ICU Psychosis (cont.)
What are the symptoms of ICU psychosis?
The cluster of psychiatric symptoms of ICU psychosis include:
- clouding of consciousness,
- fluctuating level of consciousness which include aggressive or passive behavior.
In short, patients become temporarily psychotic. The symptoms vary greatly from patient to patient. The onset of ICU psychosis is usually rapid, and is upsetting and frightening to the patient and family members.
How is ICU diagnosed?
The diagnosis of ICU psychosis can be made only in the absence of a known underlying medical condition that can mimic the symptoms of ICU psychosis. A medical assessment of the patient is important to search for other causes of mental status abnormality such as:
- drug or alcohol withdrawal, and
- any other medical condition that may require treatment.
The patient's safety must be considered at all times.
How is ICU psychosis treated?
The treatment of ICU psychosis clearly depends on the cause(s). Many times the actual cause of the psychosis involves many factors, and many issues will need to be addressed to relieve the symptoms.
A first step is a review of the patient's medications. The physician in charge of the patient along with the pharmacist can review each of the patient's medications to determine if they may be influencing the delirium.
Family members, familiar objects, and calm words may help. Sleep deprivation may be a major contributing factor. Therefore, providing a quiet restful environment to allow the patient optimal sleep is important. Controlling the amount of time visitors are allowed to stimulate the patient can also help. Dehydration is remedied by administering fluids. Heart failure requires treatment with digitalis. Infections must be diagnosed and treated. Sedation with anti-psychotic agents may help. A common medication used in the hospital setting to treat ICU psychosis is haloperidol.
It should be understood that in saving a life in the critical environment, ICU psychosis sometimes may be a small price to pay for cutting edge, precise medical life-saving measures.
Next: Can ICU psychosis be prevented? »
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