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Jim Jackson Profile picture
@DrJimJackson
Feb 5, 2023 • 7 tweets • 2 min read • Read on X
I often discuss Post Intensive Care Syndrome on Twitter - called "PICS" but what is it? Let's briefly unpack it in a 🧵 1/7
Coined by a thoughtful clinician, pioneering researcher, and winsome colleague @DrDaleNeedham in 2012 in an article that has been cited over 2,000 times. It refers to a condition that affects millions of survivors of critical illness/intensive care. @CIBScenter 2/7
PICS is a phenomenon in which individuals develop new or worsening symptoms/difficulties after the #ICU in one or more of 3 key domains - cognitive, psychological, physical. 3/7.
Cognitive problems include deficits in attention, executive functioning, language, all aspects of memory, processing speed, visuo-spatial construction, etc. Impacting 1 in 3 people. 4/7
Psychological problems include anxiety, claustrophobia, depression, OCD, psychosis, and PTSD. Impacting 1 in 3 people. 5/7
Physical problems include loss of strength, mobility problems, polyneuropathy, profound deconditioning, to name a few. Impacting 1 in 3 people. 6/7
PICS is surely one of the most prevalent conditions that many doctors have never heard of. You owe it to your patients to learn about this condition, which can be prevented, managed, and treated. @CIBScenter @WesElyMD 7/7

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More from @DrJimJackson

Jim Jackson Profile picture
Feb 4, 2023
🧵We often refer our patients for "neuropsychological" testing but what exactly is it, do you need it, and how does it add value? A thread. 1/10 @CIBScenter
Neuropsychological testing - also known as cognitive testing - aims to provide a comprehensive look at key areas of your cognitive functioning - aspects of your memory, attention, processing speed, executive functioning and more. It is a "deep dive." 2/10
Neuropsychological testing contrasts with cognitive screening (CS). Often 5 or 10 or so minutes in length. CS has a valuable place and a role to play but it provides a brief glimpse, has limitations especially in mild cases, and is not diagnostic. @CIBScenter 3/10
Read 9 tweets
Jim Jackson Profile picture
Feb 4, 2023
🧵We've been leading support groups for #ICU survivors for nearly 10 years (over 2 years with #LongCovid patients). Across literally thousands of patient encounters, what have we learned? I'll unpack these insights in tweets to follow. Thanks for reading them. @CIBScenter 1/10
To begin, the ROI for support groups is enormous- they require minimal expenses, utilize few resources, allow you to touch the lives of sometimes dozens of people at the same time, and contribute to changed lives. An inexpensive way to make a big impact. 2/10
They require competent leaders who understand group processes. You can find such people or you can become one but make sure that for at least one group leader, this is not their "first rodeo." We don't all have to be experts but we owe members that much. 3/10
Read 10 tweets
Jim Jackson Profile picture
Jan 31, 2023
PTSD is a common phenomenon in ICU survivors, impacting literally millions of people around the world, every year. What do we know about it? A 🧵 1/5
In the late 1990s, research on #PTSD after the #ICU first emerged, with early studies suggesting prevalence rates of 40 to 50 percent, far higher than in combat veterans and other high risk groups. Studies since then have documented rates of 10% to 20% - clearly a problem. 2/5
Risk factors for PTSD in ICU survivors vary but include female sex, young age, a history of delirium, and a history of psychiatric illness. The presence of delusional memories also plays a role. @CIBScenter 3/5
Read 5 tweets
Jim Jackson Profile picture
Jan 31, 2023
Today on FaceBook, an old post popped up from a decade ago . . . 25 random things about me. I'll share some of them here in a 🧵.
1. I wish that I had had the opportunity to meet Dan Fogelberg before he passed away some years ago . . . his music comforts me and makes me wistful and nostalgic, especially his poignant classic “Same Auld Lang Syne.” @DanFogelberg2
2. One of my favorite memories growing up – as funny as it may sound – was watching Georgia Championship Wrestling on Saturday afternoons with my little brother. @RicFlairNatrBoy
Read 11 tweets
Jim Jackson Profile picture
Jan 31, 2023
Executive dysfunction is common in survivors of #Covid_19 and #PICS but how is it expressed? Let's unpack the expressions of this condition in a 🧵. @CIBScenter @WesElyMD 1 of 5 Image
The 'sine qua non' of executive functioning is planning. Often measured using the WCST or the Tower Test. Deficts reflect an inability to formulate strategies, to take efficient routes, to anticipate needs in advance, to tackle problems systematically. @CIBScenter
Another key component is called "set shifting" - assessed on brief cognitive tests like the Trails B Test - it involves the ability to transition rapidly from one type of task to another, and then back again. Set shifting deficits interfere at home and work. @CIBScenter
Read 7 tweets
Jim Jackson Profile picture
Jan 30, 2023
Cognitive Impairment in survivors of #LongCovid: A 🧵. Before the pandemic, I worked with survivors of critical illness in clinical/research contexts at the @CIBScenter and @ICU_Recovery. Since 2020, I've focused on neuropsychological issues in #LongCovid. What have we learned?
"Brain fog" might better be called "brain injury" as the cognitive impairment that impacts many #longhaulers is like a brain injury in nature - it happens abruptly, impacts a wide array of cognitive domains, often is not progressive, and may respond to rehabilitation. @CIBScenter
Cognitive impairment after #Covid can be related to illness severity, yes, but that doesn't mean that people with mild illness don't grapple with impairment. Indeed, cognitive deficits can be very profound and persistent in those who were not terribly sick. @CIBScenter
Read 7 tweets

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