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Joint Paediatric and Psychiatric Follow-Up for Families following Paediatric Intensive Care Unit Admission: An Exploratory Study

DOI: 10.1155/2014/897627

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Abstract:

Psychopathology in parents and children is increased after Paediatric Intensive Care Unit (PICU) admission; few studies have evaluated interventions to reduce this. Objective. Evaluation of the feasibility of setting up a joint paediatric and psychiatric follow-up clinic for families after PICU discharge. Design. Feasibility study offering joint follow-up with a consultant paediatric intensivist and child and adolescent psychiatrist. Setting. Paediatric outpatient clinic in a university teaching hospital with a PICU. Patients. Children and their families discharged from PICU. Interventions. Outpatient appointment focussing on physical and psychological health; psychoeducation about emotional and behavioural difficulties occurring after PICU discharge, advice for parents about supporting their child’s psychological recovery, screening for more severe psychiatric disorders, and provision of a leaflet outlining possible difficulties and management strategies. Measurements. Attendance, content of discussion, psychiatric questionnaires, and family feedback. Main Results. It proved feasible to set up follow-up appointments to address physical and psychological health concerns; 4/12(33%) eligible families attended. Children and mothers who attended all reported child difficulties including sleep disturbance, increased anxiety, and PTSD symptoms in children and parents. Conclusions. Follow-up clinics after PICU discharge are feasible to set up; take-up is poor but families attending report psychopathology which may be addressed through the intervention. 1. Introduction There is accumulating evidence of increased risk of psychopathology, particularly but not exclusively posttraumatic stress disorder (PTSD), in children and parents following PICU admission [1–6]. Critical illness impacts on parenting [3, 7] and parental PTSD is associated with poorer psychological recovery in the child [8]. Although National Institute for Clinical Excellence (NICE) Guidelines [9] advocate continued monitoring and support of patients and families after intensive care treatment, follow-up is infrequent [10]. Mothers favour follow-up by the PICU team to talk through the admission and believe that this may be psychologically beneficial [11]. However, little work has evaluated the effectiveness of psychological interventions. An American randomised controlled study demonstrated the effectiveness of a combination of psychoeducation for mothers during the child’s admission and parental activities with their children to help them make sense of their experience, in improving maternal

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