Larry S. Goldman

Depression in Intensive Care Units

There is thought to be a high incidence of depression in intensive care units (ICUs), both as a result of the psychological toll of serious illness and threat to life as well as the physiologic derangements caused by illnesses and treatments. The authors outline a strategy to classify ICU depressions into major depressive illness, adjustment disorders, dysthymic disorder, or organic affective syndrome. Other psychiatric disturbances which may simulate depression are also discussed. A summary of environmental, behavioral, psychotherapeutic, and psychopharmacologic treatments for these disorders and their special application in the ICU setting is presented. The limitations and precautions with antidepressant drugs in this clinical site are reviewed.

Psychiatric Consultation in a Teaching Nursing Home

The first 60 psychiatric consultations provided to a university-affiliated teaching nursing home are reviewed. All patients seen had a diagnosable mental disorder, and over 40% suffered from major affective illness. Consultation resulted in a critical change in diagnosis and management in more than one-third of patients. The authors discuss the benefits and drawbacks of psychiatric consultation for nursing home patients, staff physicians, and the psychiatrists themselves.