Psychological Rehabilitation

Intensive Care Follow-up Clinics

Some critical care units have follow-up clinics that allow patients to discuss their progress after discharge from hospital and more units are setting these up. Follow-up clinics allow the patient to talk with staff and come to terms with having been in ICU, understand the procedures that they underwent and generally fill in the gaps that the sedation and medication will inevitably have left. Most units can provide specific information regarding issues related to critical illness and its consequences.

Changes in mood

Many patients complain of fluctuating moods, one day up, the next feeling very down. This is a normal reaction to illness and will lessen with time. If the patient has been very seriously ill, or ill for a long time, they may find that you are quite depressed for a while. Sometimes, it may seem that they will never get back to normal and that any progress you make is unbearably slow. The up and down struggle to recover physical strength in itself can be discouraging.

It is important to be realistic about what they will be able to do for themselves. Patients should gradually take on the activities that they did before you became ill and set attainable targets to help build up their confidence. Targets that are too difficult to reach should not be set as they may feel as though they have failed. Ask the nurses, doctors and physiotherapists what can be reasonably expected and try to be patient when setbacks occur. It is also important to involve family and friends in setting the targets or goals, because they will often be the people who are best able to monitor progress and give encouragement.

Family and relationships

Family and friends are obviously delighted that their loved one is getting better, but they may be overprotective and not let them do as much as they feel able to do. It has been a worrying time for them too, so talking over what has happened and sharing your worries will help you to work together towards your recovery.

The old adage 'a little of what you fancy does you good' is particularly true for sex during recovery from illness. The patient's illness may have reduced their sex drive and it is possible that either you or your partner is concerned that sex could be harmful. This is rarely the case, but as with other forms of exercise, you should do as much as feels comfortable. You will be able to return to your normal relationship, but recognise this may take some time and patience from both of you.

Stress

The period of recovery after a critical illness can be stressful. The degree of stress and how long it lasts varies. Previous sections discuss some of the symptoms that may be related to stress, such as disturbed sleep, loss of appetite, moods or depression, and problems with family relationships.

Recovering from a stressful event takes time. If at the end of each week you can look back and say that overall things were better than the previous week, then you are making good progress. However, if you feel that you are making no progress, you may wish to make use of the advice offered through the ICU follow-up service, your GP or one of the organisations listed in the further information page.

Post-traumatic stress disorder

Some patients do experience severe symptoms of stress following their ICU treatment. This is known as post-traumatic stress disorder (PTSD). It does get better over time and most sufferers have found that counselling is of great value. A counselling service should be sought through the follow-up service of your local hospital or your GP.

PTSD occurs after a traumatic event, such as critical illness, and is made up of three sets of symptoms:

Re-experiencing memories from the event through flashbacks or nightmares - for patients recovering from illness, these memories may commonly be of delusional events such as hallucinations or feelings that people were trying to hurt them while they were ill.
Avoiding reminders of the traumatic event such as not wanting to go back to the hospital for outpatient appointments or not being able to watch medical programmes on TV,
being unable to settle, feeling restless, being easily startled and not being able to sleep.
Having all of these symptoms does not necessarily mean that the sufferer has PTSD but help from a clinical psychologist should be sought through their GP or follow-up service to assess and treat this.

Patients will have some of the symptoms when they first go home but, on the whole, this settles down over the month after leaving hospital. If you find that you have PTSD symptoms and they are not settling down, or they are very difficult to cope with, then you should seek advice from your Primary Care doctor (GP) or the critical care unit follow-up clinic, where available.