Synopsis
Integrate psychiatric and physical assessment during acute illness, protect continuity of essential treatment and identify psychological and cognitive needs throughout recovery from critical care.
- Mental illness and acute physical illness require joint care; psychiatric history must not lower the standard of physical assessment.
- New inattention or fluctuating consciousness is a possible delirium syndrome even when a patient already has psychosis or dementia.
- Reconcile psychotropic medicines, actual last doses, depot dates, dependence-forming drugs and over-the-counter products early.
- Acute infection, renal or hepatic dysfunction, smoking changes and interacting prescriptions can turn a stable psychotropic regimen into a toxic one.
- Distinguish understandable fear and transient distress from persistent depressive, trauma-related, psychotic or catatonic syndromes.
- Support communication for intubated, sensory-impaired or fatigued patients and assess capacity for each relevant decision.
- Plan rehabilitation across critical care, the ward and discharge, including cognitive, psychological, family and practical needs.
Key red flags
Fever with rigidity, clonus, a falling level of consciousness or autonomic instability requires urgent assessment for toxicological syndromes, infection and neurological disease.
Clozapine treatment interrupted for more than forty-eight hours must not be restarted at the previous maintenance dose; arrange specialist retitration.
Investigation priorities
Separate baseline mental illness from changes linked to the admission, treatment and recovery.
Management branches
A patient with mental illness or psychotropic treatment is admitted to a medical or critical-care service.
- Document usual function, essential treatment, contact details and reasonable adjustments, obtaining collateral information and pharmacy input early.
- Review immediate medical threats, delirium, withdrawal and self-harm risk, with a named clinician responsible for each active problem.
- Decide explicitly which medicines continue, pause or require an alternative route, and specify review, monitoring and restart criteria in the record.
Key medicines
Clozapine after a treatment interruptionWhen more than two days have elapsed since the last Clozaril dose, the cited UK SmPC requires re-initiation at 12.5 mg orally once or twice on the first day, followed by specialist-directed retitration according to tolerance and the clinical situation.Contact the treating clozapine team and monitoring service, confirm blood monitoring and supply, and assess infection, smoking change, hypotension, sedation and interactions. A prior history of serious cardiorespiratory reactions requires particular caution.