ICU Psychosis (cont.)
Maureen Welker, MSN, NPc, CCRN
Maureen Welker received a Bachelor of Science degree from California State University, Long Beach (CSULB) and also obtained a Public Health Nurse Certification. There she served as Vice President of the Graduate Nurses Association, at CSULB and also served as President of the Graduate Nurses Association. Ms. Welker is a board-certified Nurse Practitioner and is currently on staff at Mission Hospital Regional Medical Center.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- 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 At A Glance
What are the symptoms of ICU psychosis?
The cluster of psychiatric symptoms of ICU psychosis include:
- extreme excitement,
- restlessness,
- hearing voices,
- clouding of consciousness,
- hallucinations,
- nightmares,
- paranoia,
- disorientation,
- agitation,
- delusions,
- 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 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:
- 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.
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.
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