ICU Psychosis

Miscellaneous and Personal Stuff I Must Share
1

My friend JuneBug’s husband went in to the hospital for surgery on an infected finger. Apparently he became septic and went into acute respiratory distress. Then he began to have organ failure and was transferred to another hospital where he would up ventilated and in the ICU.

He was removed from the vent this morning, but now has ICU psychosis- he is confused and agitated and attempts to comfort him agitate him more. He was yelling so much she had trouble telling me about his condition on the phone (she was in the ICU when we were talking), and is wearing padded gloves to reduce harm to himself, but not otherwise restrained.

She said he is receiving excellent care. The docs and nurses watch him closely and keep her well informed. They have treated patients with this diagnosis before and seem to klnow what to do. She finds this reassuring. Also, this ICU lets family stay in the ICU room unrestricted and allows phones. That’s kinda new, I guess.

JuneBug seemed calm thinks everything will be OK soon. I sure hope so.

I took some food to her home and offered to do laundry or shopping or driving for her. She prefers to be dropped off and picked up from the hospital so as to not pay the high parking fees.

It seems as if he very nearly died from the finger infection!

Anyone experience ICU psychosis before? Is it temporary? What should she expect to happen? I assume it is caused by a combo of illness, meds, and the abnormalities from the malfunctioning of the organs.

2

ICU psychosis is another term for delirium. It is a very common occurrence in people who are critically ill. When your body isn’t functioning well it often does affect how your brain functions too. For many people, being in an ICU is particularly disorienting - you often can’t tell if it’s day or night inside the ICU, machines are making noise, there may be uncomfortable procedures, etc.
Delirium will improve as the affected person’s overall medical condition improves. I’ve seen many cases where people are totally out of their minds, agitated, combative and then a couple days later once their acute medical problem is better they’re back to their normal self. It’s upsetting to see someone act like that, but it is a pretty common thing and any ICU doctor will have lots of experience dealing with it.

3

Thanks so much! I’m in antepartum and have never heard of ICU psychosis. Junebug didn’t want visitors (not that I was going to go anyway) because he is, well, not himself. I was surprised how calm she seemed when he was obviously acting up. I had to wait a bit while she disentangled a leg, and she said he was yelling and swatting at imaginary things in the room, but also staying mostly in bed.

Poor sweetie!

4

When I was in the hospital in January, septic as hell, I had delirium to the point of hallucinations. I was generally aware of where I was and why I was there, but I was actually SEEING things and convinced of absolutely absurd situations.

I kept seeing clouds of flies and gnats all over the place. I was convinced that my ICU room was actually the lobby of a business. I was also convinced that the hospital was host to a great demon that was on the verge of entering the world, and all the stuff they were doing to me (the IVs, the catheters, etc) were rituals to bring that about.

Like I posted, I was generally aware of the real situation so I wasn’t combative or anything, but in the quiet hours I was really, really convinced that this alternate situation was the real one.

I still have a little bit of PTSD-ish sensation when TV ads that played a lot six months or so ago are on…the Febreze commercials where they blindfold people and put them in nasty, disgusting places, and the e-surance ad music, will just kind of pull me back there in a mild way.

5

I may be wrong here but isn’t this sort of ‘psychosis’ or delirium something that is often seen in over-dosed drug-addicts being treated with Narcan (naloxone)? Once the opiates are basically instantly ‘turned off’ inside the addict, they are immediately and often violently thrust back into life and sobriety.

6

My mother-in-law was admitted to the hospital for stents when she was in her late 70s. She kept thinking she was at home, pulling at the “thing” (IV) stuck to her hand with tons of medical tape, and thought their dog was sleeping under her bed. At one point she became convinced it was a hotel room. Turns out after we left, she decided to “check out” of the hotel, and we were told it took 4 orderlies to restrain and (IIRC) sedate her! :eek: So yeah, it definitely happens.

7

Wow- that sounds truly awful!

I’m glad you are OK now. I hope JuneBug’s DH does as well. Well, except it’s been hard to get him to go to the doc in the first place, which is why the finger went so bad. I’m sure this hospital experience won’t help all that much unless presented in the right light (as in: go to the Doc early, not late in the illness!)

8

I guess I wouldn’t have been so surprised if he were elderly. I guess I thought this would not be so unusual in an elderly person.

9

ICU nurse here. Yep, ICU psychosis is definitely something that can happen to younger people, mainly if they’ve had long and complicated courses such as your friend’s husband. And like others have said, it gets better as the patient gets better–that’s probably why it’s called “ICU psychosis.” It comes from being in the ICU too long, and goes away when you get out and are better.

It’s certainly difficult to watch someone suffering from this, but there should be some comfort in knowing it’s temporary. Look at it this way–in the grand scheme, if you’re well enough to be hallucinating and combative, you’re probably still better off than when you couldn’t even breathe on your own and had organs shutting down. It’s a step in the road to recovery that I’ve seen many times.

10

My mother had a psychotic episode following surgery on her ankle. Because of her medical history, she wasn’t given a general anesthetic but a spinal block while the doctors fused a badly broken ankle. When her boyfriend and I visited her in recovery, he asked if she was hungry. She replied “I was but the doctor gave me his shoe and I’m fine now”. We looked at each other, laughed and said they must have given her happy drugs.

Oh, if we only knew what was to come.

My mother had some pretty serious medical problems during her lifetime and was usually a very compliant patient. About an hour after she was returned to her hospital room, that changed.

She’d been instructed to stay lying down due to the spinal. She kept trying to sit up and grab at her leg, which was in a huge plaster cast. While trying to keep her lying down, I noticed a bit of blood on the cast, as if possibly gloved fingers with a bit of blood on them had brushed the cast. I didn’t think much of it, and kept trying to calm my increasingly fractious mother.

A bit later I saw the blood “prints” on the cast were larger; I went to the nurses station to report it. A nurse came in and outlined the extent of the seepage, noting the time. She also informed me it wasn’t time for Mom to have a pain shot and for me to keep her lying down.

Let me interrupt myself to add: I am not now and was not then a nurse. I was a very scared 19 year old who did not have a clue as to what was going on with my mother. I had seen my mom in the hospital many times before, but I had never seen her act this way. I have a lot of respect for nurses - I’m married to one - but these dropped the ball. When a post-surgery patient with a cast on her foot that weighs as much as she does and a spinal puncture keeps screaming and trying to climb out of the bed, you do not leave a family member with no medical training to deal with it.

Mom is getting more and more disturbed. I can tell she is in a lot of pain, but she’s not rational and is not responding to anything I say to her. After the blood spot on her cast keep getting larger and other spots began appearing, a tech appeared in the room with a saw to split the cast to relieve the pressure. Did a nurse come in to assist him? Oh hell no. I had to try to hold her still so he could split the cast.

That seemed to give her a bit of relief but it didn’t last long. She had calmed a bit and I was sitting in a chair by the bed reading. She looked at me and said “You hateful bitch, I’m lying here in pain and you’re sitting there reading”. Then she started grabbing at her leg again and almost screaming.

I burst into tears.

The telephone rang; it was Mom’s coworker and friend. I’m squalling and Mom’s screaming. Carol, bless her, said “Just what the hell is going on in there?” I gave a (probably garbled) explanation and she said “I’m called that damned doctor”.

I guess she read him the riot act; or maybe the nursing shift had changed (or both) because within just a few minutes two nurses I hadn’t dealt with before were in the room. One of them very gently took me aside and told me to go home; that my mother was “not herself” but she would be ok and I didn’t need to see her like this.

A few days later as we are packing up Mom’s stuff to go home I came across a wad of what looked like straps and webbing in one of the drawers. I asked the nurse what it was; she replied “That’s the restraint system we had to use to keep your mother in the bed that night”.

Mom said “WHAT?” She didn’t remember being restrained and had no memory of being so hateful to me.

11

Delirium in general is a crisis situation. In long term care with the elderly delirium is often the first indicator staff may have that a person in their care has a serious infection. A UTI or pneumonia is usually suspected when nice calm elderly Mrs Jones suddenly freaks out, starts hitting, becomes agitated or swears like a sailor. If Mr Smith who generally is agressive, swearing and paces all day sits down and plays nice for a change, I would be alerting the doctor we need a urine specimen and possibly a chest X ray for him too.

In ICU it is compounded by a hundred little things like alarms, people moving, lights on 24/7 and general high adreniline all the time. One of the doctors involved with the geritatric psychiatry program where I work did a whole inservice on delirium and the experience of having a parent with it, and how upsetting it was for everyone, even though professionally she knew what was going on.
One of my best reminders for delirium is THINK

T Toxic Situations: CHF, shock, dehydration Deliriogenic meds
H Hypoxemia
I Infection/sepsis (nosocomial), Immobilization
N Nonpharmacological interventions
H Hearing aids, glasses, reorient, sleep protocols, music, noise control, ambulation
K K+ or Electrolyte problems
Another reminder for delirium causes is “I WATCH DEATH”
I Infection HIV, sepsis, Pneumonia
W Withdrawal Alcohol, barbiturate, sedative-hypnotic
A Acute metabolic Acidosis, alkalosis, electrolyte disturbance, hepatic failure, renal failure
T Trauma Closed-head injury, heat stroke, postoperative, severe burns
C CNS pathology Abscess, hemorrhage, hydrocephalus, subdural hematoma, Infection, seizures, stroke, tumors, metastases, vasculitis, Encephalitis, meningitis, syphilis
H Hypoxia Anemia, carbon monoxide poisoning, hypotension, Pulmonary or cardiac failure
D Deficiencies Vitamin B12, folate, niacin, thiamine
E Endocrinopathies Hyper/hypoadrenocorticism, hyper/hypoglycemia, Myxedema, hyper- parathyroidism
A Acute vascular Hypertensive encephalopathy, stroke, arrhythmia, shock
T Toxins or drugs Prescription drugs, illicit drugs, pesticides, solvents
H Heavy Metals Lead, manganese, mercury

12

Well, no good news today. Psychosis present. Kidneys better, lungs worse. Reintubated and on some kind of paralytic. Cardiology is talking about a cath and a stent, so maybe a heart attack in the mix.