what is icu psychosis

							ICU (Intensive Care Unit) Psychosis

http://www.medicinenet.com/icu_psychosis/article.htm

What is ICU psychosis?

ICU psychosis is a disorder in which patients in an intensive care unit (ICU) or a similar setting
experience anxiety, hear voices, see things that are not there, and become paranoid, severely
disoriented in time and place, very agitated, or even violent, etc. In short, patients become
temporarily psychotic.

ICU psychosis defined.

The condition has been formally defined as "acute brain syndrome involving impaired intellectual functioning
which occurs in patients who are being treated within a critical care unit."

Is there a difference between ICU psychosis and delirium?

No. ICU psychosis is a form of delirium, or acute brain failure. Organic factors which contribute or cause the
disorder include dehydration, hypoxia (low blood oxygen), heart failure (inadequate cardiac output), infection,
and drugs.

How is ICU psychosis treated?

The treatment of ICU psychosis clearly depends on the cause(s). Family members, familiar objects, and
calm words may 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.

How can ICU psychosis be prevented?

To help prevent ICU psychosis, many critical care units now have instituted more liberal visiting policies,
minimized shift changes in the nursing staff caring for a patient, and coordinated 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. Although it
may linger through the day, severe agitation usually occurs only at night. (This phenomenon, called
sundowning, is common in nursing homes).

ICU psychosis usually resolves completely when the patient leaves the ICU.

How common is ICU psychosis?

According to current estimates, one patient in every 3 who spends more than 5 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 disorder will correspondingly increase.

What causes ICU psychosis?

The causes of ICU psychosis are not fully known. Something about the ICU causes some people, who are
already experiencing great infirmity, stress and pain, to "lose their minds." Among the factors which are
believed to contribute to ICU psychosis are:

       Sensory deprivation -- being put in a room that often has no windows, and is away from family,
        friends, and all that is familiar and comforting;
       Sensory overload -- being hooked up to noisy machines that run day and night;
       Pain -- which may not be adequately controlled in an ICU;
       Sleep deprivation - hospital staff coming at all hours to check vital signs, give medications, etc.;
       Disruption of the normal rhythm and day and night; or simply
       The almost total loss of control over their lives that many patients frequently feel in an ICU.

What would be an example of a situation of ICU psychosis?

Once when we went to visit my father-in-law in an 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, I fell seriously ill with a pulmonary infection some years ago, was very
feverish, in considerable pain (from pleurisy) and felt just terrible. I was put in the hospital ICU and had a
large-bore intravenous catheter with fluids running together with several antibiotics. I was also given some
medications to relieve the pain and let me catch up on sleep. I fell asleep but awoke in the middle of the
night totally disoriented, very agitated, hallucinating, etc. I had pulled out the IV catheter and was spouting
blood all over the place. I 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. Since that time I have refused these
medications and had no recurrence of the ICU psychosis. ICU psychosis can be dangerous, even life-
threatening. It is best avoided.

ICU psychosis At A Glance

       Patients in an intensive care unit (ICU) may become deranged.
       ICU psychosis is an increasingly prevalent problem.
       ICU psychosis can be dangerous.
       All efforts should be made to relieve ICU psychosis.
       The signs of psychosis usually resolve when the patient leaves the ICU.