Psychische Störungen bei Intensivpatienten

Epidemiology of psychiatric medication use in patients recovering from critical illness at a long-term acute-care facility.

Weinert CR.                                                                                                                                                                               Chest 2001; 119:547-53

Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.

STUDY OBJECTIVES: To describe the pharmacoepidemiology of psychotropic medication prescription in patients recovering from life-threatening medical and surgical illness.
DESIGN: Retrospective analysis of a random sample of medical records.
SETTING: Regional referral center.
PATIENTS: Eighty-nine randomly selected patients transferred from an ICU to the study facility.
INTERVENTIONS: None.
MEASUREMENTS AND RESULTS: Patients had been treated at the referring ICU for 33 +/- 24 days (mean +/- SD) and remained at the study hospital for 64 +/- 52 days. Most of the patients had prolonged respiratory failure. Nearly half of the patients (47%) received an antidepressant medication while at the facility, and 48% received at least one dose of a benzodiazepine on the first day after transfer. In the sample of 75 patients not prescribed an antidepressant before transfer, 37% were started on therapy with an agent, usually within 3 weeks and predominantly in the selective serotonin reuptake inhibitor or psychostimulant class. Younger patients and those evaluated by a mental health specialist were more likely to be prescribed an antidepressant, compared to other patients. Forty percent of patients were still receiving at least one dose of a benzodiazepine in a 24-h period after their third week at the facility.
CONCLUSIONS: Although the efficacy of antidepressant pharmacotherapy in patients with comparable severity of medical illness has not been established, a substantial proportion of patients recovering from critical illness at a specialized facility are prescribed antidepressant medications. Benzodiazepine exposure is frequent after transfer, and the prevalence in patients who remain at the facility minimally decreases over time.