Psychological problems in intensive care.

Intensive care units are now well established in modem hospital practice and there can be few clinicians in any specialty who have not had some of their patients treated in such units. Intensive care units form a collection of the most ill in hospital. In our own unit the average mortality based on the last 1700 patients admitted was 13-5%, although there was a wide variation depending on the type and number of diseases that individual patients had. Without the special care, technical skill, and resources that the unit provides, the mortality of these patients would have probably been about 80°O. Serious illness, of any sort, creates psychological problems for the patients-for example, the anxiety of the patient with ischaemic heart disease or the despair of the patient with obstructive lung disease are well known. Certain psychological problems, however, develop in patients in intensive care, which would appear to be particularly related to being in such a unit. Since patients may be referred into the unit from any medical or surgical discipline it is perhaps worth drawing attention to some of these psychological problems, particularly as occasionally they may be unexpectedly severe or bizarre. Problems and case histories This intensive care unit admits about 450 patients a year, suffering from various problems and diseases ranging from postcardiac surgery to polyneuritis. The patients stay on average two to three days, although this varies widely. Over the years we have come to recognise several particular psychological problems that these patients have. SIMPLE REACTIVE APATHETIC DEPRESSION Simple reactive apathetic depression is extremely common in patients whose stay in the intensive care unit is prolonged. Its onset is almost invariably on the fifth or sixth day after admission to the unit, and it disappears spontaneously after a further week to ten days. Characteristically, the patient becomes apathetic about his own recovery-even when it is obvious that he has made a considerable improvement since admission. Cooperation with staff-for instance, physiotherapy or nursing staff-becomes minimal. The patient believes he will not recover, and so refuses to cough or expand his lungs, or move spontaneously. As a result of the fall in morale his physical condition may deteriorate-for example, sputum retention becomes a problem. This very deterioration is then used to justify a belief that he will not recover. Over half of those patients whose stay in the intensive care unit is prolonged suffer from this condition. …