Antecedente de trastorno mental en la UCI e interconsulta a psiquiatría / History of mental disorder in an ICU and referrals to psychiatry

Objetivo Determinar la prevalencia de pacientes con trastorno mental (TM) ingresados en la UCI. Comparar las características clínicas según la presencia de antecedentes psiquiátricos. Revisar la pertinencia de las interconsultas realizadas a psiquiatría. Diseño Estudio descriptivo retrospectivo. Ámbito UCI del Hospital General del Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España. Pacientes Pacientes ingresados entre enero de 2016 y junio de 2018. Intervenciones Ninguna. Variables de interés principales Nivel de gravedad (APACHEII), motivo de ingreso, días de ingreso, días de ventilación mecánica, antecedentes psiquiátricos y motivo de interconsulta a psiquiatría. Resultados Se incluyeron 1.247 pacientes; 194 (15,5%) cumplían criterios de TM, siendo su media de edad más joven (59 vs 68, p<0,001) y con menor puntuación media en la escala APACHEII (12 vs 14, p≤0,003). Se realizaron 64 interconsultas a psiquiatría (5,1% de los ingresos), 59 de las cuales fueron en pacientes con TM (92,1%). En cuanto a los motivos de la interconsulta, el 22,6% fueron por intento autolítico, el 61,3% para ajuste farmacológico, el 11,3% para descartar TM y el 4,8% para valoración de competencia. La posibilidad de que se realizara una interconsulta estando indicada fue del 89,1%, mientras que la posibilidad de no realizarla no estando indicada fue del 99,4%. Conclusiones Este estudio respalda la necesidad de ampliar las recomendaciones específicas para realizar interconsulta a psiquiatría, más allá de la valoración tras intento autolítico, puesto que un gran porcentaje (77,5%) de las interconsultas pertinentes fueron por otros motivos (AU)

Objective To 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. Design Retrospective descriptive study. Setting ICU of the General Hospital of the Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain. Patients Patients admitted between January 2016 and June 2018. Interventions None. Main variables of interest Severity level (APACHEII), reason for admission, days of admission, days of mechanical ventilation, psychiatric history and reason for psychiatric consultation. Results A 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 APACHEII 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%. Conclusions This 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 (AU)

History of mental disorder in an ICU and referrals to psychiatry.

OBJECTIVE: To 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. DESIGN: Retrospective descriptive study. SETTING: ICU of the General Hospital of the Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain. PATIENTS: Patients admitted between January 2016 and June 2018. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Severity level (APACHE II), reason for admission, days of admission, days of mechanical ventilation, psychiatric history and reason for psychiatric consultation. RESULTS: A 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%. CONCLUSIONS: This 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.