Understanding ICU Psychosis

The Diagnostic and Statistical Manual of Mental Disorders, (DSM), defines psychosis as a severe mental disorder characterized by a break with reality, involving hallucinations, delusions, and illogical thinking. In the condition known as ICU psychosis, or ICU syndrome, patients in ICU units or similar hospital units may become extremely psychotic. ICU Syndrome is a form of acute brain failure, or delirium. As a result of sensory deprivation, sleep disturbance and deprivation, continuous light, stress, lack of orientation, and constant medical monitoring, the patient loses touch with reality.

The cause of ICU Psychosis can also be medical. Maureen Wilkes, MSN, points out that pain, medication side effects, fever, dehydration, and heart failure can contribute to causing a patient to become psychotic. These causes of psychosis will need to be dealt with individually, with primary concern given to the medical condition, as opposed to the psychiatric condition. The purpose of the intensive care unit is the preservation of life, and that will take precedence over non-life threatening issues.

Symptoms of this type of psychosis may manifest as extreme excitement, anxiety, restlessness, hearing voices, or confusion. Patients may also experience hallucinations, nightmares, paranoia, disorientation, agitation, and delusion. The patient suffering from ICU Syndrome may exhibit abnormal, passive, or aggressive behaviors. In ICU Syndrome, groups of symptoms are usually observed.

This psychosis can disappear as suddenly as it appeared, or last anywhere from 24 hours to two weeks. Also According to Maureen Wilkes, there are estimates that one in every three patients that spend more than five days in the intensive care unit,(or other closed unit in the hospital), experiences some kind of delirium. ICU psychosis can occur at any time during the recovery after trauma or surgery.

As this psychosis is sudden and unexpected, it can be very scary for the patient and family. ICU psychosis can become dangerous when the patient is not conscious of his or her actions. Instances of removing Iv’s, removing catheters, and falling from hospital beds have been reported. All patients suffering from ICU Psychosis should be under constant medical observation, to prevent them from doing accidentally doing harm to themselves.

Before diagnosis of ICU Psychosis can be made, other known causes for psychotic behaviors must be examined. If the patient has had a stroke, is suffering from low blood sugar, or drug or alcohol withdrawal, they may exhibit clusters of the same symptoms.

Cumulative causes are responsible for the onset of ICU Psychosis, and must be treated respectively. A review of the patients medications and dosages will be conducted. A quieter more restful environment may be conducive to better sleep. Dehydration issues can be resolved with the administration of fluids. Sedation with anti-psychotic medications like Thorazine or Haloperidol may help ease some of the psychotic symptoms.

ICU psychosis may be prevented by more liberal visitation by family members, enhanced quality and quantity of sleep, reduced excitement levels and daily orientation exercises with the patient. The calming voices of friends and family members will help to ensure that the patient in ICU remains aware of his or her surroundings.