Dorothy Wade

Intrusive memories of hallucinations and delusions in traumatized intensive care patients: An interview study

OBJECTIVE Psychological morbidity, including post-traumatic stress disorder (PTSD), is common in survivors of intensive care. Intrusive memories of trauma are important symptoms of PTSD. Research has not established which aspects of intensive care are most traumatizing; invasive medical procedures, fear of dying from life-threatening illness or injury, or effects of psychoactive drugs, including hallucinations and delusions. Our study aimed to investigate the roots of post-intensive care trauma by interviewing survivors with symptoms of PTSD. Were their intrusive memories primarily of real events or hallucinations and delusions from intensive care? DESIGN Interview study as part of a mixed-methods investigation of psychological outcomes post-intensive care. METHODS We used purposive sampling to identify patients with intrusive memories of intensive care unit. Detailed interviews were conducted to investigate the nature and content of post-intensive care memories. Intrusive memories were categorized as factual, hallucinatory/delusional, or uncertain. RESULTS Thematic saturation was achieved after 17 interviews. Approximately 70% (12/17) of patients had hallucinatory/delusional intrusive memories of intensive care, while 12% (2/17) had factual but no hallucinatory/delusional memories; 18% (3) were uncertain whether memories were factual or hallucinatory/delusional. Further analysis suggested that 88% of all patients had hallucinatory/delusional intrusive memories. The content of intrusive memories commonly merged realistic events (involving intensive care staff, environment, medical procedures and unpleasant physical experiences) with delusions and frightening hallucinations. CONCLUSIONS We found that patients in this in-depth study were more traumatized by frightening hallucinations/delusions than real events, suggesting they may have post-psychosis PTSD, rather than classic PTSD. Interventions are needed to diagnose and treat intensive care hallucinations/delusions, or minimize effects, to prevent PTSD.

Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients (POPPI): protocol for a cluster-randomised clinical trial of a complex intervention.

Introduction Acute psychological stress, as well as unusual experiences including hallucinations and delusions, are common in critical care unit patients and have been linked to post-critical care psychological morbidity such as post-traumatic stress disorder (PTSD), depression and anxiety. Little high-quality research has been conducted to evaluate psychological interventions that could alleviate longer-term psychological morbidity in the critical care unit setting. Our research team developed and piloted a nurse-led psychological intervention, aimed at reducing patient-reported PTSD symptom severity and other adverse psychological outcomes at 6 months, for evaluation in the POPPI trial. Methods and analysis This is a multicentre, parallel group, cluster-randomised clinical trial with a staggered roll-out of the intervention. The trial is being carried out at 24 (12 intervention, 12 control) NHS adult, general, critical care units in the UK and is evaluating the clinical effectiveness and cost-effectiveness of a nurse-led preventative psychological intervention in reducing patient-reported PTSD symptom severity and other psychological morbidity at 6 months. All sites deliver usual care for 5 months (baseline period). Intervention group sites are then trained to carry out the POPPI intervention, and transition to delivering the intervention for the rest of the recruitment period. Control group sites deliver usual care for the duration of the recruitment period. The trial also includes a process evaluation conducted independently of the trial team. Ethics and dissemination This protocol was reviewed and approved by the National Research Ethics Service South Central - Oxford B Research Ethics Committee (reference: 15/SC/0287). The first patient was recruited in September 2015 and results will be disseminated in 2018. The results will be presented at national and international conferences and published in peer reviewed medical journals. Trial registration number ISRCTN53448131; Pre-results.

Psychological outcomes following a nurse-led preventative psychological intervention for critically ill patients trial: Statistical and health economic analysis plan:

The Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients trial is a cluster-randomised controlled trial of the clinical and cost-effectiveness of a complex nurse-led preventative psychological intervention compared with usual care in reducing patient-reported post-traumatic stress disorder symptom severity, and other reported psychological morbidities, at six months among Level 3 (intensive care) patients in adult general critical care units in England, Wales and Northern Ireland. This paper describes the proposed statistical and health economic analyses for the Psychological Outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients trial. It is important to complete and publish this plan before inspecting and locking the trial data to ensure that post hoc and data-derived decisions are avoided. Trial registration: ISRCTN53448131

Providing psychological support to people in intensive care: development and feasibility study of a nurse-led intervention to prevent acute stress and long-term morbidity

Objectives Adverse psychological outcomes, following stressful experiences in critical care, affect up to 50% of patients. We aimed to develop and test the feasibility of a psychological intervention to reduce acute stress and prevent future morbidity. Design A mixed-methods intervention development study, using two stages of the UK Medical Research Council framework for developing and testing complex interventions. Stage one (development) involved identifying an evidence base for the intervention, developing a theoretical understanding of likely processes of change and modelling change processes and outcomes. Stage two comprised two linked feasibility studies. Setting Four UK general adult critical care units. Participants Stage one: former and current patients, and psychology, nursing and education experts. Stage two: current patients and staff. Outcomes Feasibility and acceptability to staff and patients of content and delivery of a psychological intervention, assessed using quantitative and qualitative data. Estimated recruitment and retention rates for a clinical trial. Results Building on prior work, we standardised the preventative, nurse-led Provision Of Psychological support to People in Intensive Care (POPPI) intervention. We devised courses and materials to train staff to create a therapeutic environment, to identify patients with acute stress and to deliver three stress support sessions and a relaxation and recovery programme to them. 127 awake, orientated patients took part in an intervention feasibility study in two hospitals. Patient and staff data indicated the complex intervention was feasible and acceptable. Feedback was used to refine the intervention. 86 different patients entered a separate trial procedures study in two other hospitals, of which 66 (80% of surviving patients) completed questionnaires on post-traumatic stress, depression and health 5 months after recruitment. Conclusion The ‘POPPI’ psychological intervention to reduce acute patient stress in critical care and prevent future psychological morbidity was feasible and acceptable. It was refined for evaluation in a cluster randomised clinical trial. Trial registration number ISRCTN61088114; Results.