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      Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients

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          Abstract

          Introduction

          Critically ill patients who require intensive care unit (ICU) treatment may experience psychological distress with increasing development of psychological disorders and related morbidity. Our aim was to determine whether intra-ICU clinical psychologist interventions decrease the prevalence of anxiety, depression and posttraumatic stress disorder (PTSD) after 12 months from ICU discharge.

          Methods

          Our observational study included critical patients admitted before clinical psychologist intervention (control group) and patients who were involved in a clinical psychologist program (intervention group). The Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale-Revised questionnaires were used to assess the level of posttraumatic stress, anxiety and depression symptoms.

          Results

          The control and intervention groups showed similar demographic and clinical characteristics. Patients in the intervention group showed lower rates of anxiety (8.9% vs. 17.4%) and depression (6.5% vs. 12.8%) than the control group on the basis of HADS scores, even if the differences were not statistically significant. High risk for PTSD was significantly lower in patients receiving early clinical psychologist support than in the control group (21.1% vs. 57%; P < 0.0001). The percentage of patients who needed psychiatric medications at 12 months was significantly higher in the control group than in the patient group (41.7% vs. 8.1%; P < 0.0001).

          Conclusions

          Our results suggest that that early intra-ICU clinical psychologist intervention may help critically ill trauma patients recover from this stressful experience.

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          Most cited references13

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          Psychometric properties of the Impact of Event Scale - Revised.

          This study investigated the psychometric properties of the Impact of Event Scale -- Revised (IES-R) in two samples of male Vietnam veterans: a treatment-seeking sample with a confirmed posttraumatic stress disorder (PTSD) diagnosis (N = 120) and a community sample with varying levels of traumatic stress symptomatolgy (N = 154). The scale showed high internal consistency (alpha = 0.96). Confirmatory factor analysis did not provide support for a three-factor solution corresponding to the three subscales of intrusion, avoidance, and hyperarousal. Exploratory factor analysis suggested that either a single, or a two-factor solution (intrusion/hyperarousal and avoidance), provide the best account of date. However, correlations among the subscales were higher in the community sample than in the treatment sample, suggesting that the IES-R may be sensitive to a more general construct of traumatic stress in those with lower symptom levels. The correlation between the IES-R and the PTSD Checklist was high (0.84) and a cutoff of 1.5 (equivalent to a total score of 33) was found to provide the best diagnostic accuracy.
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            An overview of the injury severity score and the new injury severity score.

            The research was undertaken to describe the injury severity score (ISS) and the new injury severity score (NISS) and to illustrate their statistical properties. Descriptive analysis and assessment of the distribution of these scales. Three data sources--the National Pediatric Trauma Registry; the Massachusetts Uniform Hospital Discharge Data Set; and a trauma registry from an urban level I trauma center in Massachusetts--were used to describe the distribution of the ISS and NISS among injured patients. The ISS/NISS was found to have a positively skewed distribution and transformation did not improve their skewness. The findings suggest that for statistical or analytical purposes the ISS/ NISS should not be considered a continuous variable, particularly if ISS/NISS is treated as a continuous variable for correlation with an outcome measure.
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              Which instruments are most commonly used to assess traumatic event exposure and posttraumatic effects?: A survey of traumatic stress professionals.

              We report findings from a Web-based survey of the International Society for Traumatic Stress Studies' members (n = 227) regarding use of trauma exposure and posttraumatic assessment instruments. Across clinical and research settings, the most widely used tests included the Posttraumatic Stress Diagnostic Scale, Trauma Symptom Inventory, Life Events Checklist, Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale, PTSD Checklist, Impact of Event Scale-Revised, and Trauma Symptom Checklist for Children. Highest professional degree, time since degree award, and student status yielded no differences in extent of reported trauma assessment test use.
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                Author and article information

                Journal
                Crit Care
                Critical Care
                BioMed Central
                1364-8535
                1466-609X
                2011
                27 January 2011
                : 15
                : 1
                : R41
                Affiliations
                [1 ]Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy
                [2 ]Regional Referral Center on Critical Human Relations, Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy
                [3 ]Medical Director of Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy
                Article
                cc10003
                10.1186/cc10003
                3221970
                21272307
                c2f872e5-6233-443e-b532-cb526178957d
                Copyright ©2011 Peris et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 6 October 2010
                : 18 November 2010
                : 27 January 2011
                Categories
                Research

                Emergency medicine & Trauma
                Emergency medicine & Trauma

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