kinn M, Holzbach R, Pajonk FG. Psychosozialer Notfall – Substanzinduzierte Störungen durch Alkohol. Anasthesiol Intensivmed Notfallmed Schmerzther 2008; 43: 664-673
70 Rivara FP, Jurkovich GJ, Gurney JG et al. The magnitude of acute and chronic alcohol abuse in trauma patients. Arch Surg discussion 1993; 128: 912-903
71 Kinn M, Holzbach R, Pajonk FG. Psychosozialer Notfall – Substanzinduzierte Störungen durch illegale Drogen –Teil 1. Anasthesiol Intensivmed Notfallmed Schmerzther 2008; 43: 746-753
72 Kinn M, Holzbach R, Pajonk FG. Psychosozialer Notfall –Substanzinduzierte Störungen durch illegale Drogen – Teil 2. Anasthesiol Intensivmed Notfallmed Schmerzther 2009; 44: 14-20
73 Griffiths J, Fortune G, Barber V et al. The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med 2007; 33: 1506-1518
74 Jackson JC, Hart RP, Gordon SM et al. Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem. Crit Care 2007; 11
75 Davydow DS, Gifford JM, Desai SV et al. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry 2008; 30: 421-434
76 Myhren H, Ekeberg O, Toien K et al. Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care 2010; 14
77 Richter JC, Waydhas C, Pajonk FG. Incidence of posttraumatic stress disorder after prolonged surgical intensive care unit treatment. Psychosomatics 2006; 47: 223-230
78 O'Donnell ML, Creamer M, Holmes AC et al. Posttraumatic stress disorder after injury: does admission to intensive care unit increase risk?. J Trauma 2010; 69: 627-632
79 Gries CJ, Engelberg RA, Kross EK et al. Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU. Chest 2010; 137: 280-287
80 Peris A, Bonizzoli M, Iozzelli D et al. Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients. Crit Care 2011; 15
81 Capuzzo M, Bertacchini S, Jones C et al. Patients with PTSD after intensive care avoid hospital contact at 2-year follow-up. Acta Anaesthesiol Scand 2008; 52: 313-314
82 Loew T, Köllner V, Deister A. Psychische und psychosomatische Störungen bei Intensivpatienten. In: Buchardi H, Larsen R, Kuhlen R, et al. Hrsg. Die Intensivmedizin. Berlin, Heidelber, New York: Springer; 2008: 671-671

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