Implicit Emotional Memory and Post Traumatic Stress in Adult ICU Patients

Part One: Literature Review: Purpose: Treatment in an ICU is a psychologically traumatic event yet it is unclear what factors independently or cumulatively lead to PTSD in some patients. Method: Electronic databases were searched for articles published between 1960 and 2013. 21 articles were reviewed. Results: The institution that is ICU and memories of the experience contributes to the development of PTSD; however, ecological validity was compromised in many studies. Conclusion: Memory of ICU in PTSD development warrants further exploration. Part Two: Research Report: Introduction: ICU care can result in PTSD, with memories disrupted by sedative and/or analgesic drugs. We examine if a trigger for PTSD flashbacks is an emotionally salient sensory stimulus that occurred whilst sedated. Method: 24 general ICU patients were screened at 1-2 weeks and 4-5 weeks post ICU with commonly used screening tools (PTSS-14, HADS, ICUMT). Skin conductance responses to ICU and other sounds measured implicit memory. Patients’ relatives (n=15) and a non-clinical sample (n=35) also participated. Results: A mixed ANOVA failed to find a significant difference within groups, but did find between group differences F(2,69) = 6.82, p < .05. Positive correlations approaching significance were found for sedation and analgesia with delusional and factual memories. A trend was found for ICU sounds and PTSS. Nine patients reached caseness on the HADS subscales and/or PTSS-14. Conclusion: Replication in a larger sample, ICU-specific screening tools, and intra-ICU and follow up psychological support is recommended. Part Three: Critical Appraisal: Appraisal of the research process was undertaken. Reflections on conducting an independent research project are presented, and learning points highlighted. Part Four: Service Evaluation: A community tenancy of an adult with extremely challenging behaviour was evaluated using a single case study design. The intervention was the package of care. Over time, the frequency and duration of challenging behaviour decreased, tactile and play behaviours increased, and antipsychotic medication significantly reduced. Suggestions for service improvement were made.