Severe complications of psychiatric disorders: a clinical profile of patients requiring intensive care transfer

Abstract

Mental disorders can evolve unpredictably, generating both psychological and somatic complications that require emergency intervention and transfer to intensive care (ICU). Although hospitalization of psychiatric patients in ICUs remains relatively rare, it indicates an extreme form of decompensation. Assessment of clinical characteristics and causes that resulted in patients with mental disorders being transferred to the ICU section after initially being hospitalized in psychiatric wards. A retrospective study was conducted throughout the year 2025 at the IMSP Clinical Psychiatric Hospital. The study included all patients transferred from psychiatric wards to the ICU during this period. Data were collected on psychiatric diagnoses, reasons for ICU transfer, administered pharmacological treatments, and somatic comorbidities. The cohort included patients aged 13 to 90 years, children (<18 years): 2- (2.0%), women: 57- (57.0%), men: 43- (43.0%); 47% being repeat admissions. The most common psychiatric diagnoses were paranoid schizophrenia (61.7%), dementia (17%) and organic delusional disorder (6.4%). Somatic comorbidities were identified in 72.3% of cases, including ischemic cardiomyopathy, MODS, infections, and metabolic disorders. In 27.7% of patients, transfer was prompted by severe psychiatric complications, such as life-threatening behavioral syndromes, catatonia, or critical refusal of food intake. The ICU mortality rate was 9.6%. Admission to the ICU reflects the severity of the decompensation of mental disorders and the complexity of associated somatic complications. Continuous evaluation and interdisciplinary collaboration are critical for early risk identification and individualized therapeutic management.