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Psychiatric Aspects of Critical Care Medicine, An Issue of Critical Care Clinics, E-Book

Psychiatric Aspects of Critical Care Medicine, An Issue of Critical Care Clinics, E-Book

José R. Maldonado

(2017)

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Book Details

Abstract

This issue of Critical Care Clinics focuses on Psychiatric Aspects of Critical Care Medicine. Editor Jose Maldonado has assembled an expert team of authors on topics such as: Psychiatric Aspects of Organ Transplantation in Critical Care; Medical Complications of Psychiatric Treatment; Psychiatric and Palliative Care in the ICU; Psychiatric Aspects of Heart and Lung Disease in Critical Care; Alcohol Withdrawal Syndromes: Assessment and Management; Substance Abuse and Withdrawal in the Critical Care Setting; Mood Disorders and The Outcome of Suicidal Thoughts and Attempts; Anxiety Disorders and the Outcomes of Trauma; Assessment and Management of Toxidromes in the Critical Care Unit; Neuropsychiatric Consequences of Trauma and Head Injury; Detection and Management of Pre-Existing Cognitive Impairment in the Critical Care Unit; Delirium: Pathophysiology, Diagnosis and Treatment; Neuropsychiatric Aspects of Infectious Processes.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Psychiatric Aspects of Critical Care Medicine:Update\r i
Copyright\r ii
Contributors iii
CONSULTING EDITOR iii
EDITOR iii
AUTHORS iii
Contents vii
Preface: Psychiatric Aspects of Critical Care Medicine: Update vii
Neurobehavioral Management of Traumatic Brain Injury in the Critical Care Setting: An Update vii
Detection and Management of Preexisting Cognitive Impairment in the Critical Care Unit vii
Acute Brain Failure: Pathophysiology, Diagnosis, Management, and Sequelae of Delirium vii
Assessment and Management of Toxidromes in the Critical Care Unit viii
Substance Use, Intoxication, and Withdrawal in the Critical Care Setting viii
Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes–Beyond Benzodiazepines viii
Psychiatric Aspects of Lung Disease in Critical Care viii
Psychiatric Aspects of Heart Disease (and Cardiac Aspects of Psychiatric Disease) in Critical Care ix
Psychiatric Disorders and Suicidality in the Intensive Care Unit ix
Posttraumatic Stress Disorder Phenomena After Critical Illness ix
Psychiatric Aspects of Organ Transplantation in Critical Care: An Update ix
Neuropsychiatric Aspects of Infectious Diseases: An Update x
Medical Complications of Psychiatric Treatment: An Update x
Psychiatric and Palliative Care in the Intensive Care Unit x
CRITICAL CARE CLINICS\r xi
FORTHCOMING ISSUES xi
October 2017 xi
January 2018 xi
April 2018 xi
RECENT ISSUES xi
April 2017 xi
January 2017 xi
October 2016 xi
Preface:\rPsychiatric Aspects of Critical Care Medicine: Update xiii
Neurobehavioral Management of Traumatic Brain Injury in the Critical Care Setting 423
Key points 423
INTRODUCTION 423
Epidemiology 424
DEFINITION 424
CLASSIFICATION 424
PATHOPHYSIOLOGY 425
NEUROANATOMICAL CIRCUITRY 427
NEUROBEHAVIORAL SYMPTOMS 427
Acute Phase 428
POST-TRAUMATIC BRAIN INJURY SYNDROMES 429
Cognitive Deficits in Traumatic Brain Injury 429
Psychosis 430
Post-traumatic Stress Disorder 430
Post-traumatic Brain Injury Depression 430
Post-traumatic Brain Injury Mania 430
Post-traumatic Brain Injury Aggression 430
Behavioral Dyscontrol Disorder 431
TREATMENT 431
Introductory Remarks 431
Treatment of Post-traumatic Brain Injury Delirium 431
Antipsychotics 432
Anticonvulsants 432
Alpha-2 Antagonists 432
Treatment of Post-traumatic Brain Injury Cognitive Deficits 432
Dopaminergic Agents 432
Psychostimulants 433
SUMMARY 433
REFERENCES 434
Detection and Management of Preexisting Cognitive Impairment in the Critical Care Unit 441
Key points 441
IMPORTANCE OF PREEXISTING COGNITIVE IMPAIRMENT IN THE INTENSIVE CARE UNIT 441
DEFINITIONS 442
ROLE OF PREEXISTING COGNITIVE IMPAIRMENT IN INTENSIVE CARE UNIT UTILIZATION AND CARE DECISIONS 444
DETECTION OF PREEXISTING COGNITIVE IMPAIRMENT IN THE INTENSIVE CARE UNIT 445
PREVALENCE OF PREEXISTING COGNITIVE IMPAIRMENT IN THE INTENSIVE CARE UNIT 446
RELATIONSHIP BETWEEN PREEXISTING COGNITIVE IMPAIRMENT AND DELIRIUM 447
DELIRIUM SUPERIMPOSED ON DEMENTIA 447
MANAGEMENT OF NEUROPSYCHIATRIC SYMPTOMS ASSOCIATED WITH PREEXISTING COGNITIVE IMPAIRMENT 448
NONPHARMACOLOGIC MANAGEMENT 448
IMPULSE DYSCONTROL AND AGITATION 449
COMPORTMENT/PERSONALITY CHANGE 449
AFFECTIVE DYSREGULATION 452
MOTIVATIONAL DEFICIT 452
PERCEPTUAL CHANGE AND PSYCHOTIC SYMPTOMS 454
SUNDOWNING BEHAVIOR 454
SUMMARY 454
REFERENCES 455
Acute Brain Failure 461
Key points 461
EPIDEMIOLOGY OF DELIRIUM 461
Risk Factors for Delirium 461
Neuropathogenesis of Delirium 462
Clinical Presentation of Delirium 467
Delirium Phenotypes 467
Diagnosing Delirium 468
MANAGEMENT OF DELIRIUM 468
DELIRIUM PREVENTION STRATEGIES 470
Nonpharmacologic Management Strategies 470
Environmental Manipulations 473
Physical and Occupational Therapy 473
Light Therapy 483
PHARMACOLOGIC MANAGEMENT STRATEGIES 483
Pharmacologic Prevention Options 483
Dopamine-antagonist agents 483
Alpha-2 agonists 483
Glutamate antagonists and calcium channel modulators 483
Ketamine 486
Melatonin and melatonin-agonists 486
Statins 486
Acetylcholinesterase inhibitors 486
Pharmacologic Treatment Options 486
Dopamine antagonists 486
Safety concerns 486
Antipsychotic alternatives to haloperidol 487
Dopamine antagonist agents: treatment recommendations 491
Alpha-2 agonists 491
Glutamate antagonists and calcium channel modulators 500
Acetylcholinesterase inhibitors 500
Serotonin antagonists 501
Melatonin and melatonin agonists 501
MANAGEMENT OF HYPOACTIVE DELIRIUM 501
DELIRIUM MANAGEMENT: WHAT DOES AND WHAT DOES NOT WORK 501
THE IMPACT OF DELIRIUM 503
Morbidity and Mortality Related to Delirium 503
Cognitive Sequelae 503
Behavioral Sequelae 504
Fiscal Impact 505
SUMMARY 505
REFERENCES 505
Assessment and Management of Toxidromes in the Critical Care Unit 521
Key points 521
INTRODUCTION 521
GENERAL APPROACH 522
TOXIDROMES 523
Anticholinergics 526
Cholinergics 528
Sedative/Hypnotics 529
Opioids 530
Sympathomimetics 531
Serotonergics 532
Neuroleptics 534
SUMMARY 536
REFERENCES 537
Substance Use, Intoxication, and Withdrawal in the Critical Care Setting 543
Key points 543
INTRODUCTION 543
GENERAL CRITICAL CARE ISSUES RELATED TO SUBSTANCE USE 544
Overdose 544
Agitation 544
Withdrawal 544
Iatrogenic Dependence 545
CRITICAL CARE ISSUES RELATED TO SPECIFIC SUBSTANCES 545
Opioids 545
Intoxication and overdose 545
Withdrawal 546
Pain management in patients with opioid use disorder, including patients receiving opioid agonist therapy 547
Benzodiazepines 547
Intoxication and overdose 548
Withdrawal 548
Stimulants: Cocaine and Methamphetamine 548
Intoxication and overdose 549
Withdrawal 550
3,4-Methylenedioxymethamphetamine 550
Intoxication and overdose 550
Withdrawal 551
Synthetic Cannabinoids 551
Intoxication and overdose 552
Withdrawal 552
Synthetic Cathinones 552
Intoxication and overdose 553
Withdrawal 553
TRANSITIONS OF CARE FOR PATIENTS WITH SUBSTANCE USE DISORDERS 553
SUMMARY 553
REFERENCES 554
Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes–Beyond Benzodiazepines 559
Key points 559
BACKGROUND 559
NEUROBIOLOGICAL EFFECTS OF ALCOHOL 560
OVERVIEW OF ALCOHOL WITHDRAWAL SYNDROMES 560
CLINICAL DILEMMA 563
ALCOHOL WITHDRAWAL TREATMENT 564
BENZODIAZEPINE-SPARING ALTERNATIVE FOR THE TREATMENT OF ALCOHOL WITHDRAWAL 564
Other γ-Aminobutyric Acid-ergic Agents 565
Antiepileptic Drugs 565
Carbamazepine 565
Oxcarbazepine 567
Valproic acid 567
Gabapentin 571
Other antiepileptic agents 571
Alpha-2 Adrenergic Receptor Agonist 571
Clonidine 577
Dexmedetomidine 577
Guanfacine 581
DEVELOPMENT OF A NOVEL ALGORITHM FOR THE PROPHYLAXIS AND TREATMENT OF ALCOHOL WITHDRAWAL 581
SUMMARY 587
REFERENCES 587
Psychiatric Aspects of Lung Disease in Critical Care 601
Key points 601
INTRODUCTION 601
EPIDEMIOLOGY OF PSYCHIATRIC ILLNESS IN CHRONIC LUNG DISEASE 602
Substance Use Disorders and Pulmonary Disease 602
ANXIETY IN CRITICALLY ILL PATIENTS WITH LUNG DISEASE 603
Comorbid Anxiety Disorders and Pathophysiology of Comorbidity 603
Acute Anxiety Disorders Emerging in Pulmonary Patients in the Intensive Care Unit 605
Medical Conditions Manifesting as Anxiety in Pulmonary Patients in the Intensive Care Unit 605
MOOD DISORDERS IN CRITICALLY ILL PATIENTS WITH LUNG DISEASE 606
DELIRIUM IN CRITICALLY ILL PATIENTS WITH LUNG DISEASE 607
PULMONARY MEDICATIONS LEADING TO NEUROPSYCHIATRIC SYMPTOMS 608
ASSISTIVE RESPIRATORY TREATMENTS IN THE INTENSIVE CARE UNIT AND PSYCHOLOGICAL SYMPTOMS 610
PSYCHIATRIC CONDITIONS AFTER THE INTENSIVE CARE UNIT 611
USE OF PSYCHOTROPIC MEDICATIONS AMONG LUNG DISEASE PATIENTS IN THE CRITICAL CARE SETTING 611
Sedative Infusions 611
Antipsychotics 611
Antidepressants 612
Antianxiety Medications 612
Drug–Drug Interactions 613
SUMMARY 613
REFERENCES 614
Psychiatric Aspects of Heart Disease (and Cardiac Aspects of Psychiatric Disease) in Critical Care 619
Key points 619
PSYCHOLOGICAL RESPONSES TO CRITICAL CARE 619
PSYCHIATRIC DISORDERS AND HEART DISEASE 621
Differential Diagnosis 621
Anger, Hostility, and Stress 622
Takutsubo Cardiomyopathy 623
Anxiety 623
Depression 623
Bipolar Affective Disorder 624
Posttraumatic Stress Disorder 625
Psychosis 625
Delirium and Cognitive Impairment 627
Alcohol Withdrawal 627
CARDIOVASCULAR EFFECTS OF PSYCHOTROPIC DRUGS 628
SPECIAL SITUATIONS 629
Left Ventricular Assist Devices 629
Atrial Fibrillation 629
SUMMARY 630
REFERENCES 630
Psychiatric Disorders and Suicidality in the Intensive Care Unit 635
Key points 635
INTRODUCTION 635
Psychiatric Disorders 636
Mood Disorders 636
Psychotic/Thought Disorders 636
Substance Use Disorders 636
Personality Disorders 638
NEUROBIOLOGY OF SUICIDE 638
SUICIDE SAFETY ASSESSMENT IN THE INTENSIVE CARE UNIT 639
Current State of Suicidality 639
Risk Factors 639
Protective Factors 639
Precipitating and Perpetuating Factors 639
Environmental Safety Assessment 641
Staff Attitudes Toward Patients Who Self-Harm 642
The Patient’s Perspective 642
Suicide Attempts and Completions in General Hospitals 642
INVOLUNTARY PSYCHIATRIC HOLDS IN THE INTENSIVE CARE UNIT 643
LIMITATIONS OF SUICIDE ASSESSMENTS 644
OUTCOMES OF SUICIDE ATTEMPTS 644
SUMMARY 644
REFERENCES 645
Posttraumatic Stress Disorder Phenomena After Critical Illness 649
Key points 649
INTRODUCTION 649
WHAT IS STRESSFUL ABOUT CRITICAL ILLNESS? 650
ARE POSTTRAUMATIC STRESS PHENOMENA REALLY A PROBLEM AFTER CRITICAL ILLNESS? 651
SO PSYCHIATRIC ILLNESS IS A “RISK MARKER” FOR PSYCHIATRIC ILLNESS? 652
WHAT ARE INTENSIVE CARE UNIT DIARIES? 653
REFERENCES 654
Psychiatric Aspects of Organ Transplantation in Critical Care 659
Key points 659
INTRODUCTION 659
EPIDEMIOLOGY OF TRANSPLANTATION 660
PRETRANSPLANT PERIOD 660
Psychosocial Transplant Evaluation 660
Waiting Period 660
Psychological Considerations in Assistive Devices in Intensive Care Unit 661
Ventricular assist devices for heart transplant candidates 661
Extracorporeal membrane oxygenation in lung transplant patients 662
PSYCHIATRIC DISORDERS IN TRANSPLANT PATIENTS 662
Depression and Anxiety 662
Suicidality 663
Severe Mental Illness 664
Cognitive Impairment and Delirium 664
Substance Use Disorders 665
Acute alcohol hepatitis 666
Methadone maintenance therapy 666
PSYCHOPHARMACOLOGY IN TRANSPLANT PATIENTS 667
Effects of Immunosuppressant Medications 667
Steroids 667
Calcineurin-inhibiting immunosuppressants 667
Treatment of Psychiatric Conditions in Transplant Patients 668
Sedative drips 668
Antidepressants 669
Antipsychotics 669
Mood stabilizers 670
Antianxiety medications 670
LIVE DONORS 670
CAREGIVERS 672
Patient Caregivers 672
Health Care Provider Caregivers 672
SUMMARY 673
REFERENCES 673
Neuropsychiatric Aspects of Infectious Diseases 681
Key points 681
INTRODUCTION 681
MEDICAL HOSPITALIZATION IN HUMAN IMMUNODEFICIENCY VIRUS–AIDS 682
EPIDEMIOLOGY OF PSYCHIATRIC DISORDERS IN MEDICAL INPATIENTS WITH HUMAN IMMUNODEFICIENCY VIRUS–AIDS 682
HUMAN IMMUNODEFICIENCY VIRUS AND THE BRAIN 682
DIFFERENTIAL DIAGNOSIS 685
DIAGNOSTIC EVALUATION 687
PSYCHIATRIC DISORDERS IN HUMAN IMMUNODEFICIENCY VIRUS–AIDS AND THEIR TREATMENT 688
Depression 688
Delirium 689
Mania 690
Psychosis 691
Anxiety 692
Herpes Simplex Encephalitis 692
PEDIATRIC AUTOIMMUNE NEUROPSYCHIATRIC DISORDERS ASSOCIATED WITH STREPTOCOCCAL INFECTIONS 693
NEUROCYSTICERCOSIS 698
NEUROSYPHILIS 699
CREUTZFELDT-JAKOB DISEASE 700
LYME DISEASE ENCEPHALOPATHY (NEUROBORRELIOSIS) 703
SUMMARY 704
REFERENCES 704
Medical Complications of Psychiatric Treatment 713
Key points 713
CENTRAL NERVOUS SYSTEM 714
Neuroleptic Malignant Syndrome 714
Serotonin Syndrome 715
Delirium 716
Seizures 717
Cerebrovascular Events 718
Reversible Cerebral Vasoconstriction Syndrome 718
Extrapyramidal Syndromes 718
Discontinuation Syndromes 719
Sedation 719
Myoclonus 719
Thermoregulation 719
CARDIOVASCULAR SYSTEM 720
Arrhythmia 720
Tricyclic antidepressants 720
QT prolongation 720
Orthostatic hypotension 720
Hypertension 722
Cardiotoxicity 722
GASTROINTESTINAL 722
Gastrointestinal Symptoms 722
Pancreatitis 723
Hepatic Dysfunction 723
IMMUNOLOGIC 723
RENAL 723
Lithium 724
Hyponatremia 724
Urinary Symptoms 724
ENDOCRINOLOGIC 725
Weight Gain and Diabetic Ketoacidosis 725
Thyroid Disorders 725
HEMATOLOGIC 726
Blood Dyscrasias 726
Bleeding 727
RESPIRATORY 727
Respiratory Depression 727
Respiratory Dyskinesia 727
Pulmonary Embolism 727
DERMATOLOGIC 728
REPRODUCTIVE 728
Sexual Dysfunction 728
Priapism 729
Pregnancy 729
SUMMARY 729
REFERENCES 729
Psychiatric and Palliative Care in the Intensive Care Unit 735
Key points 735
INTRODUCTION 735
PALLIATIVE CARE EVALUATION OF INTENSIVE CARE UNIT PATIENTS AND FAMILIES 736
Evaluation and Management of Patients with Preexisting Chronic Mental Illness 737
Spiritual Care Needs 737
MODELS OF PALLIATIVE CARE IN THE INTENSIVE CARE UNIT 737
The Consultative Model 737
The Integrative Model 738
The Combined Consultative-Integrative Model 738
COMMUNICATION AND PALLIATIVE CARE IN THE INTENSIVE CARE UNIT 738
PALLIATIVE PSYCHIATRY IN THE INTENSIVE CARE UNIT 739
PSYCHIATRIC AND PALLIATIVE CARE IN THE POST–INTENSIVE CARE UNIT SETTING 740
The Patient Experience 740
The Family Experience 741
SUMMARY/DISCUSSION 741
REFERENCES 742
Index 745