What Is ICU Psychosis?

Tom Archer
Second Wind St. Louis
July, 2005

Over the last several weeks I have received emails requesting information about ICU psychosis. What is it? How is it treated? Does everyone with an ICU stay experience ICU psychosis? What is the cause? and how can it be prevented?

The following will address some of your questions.

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.

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.”

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.

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.

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. 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.

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 grows, the disorder will correspondingly increase.

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 of day and night; or simply the almost total loss of control over their lives that many patients frequently feel in an ICU.

If you have concerns about your stay in ICU following your transplant, be sure and discuss them with your Doctor and your Nurse Coordinator.