Psychotherapy & Liaison
The patient’s emotional response to acute medical illness in the modern hospital environment can evoke feelings of fear, helplessness, and hopelessness and is often further complicated by delirium-related phenomena, which include disorientation, impaired perceptions, and impaired interpretation of external stimuli. Furthermore, the intense psychological distress from prolonged critical illness can be substantial and long-lasting, persisting well into the post-hospitalization period.
As consult psychiatrists we often bear witness to how the complex display of raw emotions, misperceptions, and primitive coping skills from a disinhibited and often regressed medically ill patient can be incredibly disruptive and ultimately impede the provision of appropriate medical care. Many consultants struggle to find an appropriate psychological framework for identifying the patient’s core distress, allowing for targeted intervention, let alone guiding the medical team in thoughtful management of the patient’s behavior.
During this interactive workshop, we will review normal and pathologic emotional responses to medical illness and particularly the negative psychological effects of delirium. Considering a psychodynamic model of developmental level (from psychotic to neurotic) as well as key character traits drawn from the patient’s history and current presentation, we will demonstrate how to draw a simple formulation of the patient’s key psychic conflict and design an appropriate psychological intervention. Additionally, considering the psychological repercussions following acute critical illness, we will review strategies (ie. ICU diaries) for helping patients process their illness experience and thereby mediate post-ICU anxiety and depressive symptoms.
This session is designed for both novice and experienced consultation psychiatrists interested in the psychic distress of the medically ill patient and in designing psychotherapeutically-minded interventions. This Psychological Considerations SIG-sponsored general session will consist of a lead presentation (20min) with small group activity (10 minutes), followed by 2 additional presentations (20 min each) with subsequent large group discussion incorporating an electronic audience response system.
Dr. Katy LaLone and Dr. Joshua Leo will outline the normative response to medical illness, correlate this to the psychodynamic developmental model, and then demonstrate how to design interventions based on individual character traits and by developmental level. This presentation will be followed by a small group activity in which participants will be able to practice utilizing this model on a case example.
Dr. JJ Rasimas will review the pathologic emotional responses to medical illness with a focus on the negative psychological effects and lasting consequences of delirium from his own experiences and drawing from the current literature.
Dr. O. Joseph Bienvenue will describe the rationale for use of ICU diaries and discuss the results of implementing these tools at Johns Hopkins. He will also serve as the expert discussant during periods of large group discussion.