ICU induced Psychosis

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    I am a nursing student working on a project about ICU induced psychosis. Have you ever cared for a pt that experienced ICU induced psychosis?? Below is part of an article written in the NY times about the condition. If you have any comments from personal experience I would love to understand more about this condition and how difficult it can be to detect.

    (It seems that no one knows exactly what causes this reaction, but it is generally accepted that something about the environment of the intensive care unit makes some patients, already experiencing high levels of stress, debility and pain, lose their minds.
    Perhaps it is sensory deprivation from being caged in a windowless room, away from family and familiar things. Or perhaps the sensory overload from being tethered to noisy machines that are on all day and night. Some believe that it is contributed to sleep deprivation and disruption of the normal day-night rhythm. Or perhaps it is simply the loss of control that patients must feel as their bodies are probed and medicated.
    Delirium, or acute brain failure, often has organic causes. Dehydration, infection, low blood oxygen, inadequate cardiac output and drugs can all bring it on. And though environmental stressors are often implicated in the delirium of the ICU, studies show that more often organic factors are to blame.
    When patients leave the ICU, the problem almost always vanishes. Even in the ICU, the psychosis often resolves spontaneously, with the coming of morning or sleep. Sometimes it lingers through the day. Severe agitation usually occurs only at night, however, which is why doctors and nurses often call it sundowning, also a kind of delirium common in nursing homes.)

    http://www.nytimes.com/library/natio...psychosis.html
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    Also, after open heart surgery they can get bombarded with micro-emboli which causes "pump head" which clears in a couple days. Not the most politically correct term, perhaps, but accurately descriptive!

    Not every patient in the ICU develops some sort of psychosis, but it does happen quite often. I swear, whenever I was floated to work in the Neuro ICU all the patients I took care of were "Please" and "Thank you", then when returning to our open heart patients it was back to crawling out of bed, pulling at tubes, and acting crazy again! :smackingf
    Last edit by Biffbradford on Oct 9, '11
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    I've cared for patients with ICU-psychotic parents!
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    I work in the psych C&L service of a large academic medical center, and a lot of our consults are for delirium -- in the ICU, and throughout the rest of the medical center. Being in the ICU is considered one of the risk factors for delirium while hospitalized, but there's nothing special or different about delirium in the ICU compared to delirium anywhere else. It's all delirium (although delirium can be either hypoactive or hyperactive).


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