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The psychological scars of Intensive Care
  1. Dorothy Wade
  1. Consultant health psychologist at Royal Free London NHS Foundation Trust, UK


Dr Dorothy Wade is Consultant health psychologist at Royal Free London NHS Foundation Trust. She has a PhD in health psychology and healthcare evaluation from University College London, where she is an honorary associate professor. Her clinical and research area of expertise is in psychological risk factors, outcomes and interventions in Critical Care.

Abstract While more people survive critical illness now than ever before, their physical and psychological recovery is often poor. There is strong evidence that people suffer adverse psychological outcomes including anxiety, depression, posttraumatic stress disorder and cognitive impairment after an Intensive Care admission.

Risk factors for adverse psychological outcomes include acute stress, delirium and delusional memories of the Intensive Care Unit (ICU). About half of patients suffer acute stress in the ICU. They may be in pain and undergo repeated invasive clinical interventions. The environment can be harsh, clinical and badly-lit. ICUs are frequently noisy and overcrowded, with patients and upset, grieving families in close proximity to each other. In addition, most patients become delirious, acutely confused and experience terrifying, long-lasting hallucinations and delusions.

In the past decade clinical health psychologists have become increasingly involved in supporting patients clinically in the ICU, and in research to develop and evaluate psychological interventions. Clinically they have a role in psychological assessment and care of patients along the pathway from ICU admission to follow-up reviews around 3 months post ICU-discharge. Current research includes a self-management intervention to reduce anxiety, and psychology-led support to reduce delirium-related distress in the ICU.

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