Psychiatric Symptoms

Consult requests in pediatric critical care settings often concern psychiatric symptomatology, including depression, anxiety, substance abuse, and suicidal ideation or intent, and externalizing behavior problems that may interfere with treatment. Rates of anxiety, depression, and somatic symptoms in PICU patients have been found to be at least comparable to those observed in children hospitalized in general pediatric wards (Rees et al. 2004). As in other pediatric settings, prompt and thorough evaluation is needed to clarify the nature of the symptoms (e.g., whether depressive symptoms reflect a primary mood disorder; are caused by a medical condition or its treatment; or are best conceptualized as an adjustment reaction to injury, illness, or treatment-related factors), generate a working formulation, and guide recommendations and interventions (Shaw and DeMaso 2006). In the case of accidental overdoses, thorough assessment is warranted regarding the circumstances contributing to the ingestion and any ongoing risk potential; the psychiatric consultant often collaborates closely with social work and/or child protection colleagues. In such cases, the consultant may also be asked to assist with disposition planning.

The consultant may also be called regarding management of preexisting psychiatric symptomatology that is unrelated to the medical condition for which the child is hospitalized yet warrants clinical attention in the context of the child's illness. For exam ple, staff may solicit input regarding management of a patient who, at baseline, carries a diagnosis of autism and often exhibits self-injurious behavior and who might have particular difficulties in the PICU with sensory stimuli such as vital sign leads and noisy medical equipment. In such situations, the psychiatric consultant may speak with the patient and/or family about strategies and supports that have been effective in other settings and may provide staff with psychoeducation and guidance for managing behaviors that might interfere with optimal medical care and practice.

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