Integrating ICU and Internal Medicine Experience to Enhance Psychiatric Care
Written by: Ashley Hughes, PMHNP-FNP
Psychiatric Mental Health Nurse Practitioner and Family Nurse Practitioner
Mental health care often requires a broad and nuanced understanding of a patient’s overall health. As a psychiatric nurse practitioner with a background in intensive care unit (ICU) and internal medicine, I bring a unique perspective to psychiatric care. This experience allows me to consider the complex interplay between physical health and mental well-being, especially in patients with chronic conditions. In this post, I will explain how my medical background shapes my psychiatric approach, why initial visits are longer and more detailed, and how addressing root causes can improve patient outcomes.
ICU and Internal Medicine Experience to Enhance Psychiatric Care
Working both in the ICU and working as a Family Nurse Practitioner in internal medicine exposes clinicians to patients with severe, complex medical conditions. This experience builds a deep understanding of how physical illnesses can influence mental health. For example, chronic pain, inflammation, or metabolic imbalances often worsen symptoms of anxiety, depression, or cognitive dysfunction.
In psychiatric care, this means:
Recognizing medical contributors to psychiatric symptoms rather than attributing everything to mental illness alone.
Understanding how medications for chronic diseases might interact with psychiatric treatments.
Identifying when physical symptoms mimic or worsen mental health conditions.
This background helps me approach each patient holistically, considering both mind and body in diagnosis and treatment.
The Importance of Prolonged Initial Visits
Many psychiatric practices schedule brief initial appointments, but I dedicate more time to these first visits. This approach allows me to:
Explore the full history of physical and mental health.
Discuss lifestyle factors such as sleep, diet, exercise, and stress.
Review past medical records and treatments.
Identify potential root causes of symptoms, including undiagnosed medical issues.
For example, a patient with chronic fatigue and depression might have an underlying thyroid disorder or vitamin deficiency. Without a thorough evaluation, these conditions could be missed, leading to ineffective psychiatric treatment.
Evaluating Root Causes of Psychiatric Symptoms
Mental health symptoms often have multiple contributing factors. My approach involves digging deeper to find these underlying causes. This can include:
Chronic medical conditions like diabetes or heart disease that affect brain function.
Side effects from medications prescribed for physical illnesses.
Nutritional deficiencies or hormonal imbalances.
Sleep disorders or chronic pain syndromes.
Psychosocial stressors related to chronic illness management.
By identifying these factors, I can tailor treatment plans that address both psychiatric symptoms and their physical contributors.
Practical Examples of Integrated Care
Mental and physical health do not exist separately. When I evaluate psychiatric symptoms, my internal medicine background helps me consider what else may be contributing rather than automatically assuming every symptom is caused by a psychiatric diagnosis.
Fatigue, poor concentration, and low motivation: These symptoms may look like depression or ADHD, but anemia, iron deficiency, thyroid dysfunction, vitamin deficiencies, sleep disorders, hormonal changes, and other medical conditions can cause or worsen very similar symptoms. Sometimes the right next step includes looking beyond psychiatric medication.
New or worsening anxiety with physical symptoms: A racing heart, shakiness, sweating, shortness of breath, or feeling constantly “on edge” can certainly occur with anxiety, but I also consider thyroid abnormalities, anemia, medication effects, excessive caffeine or stimulants, hormonal changes, and other medical contributors.
A woman in her 40s experiencing worsening ADHD, anxiety, and sleep: Changes during perimenopause can affect sleep, mood, concentration, and emotional regulation. Instead of viewing each symptom as a completely separate psychiatric problem, it can be helpful to look at how hormonal changes, existing ADHD or anxiety, sleep disruption, and current medications may be interacting.
Suggestions for Patients Managing Chronic Conditions and Mental Health
Patients with chronic illnesses often face unique challenges in managing mental health. Here are some practical suggestions I offer:
Keep a detailed symptom diary to track physical and mental health changes.
Communicate openly with all healthcare providers about medications and symptoms.
Prioritize sleep hygiene and regular physical activity within medical limits.
Seek support groups for chronic illness to reduce isolation.
Consider nutritional assessments to identify deficiencies.
These steps empower patients to take an active role in their health and improve overall well-being.
Collaborating with Other Healthcare Providers
Effective psychiatric care for patients with chronic conditions requires teamwork. My history has involved working as the clinician whose role was to oversee all aspects of care, not just in isolation. Fragmented care can be detrimental to a client, therefore at Aligned Psychiatric Care I work closely with your:
Primary care physicians
Specialists such as cardiologists, endocrinologists, neurologist, and pulmonologists
Physical therapists and nutritionists
Social workers and counselors
This collaboration ensures a comprehensive approach that addresses all aspects of a patient’s health. I collaborate with your providers (with approval of course) by sending the office visit notes and making phone calls to review areas of concern and/or summarize changes.
About the Author
Ashley Hughes, PMHNP-FNP is a board-certified Psychiatric Mental Health Nurse Practitioner and Family Nurse Practitioner with over 18 years of healthcare experience. She specializes in comprehensive psychiatric evaluations and medication management for adolescents and adults, taking an evidence-based, patient-centered approach that considers the whole person. Ashley has a special interest in anxiety, depression, ADHD, women's mental health, and integrative psychiatry, including the role of lifestyle, nutrition, sleep, and medical conditions in mental wellness.
Through Aligned Psychiatric Care, she provides both in-person care in the Lake Norman area and telehealth services throughout North Carolina.
Disclaimer: The information provided in this article is for educational purposes only and is not intended to diagnose, treat, or replace individualized medical or mental health care. Every person is unique, and symptoms of depression or other mental health conditions should be evaluated by a qualified healthcare professional. If you are experiencing symptoms of depression or have concerns about your mental health, schedule an appointment with a licensed provider for a comprehensive evaluation.
If you are experiencing thoughts of harming yourself or believe you are in immediate danger, call 911 or go to your nearest emergency department immediately. You can also call or text 988 to reach the Suicide & Crisis Lifeline for free, confidential support available 24 hours a day, 7 days a week.
