This document discusses ICU psychosis/ICU syndrome, which is an acute organic brain syndrome that occurs in critically ill patients treated in intensive care units. It has an incidence rate of 15-80% among ICU patients. Factors that can precipitate it include sensory overload, sleep deprivation, immobilization, and various medical conditions. Symptoms include impaired cognition, disorganized thinking, and altered perception. Diagnosis involves assessments for confusion. Treatment aims to minimize risk factors and control symptoms, with close monitoring, a calm environment, and occasionally antipsychotic medications. As more patients receive ICU care, ICU psychosis is a growing problem.

1. ICU SYNDROME/ICU
PSYCHOSIS
Presented by
Basil Kuriakose

2. INTRODUCTION
 Advances in medical science and technology have
prompted the establishment of many highly
specialized units (ICUs) providing intensive patient
care.
 ICU psychosis /Delirium in the intensive care unit is
a serious problem that has recently attracted much
attention.
 As the number of intensive care units and the
number of people in them grow, ICU psychosis is
perforce increasing as a problem.

4. DEFINITION
 Eisendrath defined "ICU Syndrome" /"ICU
psychosis" as an acute organic brain syndrome
involving impaired intellectual functioning and
occurring in patients treated within a critical care
unit.

5. INCIDENCE
 It is commonly found in the critically ill with a reported
incidence of15-80%
 By some estimates, 80% of elderly intensive-care
patients develop the condition, which frequently leads to
nursing home stays and a hastened death.

6. ETIOLOGY AND PRE DISPOSING FACTORS
 Sensory overload
 Sleep deprivation
 Immobilization
 Severe emotional stress
 Unfamiliar environment
 Dehydration
 Low Hemoglobin level
 Hypoxemia
 Pain
 Infection
 Drugs
 Prolonged stay in ICU and advancing age

7. CLINICAL MANIFESTATIONS
Sudden onset of impairment in cognition
 Disorganized thinking
 Difficulty in concentrating
 Problems with orientation in time and/or place
and/or person
 Altered affect, often with emotional liability
 Altered perception of external stimuli
 Impairment of memory
 Changes in sleep–wake cycle
 Hallucinations
 Agitation or change in activity levels

8. DIAGNOSTIC EVALUATION
 Confusion Assessment Method
 Mini mental status examination
 Explore other organic causes

9. MANAGEMENT
 The management strategy is to
“wait and watch”.
Non Drug Management
 Continuity of health care personal
 Clear concise communication
 Repeated verbal reminders of time, place and
person.
 Clock, calendar, TV, newspaper, radio readily
accessible as a means of orientating in time

10.  Simplify the environment, single room when
available, reduce noise levels, remove unnecessary
equipment
 Adjust lighting according to day and night cycle.
 Keep familiar objects
 Flexible visiting hours
 Allow maximum periods of uninterrupted sleep
 Encourage mobilisation and increase activity levels
 Relaxation techniques like music therapy and
massage may also help.

12. PHARMACOLOGICAL MANAGEMENT
 Antipsychotic agents such as haloperidol is
commonly used.
 Olanzapine and respiridone have been used as
they are less sedating and have fewer side effects
 Benzodiazepine would be beneficial, and
lorazepam is the drug of choice.

13. OTHER THERAPEUTIC MEASURES
 Adequate pain management
 Avoid offending drugs
 Correct fluid and electrolytes
 Treat infection
 Administer oxygen
 Correct hypoglycemia
 Treat underlying cardiac problems

14. ASSIGNMENT
 Do a concealed observation of your ICU and find out
things and factors that can be avoided to prevent
ICU syndrome also suggest some measures to
prevent ICU syndrome.
 Formulate a scale to assess ICU syndrome

15. REFERENCES
 Lewis, Heitkemper, Dirksen O’Brien, Bucher. Medical
Surgical Nursing. Seventh edition. Nodia: Elsevier
publication; 2007.p no-1576-78,1736-37.
 Mark Borthwick. Richard Bourne. Mark Craig. Annette
Egan. Prevention and Treatment of Delirium in Critically
Ill Patients. United Kingdom Clinical Pharmacy
Association. June. 2006.
 Granberg. Malmros. Bergbom. Lundberg. Intensive Care
Unit Syndrome/Delirium Is Associated With Anemia,
Drug Therapy And Duration Of Ventilation Treatment.
Acta Anaesthesiol Scand 2002; 46: 726–731
 Sandeep Jauhar .When A Stay in Intensive Care
Unhinges the Mind. The New York Times. December 8,
1998.
 Richard C. Monks. Intensive Care Unit Psychosis.
Canadian Family Physician. Vol. 30: February 1984, P
No- 383-389