ICU trauma probe: Psychiatrist studies triggers of mental illness in patients
Psychiatrists call it post-ICU syndrome, or the development of mental illness after admission to an intensive care unit, which is common in patients around the world.
“In addition to the experience of going into ICU, SA patients live in a society with high levels of crime and trauma and many of us have symptoms of post-traumatic stress disorder (PTSD),” said Dr Sarah Boshoff, a psychiatry registrar studying the triggers of PTSD in ICUs.
Boshoff is involved in research that stems from a larger cohort study which Dr Elizabeth van der Merwe is conducting at Livingstone Hospital in Port Elizabeth.
She has received a Rural Individual Award from the Discovery Foundation to cover the costs of the study, which she is completing as part of her MMed degree.
“I am looking at the impact of an ICU admission on a patient’s mental health by identifying experiences (shared and contrasting) among critical care survivors who have gone on to develop PTSD,” she said.
Boshoff attended Pearson High School in Port Elizabeth and studied medicine at the University of Cape Town.
“I have worked in Johannesburg but have found my way back to PE, first to work back my [Eastern Cape department of health] bursary and now to specialise in psychiatry at Dora Nginza Hospital through Walter Sisulu University,” she said.
“Doctors don’t always have the time to really talk to their patients to find out more about their life stories,” she said.
“As a psychiatry registrar, that is part of my job and I really enjoy it.
“The study involves interviewing patients who developed PTSD after being admitted to ICU,” she said.
“The aim is to identify shared experiences that can be used to recognise possible triggers during an intensive care admission.
“These triggers can have adverse mental health effects and contribute toward the development of PTSD.”
She said post-intensive care syndrome (post-ICU syndrome or Pics) has been defined as new or worsened impairments in physical, cognitive, and/or psychological health which persist after discharge from an intensive care unit..
One of the difficulties she finds in her work is that people sometimes cannot admit they are suffering from mental health problems, and this prevents them from accessing treatment.
“It’s not that we are more resilient as a nation. Avoidance can be part of the problem of dealing with mental health issues,” she said.
About 10% of patients admitted to ICUs for critical care develop some form of PTSD, according to the National Institutes of Health.
Interviews with patients are a big part of her research. There is sometimes a language barrier, and she has to use the services of a translator.
Many patients do not remember what they went through in the ICU, and sometimes Boshoff has to rely on staff and families to fill in the gaps.
Patients are often sedated, or they do not have a clear understanding of the procedures they went through, which can worsen the problem.
Where possible, she encourages patients to keep an ICU diary.