ICU psychosis is a recognized complication following being admitted to an ICU usually for treating life threatening medical conditions or following undergoing major surgeries and traumatic injuries. It usually resolves itself after being discharged from the ICU although the symptoms that culminate towards defining a person as suffering from ICU psychosis could make matters worse at the ICU. However, even during the ICU stay, it is possible for a patient to recover from ICU psychosis if proper care and attention is given to the causes that precipitate the psychosis in the first place.
What is the definition?
As described earlier, ICU psychosis is defined as a ‘disorder in which patients in an intensive care unit (ICU) or a similar setting experience a cluster of serious psychiatric symptoms.’ It is also known as ‘ICU syndrome’ because it mimics an instance of ‘delirium’ or acute brain failure.
What are the symptoms shown by a patient with ICU psychosis?
A patient suffering from ICU syndrome would show extreme excitement, anxiety, restlessness, clouding of consciousness, paranoia, disorientation and agitation. At the same time, they will also hear voices, see images that are not realistically present, could become disoriented, show abnormal behavior and could fluctuate between aggressive and passive behaviors. Nightmares can be a real issue for these patients, along with delusions, which can make the task of health care professionals extremely difficult.
What are the causes of ICU syndrome?
The commonest cause for ICU psychosis is believed to be the effect made by the ICU environment on the patient. Among these causes, the sensory deprivation suffered by a patient as a result of being enclosed in a room that does not have windows and which does not allow family or friends to visit at any time could be a leading cause. The sleep disturbances suffered by these patients as a result of constant attention given by the nursing and medical staffs, the noise of various monitoring equipment as well as due to the stress of being in the ICU could also precipitate a state of psychosis which results in the ICU syndrome. In addition, the continuous exposure to light, lack of orientation, as well as the frequent shift changes of the ICU staff,have also being noted as contributing towards developing ICU psychosis.
Among the medical causes that contribute towards developing ICU psychosis, pain, the bodily changes that take place due to critical illnesses, side effects of medications, infections, dehydration, metabolic derangements as well as heart failure should be highlighted.
What are the treatment strategies available?
In managing these patients, there are no specific medicines to be given but certain environmental adjustments could well be enough to relieve the most serious manifestations. Thus, allowing sleep time, reducing the frequency of monitoring or checking vital signs as medically permissible and adapting a more liberal strategy for visitors from the family should help immensely in preventing ICU psychosis in certain patients. At the same time, explaining to the patients with regard to medical treatments, procedures as well as with regard to positive aspects of his or her condition at the correct time would also help in alleviating the unnecessary anxiety and therefore the tendency to develop ICU psychosis. In addition, ICU patients should be managed with the utmost care to reduce their pain and suffering, cure any underlying infections, as well as to maintain adequate hydration and nutrition that may aggravate a potentially psychotic state.
What is the prognosis of ICU psychosis?
Usually, ICU psychosis resolves within 24 hours after the arrival of sleep, or it may last for few days to weeks. However, in almost all instances, ICU psychosis is a recoverable illness, which does not lead to residual symptoms or chances of relapse.