History of mental disorder in an ICU and referrals to psychiatry

Abstract

ObjectiveTo describe the prevalence of patients with mental disorders (MD) admitted to the ICU. To compare the clinical characteristics according to the presence of psychiatric history. To review the relevance of the consultations made to Psychiatry. DesignRetrospective descriptive study. SettingICU of the General Hospital of the Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain. PatientsPatients admitted between January 2016 and June 2018. InterventionsNone. Main variables of interestSeverity level (APACHE II), reason for admission, days of admission, days of mechanical ventilation, psychiatric history and reason for psychiatric consultation. ResultsA total of 1,247 patients were included; 194 (15.5%) met MD criteria, their mean age being younger (59 vs 68, P < .001) and with a lower mean score on the APACHE II scale (12 vs 14, P ≤ .003). There were 64 consultations to Psychiatry (5.1% of admissions), 59 of which were in patients with TM (92.1%). Regarding the reasons for the consultation, 22.6% were for attempted suicide, 61.3% for pharmacological adjustment, 11.3% to rule out mental disorder, and 4.8% for competence assessment. The probability of a consultation being carried out while it was indicated was 89.1%, while the probability of not carrying it out when it was not indicated was 99.4%. ConclusionsThis study supports the need to expand the specific recommendations for consultation to Psychiatry, beyond the assessment after a suicide attempt, since a large percentage (77.5%) of the pertinent consultations were for other reasons.