ICU Psychosis

1. ICU SYNDROME/ICU
PSYCHOSIS

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. 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