- ICU Psychosis (Intensive Care Unit Psychosis) Center
- Phobias Slideshow Pictures
- Depression Tips Slideshow
- Top Concentration Killers Slideshow
- Patient Comments: ICU Psychosis - Symptoms
- Patient Comments: ICU Psychosis - Treatment
- ICU psychosis facts
- What is ICU psychosis?
- What causes ICU psychosis?
- What are the symptoms of ICU psychosis?
- How is ICU psychosis diagnosed?
- How is ICU psychosis treated?
- Can ICU psychosis be prevented?
- How long does ICU psychosis last?
- How common is ICU psychosis?
- What is an example of a situation of ICU psychosis?
- Can ICU psychosis be dangerous?
ICU psychosis facts
- Patients in an intensive care unit (ICU) or hospital may become delirious.
- ICU psychosis is a temporary condition and can be treated.
- There is no difference between ICU psychosis and delirium.
- ICU psychosis can be treated by a variety of methods and treatments.
- ICU psychosis is an increasingly prevalent problem and may occur at any time during recovery from an acute illness or traumatic event.
- ICU psychosis can be dangerous.
- All efforts should be made to relieve ICU psychosis.
- The signs of psychosis usually resolve shortly after the patient leaves the ICU.
- ICU psychosis may last 24 hours or even up to two weeks with various symptoms occurring at different times.
- Many factors can be involved in causing ICU psychosis.
What is ICU psychosis?
ICU psychosis is a disorder in which patients in an intensive care unit (ICU) or a similar setting experience a cluster of serious psychiatric symptoms. Another term that may be used interchangeably for ICU psychosis is ICU syndrome. ICU psychosis is also a form of delirium, or acute brain failure.
What causes ICU psychosis?
- Sensory deprivation: A patient being put in a room that often has no windows, and is away from family, friends, and all that is familiar and comforting.
- Sleep disturbance and deprivation: The constant disturbance and noise with the hospital staff coming at all hours to check vital signs, give medications, etc.
- Continuous light levels: Continuous disruption of the normal biorhythms with lights on continually (no reference to day or night).
- Stress: Patients in an ICU frequently feel the almost total loss of control over their life.
- Lack of orientation: A patient's loss of time and date.
- Medical monitoring: The continuous monitoring of the patient's vital signs, and the noise monitoring devices produce can be disturbing and create sensory overload.
- Pain which may not be adequately controlled in an ICU
- Critical illness: The pathophysiology of the disease, illness or traumatic event - the stress on the body during an illness can cause a variety of symptoms.
- Medication (drug) reaction or side effects: The administration of medications typically given to the patient in the hospital setting that they have not taken before.
- Infection creating fever and toxins in the body.
- Metabolic disturbances: electrolyte imbalance, hypoxia (low blood oxygen levels), and elevated liver enzymes.
- Heart failure (inadequate cardiac output)
- Cumulative analgesia (the inability to feel pain while still conscious)
Quick GuideWhat's Your Biggest Fear? Phobias
What are the symptoms of ICU psychosis?
The cluster of psychiatric symptoms of ICU psychosis include:
- extreme excitement,
- hearing voices,
- clouding of consciousness,
- abnormal behavior,
- 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 psychosis 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:
- Infection or sepsis
- Medication side effects or interactions
- low blood sugar,
- 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 or other medications for psychosis (antipsychotics).
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.
Can ICU psychosis be prevented?
The primary goal is to correct any imbalance, restore the patient's health, and return the patient to normal activities as quickly as possible. To help prevent ICU psychosis, many critical care units are now:
- using more liberal visiting policies,
- providing periods for sleep,
- protecting the patient from unnecessary excitement,
- minimizing shift changes in the nursing staff caring for a patient, orienting the patient to the date and time,
- reviewing all medical procedures with an explanation about what to expect,
- asking the patient if there are any questions or concerns,
- talking with the family to obtain information regarding religious and cultural beliefs, and
- even coordinating the lighting with the normal day-night cycle, etc.
How long does ICU psychosis last?
ICU psychosis often vanishes magically with the coming of morning or the arrival of some sleep. However, it may last 24 hours or even up to two weeks with fluctuations of the level of consciousness and behavior patterns. Although it may linger through the day, agitation frequently is worst at night. (This phenomenon, called sundowning, is also common in nursing homes).
Fortunately, ICU psychosis usually resolves completely when the patient leaves the ICU.
How common is ICU psychosis?
Some estimate that one patient in every three who spends more than five days in an ICU experiences some form of psychotic reaction. As the number of intensive care units and the patient population in them grow, the number of individuals affected by this disorder will correspondingly increase. With patients being transferred out of the ICU more rapidly than in years past; ICU psychosis may be more common in other areas such as the regular medical floor of the hospital or sometimes may even occur after discharge from the hospital.
What is an example of a situation of ICU psychosis?
Years ago, when we went to visit my father-in-law in a hospital ICU, we found him disoriented and very depressed. He couldn't hear or see well. It was like being in a medically-induced whiteout. His room was windowless. He was unable to listen to a radio, watch television or talk on the telephone. He had virtually no human contact other than brief visits by medical staff because he was in isolation with an infection. The staff he did see were in mask and gown and all looked alike. He felt cut off from human contact. He was sure he was going to die (which he didn't). He had ICU psychosis.
It turned out that my father-in-law's customized hearing aid left lying on the nightstand had disappeared. It had apparently fallen into the waste basket and been thrown out with the trash. To safeguard his glasses, a well-meaning nurse suggested that his glasses be taken home. Hence, he could not hear or see much. Restoration of his hearing aid and glasses largely relieved his ICU psychosis.
Can ICU psychosis be dangerous?
Yes. To give another example, a friend fell seriously ill with a pulmonary infection some years ago, was very feverish, in considerable pain (from pleurisy) and felt just terrible. She was put in the hospital ICU and had a large-bore intravenous catheter with fluids running together with several antibiotics. She was also given some medications to relieve the pain let me catch up on sleep. She fell asleep but awoke in the middle of the night totally disoriented, very agitated, hallucinating, etc. She had pulled out the IV catheter and was spouting blood all over the place. She was experiencing ICU psychosis. While still in the hospital, a repeat dose of the pain medications led to a repeat episode of the ICU psychosis. ICU psychosis can be dangerous, even life-threatening. It is best avoided if possible.
Daily Health News
Mental Health Resources
Subscribe to MedicineNet's Depression Newsletter
Francis, Joseph Jr., M.D. "Prevention and treatment of delirium and confusional states." UptoDate.com. Updated Aug. 13, 2014.
ICU Psychosis - Symptoms
What symptoms did you or someone you know experience with an ICU psychosis? How long did they last?Post View 10 Comments
ICU Psychosis - Treatment
What types of treatment, including therapy and medication, were used for an ICU psychosis in you or a relative?Post View 2 Comments
Top ICU Psychosis Related Articles
AnxietyAnxiety is a feeling of apprehension and fear characterized by symptoms such as trouble concentrating, headaches, sleep problems, and irritability. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. Treatment for anxiety may incorporate medications and psychotherapy.
Acute respiratory distress syndrome (ARDS) is a lung condition in which trauma to the lungs leads to inflammation of the lungs, accumulation of fluid in the alveolar air sacs, low blood oxygen, and respiratory distress. ARDS can be life-threatening. Signs and symptoms of are shortness of breath and low levels of oxygen in the blood, which can cause your organs to fail.
Causes of ARDS include:
- Aspiration into the lungs
- Severe blow to the chest
- Severe injury with shock
- Drug overdose
- Inflamed pancreas
- Other lung conditions and infections
- Near drowning
There have been genetic factors linked to ARDS. Treatment for includes supplemental oxygen, and/or medication. According to some studies, survival rates for ARDS depend upon the cause associated with it, but can vary from 48% to 68%.
Harman, EM, MD. "Acute Respiratory Distress Syndrome Clinical Presentation." Medscape. Updated: Aug 11, 2016.
Harman, EM, MD. "Acute Respiratory Distress Syndrome." Medscape. Updated: Aug 11, 2016.
PubMed Health. "ARDS." Updated: Jun 11, 2014.
Reynolds, HN. et al. Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base. Crit Care. 1998; 2(1): 29–34. Published online 1998 Mar 12. doi: 10.1186/cc121
BiorhythmsBiologic rhythms, or biorhythms, are how our bodies respond to the regular phases of the sun, moon, and seasons. A medical chronobiologist studies how the "body clock" or biorhythms affect diseases and how the body clock responds to treatment of diseases and conditions at different times of the day.
CaregivingMost often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
DehydrationDehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. Symptoms of dehydration include:
- constipation, and
- bad breath.
Extensively Drug-Resistant Tuberculosis (XDR TB)Extensively drug-resistant tuberculosis (XDR TB) is a rare form of multidrug-resistant tuberculosis (MDR TB) that's transmitted when TB germs are expelled into the air by sneezing, speaking, singing, or coughing.
Heart failure (congestive) is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include
- congested lungs,
- fluid and water retention,
- fatigue and weakness, and
- rapid or irregular heartbeats.
There are two types of congestive heart failure, systolic or left-sided heart failure; and diastolic or right-sided heart failure. Treatment, prognosis, and life-expectancy for a person with congestive heart failure depends upon the stage of the disease.
Mental Health (Psychology)Mental health is an optimal way of thinking, relating to others, and feeling. All of the diagnosable mental disorders fall under the umbrella of mental illness. Depression, anxiety, and substance-abuse disorders are common types of mental illness. Symptoms and signs of mental illness include irritability, moodiness, insomnia, headaches, and sadness. Treatment may involve psychotherapy and medication.
Panic DisorderPanic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizziness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
Psychotic DisordersPsychotic disorders are a group of serious illnesses that affect the mind. Different types of psychotic disorders include schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, shared psychotic disorder, delusional disorder, substance-induced psychotic disorder, paraphrenia, and psychotic disorders due to medical conditions.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. The National Institutes of Health recommend about 7-9 hours of sleep each night for older, school-aged children, teens, and most average adults; 10-12 for preschool-aged children; and 16-18 hours for newborns. There are two stages of sleep; 1) REM sleep (rapid-eye movement), and 2) NREM sleep (non-rapid-eye movement). The side effects of lack of sleep or insomnia include:
- Feeling sleepy during the day
- Concentration or memory problems
Lack of sleep and insomnia can be caused by medical conditions or diseases, medications, stress, or pain. The treatment for lack of sleep and insomnia depends upon the cause.
StressStress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Vancomycin-Resistant Enterococci (VRE)Vancomycin-resistant enterococci (VRE) infection is the most common type of infection acquired by patients while hospitalized. Patients at risk for VRE are those who are already ill, and hospitalized, including individuals with diabetes, elderly, ICU patients, kidney failure patients, or patients requiring catheters. Enterococci can survive for months in the digestive tract and female genital tract. Other risk factors for acquiring VRE include those how have been previously treated with vancomycin and combinations of other antibiotics. Treatment of VRE is generally with other antibiotics other than vancomycin. Prevention of VRE can be achieved by proper hand hygiene.