INTRODUCTION: A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU stay. This study addresses the following questions. What is the incidence of discomfort reported by patients recently discharged from an ICU? What were the sources of discomfort reported? What was the degree of factual recollection during patients' stay in the ICU? Finally, was discomfort reported more often in patients with good factual recollection?METHODS: All ICU patients older than 18 years who had needed prolonged (>24 hour) admission with tracheal intubation and mechanical ventilation were consecutively included. Within three days after discharge from the ICU, a structured, in-person interview was conducted with each individual patient. All patients were asked to complete a questionnaire consisting of 14 questions specifically concerning the environment of the ICU they had stayed in. Furthermore, they were asked whether they remembered any discomfort during their stay; if they did then they were asked to specify which sources of discomfort they could recall. A reference group of surgical ward patients, matched by sex and age to the ICU group, was studied to validate the questionnaire.RESULTS: A total of 125 patients discharged from the ICU were included in this study. Data for 123 ICU patients and 48 surgical ward patients were analyzed. The prevalence of recollection of any type of discomfort in the ICU patients was 54% (n = 66). These 66 patients were asked to identify the sources of discomfort, and presence of an endotracheal tube, hallucinations and medical activities were identified as such sources. The median (min-max) score for factual recollection in the ICU patients was 15 (0-28). The median (min-max) score for factual recollection in the reference group was 25 (19-28). Analysis revealed that discomfort was positively related to factual recollection (odds ratio 1.1; P < 0.001), especially discomfort caused by the presence of an endotracheal tube, medical activities and noise. Hallucinations were reported more often with increasing age. Pain as a source of discomfort was predominantly reported by younger patients.CONCLUSION: Among postdischarge ICU patients, 54% recalled discomfort. However, memory was often impaired: the median factual recollection score of ICU patients was significantly lower than that of matched control patients. The presence of an endotracheal tube, hallucinations and medical activities were most frequently reported as sources of discomfort. Patients with a higher factual recollection score were at greater risk for remembering the stressful presence of an endotracheal tube, medical activities and noise. Younger patients were more likely to report pain as a source of discomfort.
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Menschen mit einer psychotischen Störung haben häufig ein negatives Selbstbild und damit ein geringes Selbstwertgefühl. Untersuchungen haben auch gezeigt, dass Paranoia direkt mit negativen Vorstellungen über das Selbst zusammenhängen kann. Sich minderwertig zu fühlen und an Paranoia zu leiden, kann zu Verletzlichkeit und Aggression führen. In der forensischen Psychiatrie gibt es eine Kategorie stationärer Patienten mit einer psychotischen Erkrankung und Paranoia. Diese Patienten leiden schwer unter ihrer Störung, die obendrein ein Prädiktor für einen ungünstigen Behandlungsverlauf ist und eine lange Verweildauer innerhalb der (forensischen) Psychiatrie nach sich zieht. In einer randomisierten kontrollierten Studie wird die Wirksamkeit des Competitive Memory Training (COMET), eines kognitiv-verhaltenstherapeutischen Behandlungsprogramms zur Verbesserung des Selbstbildes bei in der Forensik untergebrachten psychotischen Patienten, die ebenfalls an Paranoia leiden, evaluiert und untersucht, ob ein positiveres Selbstbild auch zur Verringerung der Paranoia dieser Patienten führt. Die an einer kleinen Stichprobe durchgeführte Studie ergab eine signifikante Verbesserung des Selbstwertgefühls, aber keine Verringerung der Paranoia bei den Patienten, die an COMET teilnahmen.
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Humans use metaphors in thinking. Most metaphors are visual. In processing information stimuli the mind depends partly on visual codes. Information is processed and stored through two channels: one for non-verbal information and another for verbal information. The two different areas of information in the brain are interconnected. The information is stored in patterns that form an inner representation of how individuals perceive their reality and their self. The active processing of new information, remembering and the self-image are related phenomena, that influence each other, sometimes leading to biased interpretation or even reconstruction of contents in each of these areas. Imagination, expectations and anticipations of the future and memories are the more active manifestations of this process. In this process mimesis plays an important role. Mimesis is the imitation of reality in play, story-telling or creating images of how things should look like in the future. Through mimesis people can anticipate on roles in social life, or appropriate experiences from someone else and relate them to one’s own life story. When this happens the information is related to the self through processes of association and becomes ‘Erfahrung’.
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