Trevick Stephen A, Lord Aaron S
Division of Neurocritical Care, Department of Neurology, Northwestern University Mcgaw Medical Center, Chicago, IL, USA.
Division of Neurocritical Care, Department of Neurology, NYU School of Medicine, New York, NY, USA.
Neurocrit Care. 2017 Jun;26(3):436-443. doi: 10.1007/s12028-016-0372-5.
To explore the effect of end of life and other palliative decision making scenarios on the mental health of family members of patients in the neuro-intensive care unit.
Decision makers of patients in the neuro-ICU at a large, urban, academic medical center meeting palliative care triggers were identified from November 10, 2014, to August 27, 2015. Interviews were conducted at 1 and 6 months post-enrollment. At 1 month, the Inventory of Complicated Grief-Revised (ICG-R), Impact of Events Scale-Revised (IES-R), and the Family Satisfaction-ICU (FS-ICU) were performed along with basic demographic questionnaires. At 6 months, only the ICG-R and IES-R were repeated.
At 1 month, 9 (35%) subjects had significant symptoms in at least one of the three domains of traumatic response. Two (7.7%) subjects met full criteria for PTSD (IES-R ≥ 1.5). At 6 months, 5 (22%) subjects met criteria for PTSD and 5 (22%) for Complicated Grief (ICG-R ≥ 36). Fifteen (50%) had at least one domain of PTSD symptoms identified in follow-up. Time spent at bedside and lower household income were associated with PTSD at 1 and 6 months, respectively. In all, clinically significant psychological outcomes were identified in 9 (30%) of subjects.
Clinically significant grief and stress reactions were identified in 30% of decision makers for severely ill neuro-ICU patients. Though factors including time at bedside during hospitalization and total household income may have some predictive value for these disorders, further evaluation is required to help identify family members at risk of psychopathology following neuro-ICU admissions.
探讨临终及其他姑息治疗决策情景对神经重症监护病房患者家庭成员心理健康的影响。
从2014年11月10日至2015年8月27日，在一家大型城市学术医疗中心，确定符合姑息治疗触发条件的神经重症监护病房患者的决策者。在入组后1个月和6个月进行访谈。1个月时，除了基本人口统计学问卷外，还进行了修订版复杂悲伤量表（ICG-R）、修订版事件影响量表（IES-R）和家庭对重症监护病房满意度量表（FS-ICU）的评估。6个月时，仅重复进行ICG-R和IES-R评估。
1个月时，9名（35%）受试者在创伤反应的三个领域中至少有一个出现显著症状。两名（7.7%）受试者符合创伤后应激障碍的全部标准（IES-R≥1.5）。6个月时，5名（22%）受试者符合创伤后应激障碍标准，5名（22%）符合复杂悲伤标准（ICG-R≥36）。15名（50%）受试者在随访中至少有一个创伤后应激障碍症状领域被识别出来。分别在1个月和6个月时，在床边陪伴的时间和较低的家庭收入与创伤后应激障碍相关。总体而言，9名（30%）受试者出现了具有临床意义的心理结果。
在重症神经重症监护病房患者的30%的决策者中发现了具有临床意义的悲伤和应激反应。尽管包括住院期间在床边陪伴的时间和家庭总收入等因素可能对这些疾病有一定的预测价值，但仍需要进一步评估，以帮助识别神经重症监护病房入院后有精神病理学风险的家庭成员。
