Post-Intensive Care Psychological Survivorship across the Lifespan: Evaluating Current Theoretical Frameworks, Interventions, and Practice Models

Watch the accompanying interview to this session here: https://youtu.be/hwpcK51yEZY

Over half of intensive care unit (ICU) survivors will acquire Post-Intensive Care Syndrome (PICS) – downstream neuropsychiatric dysfunction, cognitive impairment, or physical weakness. These lasting, multifaceted complications are influenced by a multitude of factors across the trajectory of critical illness, including brain injury and delirium; and the shock, fear, and horror endured as part of the experience of intensive care (leading to post-traumatic stress, anxiety disorders, and depression) in patients and family members.

The high prevalence and significant functional impairment seen in PICS demands ongoing investigation and improvement with respect to best practices, and interventions to enhance survivorship and wellbeing across the lifespan. The course of critical illness and its aftermath involve many emerging opportunities for constructive intervention to reduce psychiatric morbidity. Consultation-Liaison (C-L) psychiatrists carry a mounting role within this multidisciplinary space of patient care. In this workshop, our panelists will present an overview of PICS with special attention to trauma-focused frameworks, non-pharmacologic interventions, and innovative practice models.

George Sayde, MD, MPH is a C-L psychiatry fellow at Columbia University. Dr. Sayde will discuss our emerging understanding of PICS, the identification of patients at highest risk, and long-term ICU-related psychological outcomes. He will provide a patient case vignette and introduce the format of this workshop.

Ewa Bieber, MD is a C-L psychiatrist at Ann and Robert H. Lurie Children’s Hospital of Chicago. Dr. Bieber will review the pediatric and family framework of PICS (PICS-p and PICS-f) through pre-recorded conversations with two, now-adult PICU survivors. She will discuss the impact of critical care illness on psychosocial development and family dynamics.

Kemuel Philbrick, MD serves as the medical director for the hospital psychiatry C-L service at Mayo Clinic, Rochester. Dr. Philbrick will discuss the theory and implementation of psychological support by positive suggestion (PSBPS) to ameliorate the consequences of PICS. As a co-investigator in a trial evaluating the efficacy of this psychological intervention, Dr. Philbrick will discuss how modifying the encoding of memory during the ICU experience by reframing can favorably shape the emotional imprint associated with traumatic experience.

Joseph Bienvenu, MD, PhD is the Judy Yin Shih, PhD Professor in Anxiety Disorders at Johns Hopkins. Dr. Bienvenu will discuss recently studied methods to improve depression, non-specific anxiety, and post-traumatic stress symptoms after critical illness. Specifically, he will discuss ICU follow-up clinics; diaries; telephone, computer, and app-based coping interventions; and virtual reality interventions; and the opportunity to incorporate these tools in psychotherapy. Dr. Bienvenu will briefly describe the interventions themselves as well as evidence supporting their utility.

Rachel Hammer, MD, MFA is an Assistant Professor of Psychiatry and Internal Medicine at Tulane University. In this final segment, Dr. Hammer will discuss how she has interwoven elements of Expressive Writing Therapy, Meaning-Centered Psychotherapy, and psychodynamic psychotherapy in her work with critical illness survivors at a Post-ICU clinic. Dr. Hammer will explore approaches for psychotherapists to engage with near-death survivors facing themes of loss, guilt, and grief – as patient and provider work together to uncover and integrate past experiences into imagined futures.