title: The spectrum of psychocognitive morbidity in the critically ill: a review of the literature and call for improvement.
abstract: OBJECTIVE
  The objective of the study is to review the cognitive and psychiatric dysfunction experienced by critically ill patients during and after hospitalization.
  
  
  METHODS
  A structured PubMed search identified studies and reports in English pertaining to intensive care unit (ICU)-related cognitive and psychological dysfunction, known risk factors, and treatment modalities.
  
  
  RESULTS
  This article summarizes recent literature on psychological sequelae experienced by critically ill patients including delirium, cognitive impairment, acute stress disorder, posttraumatic stress disorder, anxiety, and depression. Known risk factors for cognitive dysfunction and psychological trauma are discussed, encompassing clinical, demographic, socioeconomic, and psychiatric domains as well as the memories of the ICU stay. Specific treatment and prevention modalities are discussed including post-ICU physical rehabilitation and psychotherapeutic interventions as well as interventions available to patients still in the ICU, including early mobilization, minimization of sedation, improved sleep hygiene, and available psychological interventions.
  
  
  CONCLUSIONS
  We propose a paradigm change highlighting the need for interventions focused on early psychological support applied in parallel with stabilization of physiologic status in the ICU.
authors.affiliation: Mayo Clinic, Division of Pulmonary & Critical Care Medicine, Rochester, MN 55905 USA. Electronic address: karnatovskaia.lioudmila@mayo.edu.
authors.forename: Lioudmila V
authors.initials: LV
authors.lastname: Karnatovskaia
authors.affiliation: Mayo Clinic, Division of Pulmonary & Critical Care Medicine, Jacksonville, FL 32224 USA. Electronic address: johnson.margaret2@mayo.edu.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Johnson
authors.affiliation: Mayo Clinic, Division of Pulmonary & Critical Care Medicine, Rochester, MN 55905 USA. Electronic address: benzo.roberto@mayo.edu.
authors.forename: Roberto P
authors.initials: RP
authors.lastname: Benzo
authors.affiliation: Mayo Clinic, Division of Pulmonary & Critical Care Medicine, Rochester, MN 55905 USA. Electronic address: gajic.ognjen@mayo.edu.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D000208:Acute Disease; D001007:Anxiety / Q000209:etiology / Q000628:therapy; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy; D016638:Critical Illness / Q000523:psychology*; D003693:Delirium / Q000209:etiology / Q000628:therapy; D003863:Depression / Q000209:etiology / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D009017:Morbidity; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000628:therapy
keywords: Anxiety; Critical illness; Depression; Post-ICU syndrome; Post-traumatic stress disorder; Psychological trauma