Prevalence, detection and treatment of anxiety, depression, and delirium in the adult critical care unit

This study assesses the levels of depression, anxiety, and delirium during admission to three adult critical care units (CCU) and the performance of C CU staff with respect to detection and treatment. During a 1-month period, 96 consecutive patients were evaluated on the first day of admission by an independent rater, using the Hospital Anxiety Depression Scale and the Conf usional Assessment Method. Frequency of alcohol use and demographic data we re recorded. CCU teams rarely made diagnoses of anxiety, depression, or del irium. On at least one screening test, 29.2% of patients were positive. Del irium was present in 7.3%, depression in 13.7%, anxiety in 24%, and possibl e problem drinking in 37.9%. Although some form of psychiatric treatment wa s offered to 58%, there was low agreement between psychiatric diagnoses mad e by the independent rater and the diagnoses made and treatments used by CC U staff. This suggests that the CCU staff are using psychotropic medication s without any clear documentation and perhaps clear understanding of the ps ychiatric diagnoses they are treating. In summary, we found high rates of p sychiatric disorders in adult CCU patients but low rates of detection and o nly moderate rates of treatment by CCU staff.