ICU Psychosis & Delirium: Symptoms, Treatment, & Death Risk

ICU psychosis or delirium describes the unique psychiatric symptoms that happen to a person in the hospital ICU. ICU patients with delirium ... firstAid&injuriescenterTopicGuide CanICUPsychosisCauseDeath? MedicalEditor: JohnP.Cunha,DO,FACOEP Reviewedon3/25/2021 ICUPsychosis&DeliriumSymptoms WhatAreSymptomsofICUPsychosis? Causes WhatCausesICUPsychosis? Diagnosis HowIsICUPsychosisDiagnosed? Treatment WhatIstheTreatmentforICUPsychosis? Guide CanICUPsychosisCauseDeath?TopicGuide ICUpsychosisordeliriumdescribestheuniquepsychiatricsymptomsthatcanhappentoapersoninthehospitalICU.ICUpatientswithdeliriumareatahigherriskofdeathandcomplications. Intensivecareunit(ICU)psychosis(alsocalledintensivecareunit[ICU]syndrome)describesagroupofseriouspsychiatricsymptomsofdeliriumthatareuniquetotheICUenvironment. ICUdeliriumisassociatedwithhighermortalityrates.Ameta-analysisfoundthatICUpatientswithdeliriumwerethreetimesmorelikelytodiethanpatientswithoutdeliriumandsixtimesmorelikelytohaveoneormorecomplications.  ICUpsychosismaycausedeathif,forexample,apatientfallsorremovesanIVwithneededmedication,butthedeliriuminitselfdoesnotcausedeath. WhatAreSymptomsofICUPsychosis? SymptomsofICUpsychosisusuallycomeonquicklyandlast24to48hours,thoughitcanlastaslongastwoweeksinsomecases.  SymptomsofICUpsychosisarethesameasthoseofdeliriumandmayinclude:  Fluctuatinglevelsofconsciousness Delusions  Confusionanddisorientation  Visualhallucinations Abnormalbehaviorsuchasaggressionorpassivity Emotionalorpersonalitychanges,withfrequentmoodchanges,includinganger,agitation,anxiety,apathy,depression,fear,euphoria,irritability,suspicion  Slurredspeechandlanguagedifficulties Sayingthingsthatdon’tmakesense  Changesinfeeling(sensation)andperception  Lossofattention Inabilitytoconcentrate Changesinmovement(restlessnessorslowmovement) Changesinsleeppatterns Memoryloss Disorganizedthinking  Incontinence  Signsofmedicalillness(suchasfever,chills,pain,etc.)ormedicationsideeffects Deliriumisnotthesameasdementia,whichdevelopsslowlyandprogressivelyworsens.  WhatCausesICUPsychosis? ICUpsychosisisbelievedtobecausedbyaperson’sunderlyingmedicalconditionandperhapsworsenedbycharacteristicsoftheICU,suchassleepdeprivationandsensoryoverloadormonotony.  ThemaincauseofICUpsychosisisbelievedtobeunderlyingmedicalfactors.ThemostcommonunderlyingmedicalfactorsthatmayleadtoICUpsychosisinclude:  Metabolicdisturbances Electrolyteimbalances Withdrawalsyndromes Acuteinfection(intracranialandsystemic) Seizures Headtrauma Vasculardisorders Intracranialspace-occupyinglesions Useofcertainmedicationsandsubstances,eitherthroughintoxicationorwithdrawal,suchasanti-anxietymedicationsandnarcotics OtherpossiblecausesofICUdeliriumincludecharacteristicsoftheICUandpsychologicalfactors,thoughgenerallynoneoftheseconditionscausedeliriumontheirown. ICUenvironment(notaconclusivecause) Sleepdeprivation  Socialisolation Immobilization Unfamiliarsurroundings Excessivenoise Sensorymonotony Absenceofdiurnallightvariation Psychologicalfactors  StressofbeingintheICU Patientsareextremelyillandinlife-threateningsituations Patientshavemultipleorseriousmedicalproblems Theymaybeunabletocommunicatetheirneeds Thereisalossofpersonalcontrol Patientsareinanewandthreateningenvironment CognitivestatuspriortoICUadmission Apatient’spriorcognitivelevelandagemaypredisposeapatienttodelirium QUESTION Laughterfeelsgoodbecause… SeeAnswer HowIsICUPsychosisDiagnosed? AdiagnosisofICUdeliriumcanbedifficulttomake,duetothepatient’smedicalstateandbecausesymptomsofdementiacanoftenresemblethoseofdelirium.  InordertodiagnoseICUpsychosis,otherconditionsthatcancausesimilarsymptomsmustberuledout,suchas: Stroke Lowbloodsugar(hypoglycemia) Infectionorsepsis Sideeffectsorinteractionsofmedications Drugoralcoholwithdrawal Teststodeterminetheunderlyingcauseforthesymptomsmayinclude:  Completebloodcellcount(CBC) Biochemicalscreen Measurementofarterialbloodgaslevels ChestX-ray Urinemicrobiologicaltesting WhatIstheTreatmentforICUPsychosis? ICUdeliriumisreversibleandtreatableinmostcases.Treatingtheunderlyingmedicalconditioncanoftenreversesymptomsofdelirium.  OthertreatmentsforICUdeliriuminclude: Adequatefluidandelectrolytebalance Adequatenutritionandvitaminsupply Weaningpatientsoffbreathingmachinessooner Providingthepatientanenvironmentinwhichtheycangetbettersleepandallowingpatientstopreservetheirnormalsleep-wakecycles  Usingmedicationsthatmaybelesslikelytotriggerdelirium Providingadequatepainrelieversifneeded Establishingclearcommunicationwiththepatient  Reorientingthepatienttotimeandplacefrequently Involvingfamilymembersincare BadBugsandTheirBites SexDriveKillers CancerousTumors MultipleSclerosis AdultSkinProblems HabitsThatWreckYourTeeth ManageDiabetesin10Minutes ErectileDysfunction Type2DiabetesWarningSigns HealthBenefitsofSex Scalp,HairandNails ADHDSymptomsinChildren? HealthSolutionsFromOurSponsors PenisCurvedWhenErect CouldIhaveCAD? TreatBentFingers TreatHR+,HER2-MBC TiredofDandruff? LifewithCancer From MentalHealthResources BipolarAssessment:CanYouDoMore?MedicationsforPain TheEmotionalSideofItAll FeaturedCenters GoodandBadFoodsforPsoriasisVideo:GettingPersonalonLifeWithMS HealthSolutionsFromOurSponsors Shot-FreeMSTreatment YourChildandCOVID-19 Reviewedon3/25/2021 References https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/522898 https://www.healthinaging.org/a-z-topic/delirium/symptoms https://www.sciencedaily.com/releases/2012/12/121207094325.htm