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The impact of disaster and crisis events encompass all aspects of a patient’s being. The physical injuries are clear and obvious. However, the new or underlying mental health issues that arise from a crisis or trauma may not become as apparent in an acute situation. This is applicable not only for the patient but to the care team and the family of those affected. Pandemics and violent traumas are obvious precipitating factors for mental health illnesses, and acute changes in mental health and behaviors are expected. The factors involved in the aforementioned crisis situations that perpetuate the mental health and behavioral comorbidities become the challenge clinically moving forward in a patient’s care. Over time, many of the memorable and devastating world events have highlighted the need to address and manage psychiatric comorbidities. World War II, mass shootings, natural disasters, and global pandemics all have left an indelible impression on the mental health of patients, their families, the medical care team, and the hospital system. In this day and age where information comes fast and often, the recent COVID-19 pandemic has further emphasized the many mental health issues that affect the community during times of an ongoing disaster. The media coverage from the disastrous COVID-19 pandemic has highlighted how hospital systems around the world have been overwhelmed. Hospital systems are struggling with not only addressing how to contain the pandemic but also the difficulty addressing issues such as Personal Protective Equipment resources, allowing family members to see their sick loved ones, medical staffing, physical space to handle patient volume, and the degree of complexity the patient themselves present with during this pandemic. All of these issues bring about stress and strain to all those involved, which in turn has the ability to precipitate or exacerbate mental health comorbidities. This chapter hopes to serve as a conceptual guide for the evaluation, management, and treatment of various psychiatric issues that arise for patients, their families, and the medical team in an acute critical care setting.
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EVALUATION OF PSYCHIATRIC DISORDERS IN CRITICAL CARE SETTINGS
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Typical psychiatric disorders that are recognized in the critical care setting typically consist of the following: delirium, anxiety disorders (from a reactionary or anticipatory anxiety to panic disorder with agitation and restlessness), adjustment disorders with depressive mood, brief psychotic disorders with or without persecutory delusions, and acute stress or post-traumatic stress disorders. The manifestations of psychiatric disorders occur not only during the stay in the intensive care unit (ICU) but also after transfer from ICU and possibly even several months after discharge from hospital.
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In a critical care setting, a significant precipitating factors for the acute appearance of psychiatric symptoms are largely thought to be due to organic or toxic causes (metabolic disturbances, electrolyte imbalance, withdrawal syndromes, infection, vascular disorders, and head trauma) despite even having a preexisting psychiatric comorbidity. The critical care environment or setting itself can precipitate much ...