Classification of mental disorders in the Intensive Care Unit

Purpose: To determine the incidence and characteristics of mental disorders (MD) in the Intensive Care Unit (ICU), and to define a classification system adapted to the ICU environment. Design: A retrospective, descriptive analysis. Setting: Intensive Care Unit, Arnau de Vilanova Hospital in Lerida (Spain). Patients: All patients with MD admitted during 5-year period (January, 1 2004 to December 31, 2008). Main variables: General variables included clinical-demographic data, diagnostic variables, procedures, severity score, length of stay and mortality. Specific variables included psychiatric history, screening for substance abuse, psychiatric assessment, monitoring and transfer to a psychiatric center. Classification of the MD was as follows: 1) acute substance intoxication (SI); 2) suicide attempts (SA); and 3) MD associated with the main diagnosis (AMD). Results: A total of 146 patients had MD (7.8%); they were predominantly male (74%) and were younger than the general ICU population (43.9 vs. 55.3 years, p < 0.001). The ICU stays of the patients with MDs were shorter (4 days vs. 7 days, p < 0.001), and there was less hospital mortality (17.1 vs. 25%, p < 0.05). They also showed a higher incidence of pneumonia (19.9 vs. 13.8%, p < 0.05), but no differences in the level of severity were observed. The SI group (24.7%) contained the highest number of young people; the SA group (36.3%) showed a predominance of women; and the AMD (39%) group had the longest stays and the highest mortality. Psychiatric consultation was carried out mainly in the SA group (62.3%). Conclusions: MD is a relatively common problem in the ICU. Collaboration with the Psychiatry Department seldom occurs, but must be encouraged to develop fully integrated management of critical patients with MD. (C) 2011 Elsevier Espana, S.L. and SEMICYUC. All rights reserved.