ICU Psychosis Symptoms & Signs
Signs and symptoms of ICU psychosis can vary and may include
- restlessness,
- hearing voices,
- clouding of consciousness,
- hallucinations,
- nightmares,
- paranoia,
- disorientation,
- agitation,
- delusions, or
- abnormal behavior.
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.
Signs and symptoms of ICU psychosis can vary and may include
The cluster of psychiatric symptoms of ICU psychosis include:
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.
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:
The patient's safety must be considered at all times.
The treatment of ICU psychosis 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 number of times 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 a critical environment, ICU psychosis sometimes may be a small price to pay for cutting-edge, precise medical life-saving measures.
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:
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.
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.
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 the radio, watch television or talk on the telephone. He had virtually no human contact other than brief visits by the medical staff because he was in isolation with an infection. The staff he did see were in masks and gowns 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 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.
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 and let me catch up on sleep. She fell asleep but awoke in the middle of the night 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 ICU psychosis.
ICU psychosis can be dangerous, even life-threatening. It is best avoided if possible.
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