What Is Hospital Psychosis?
In general, someone is admitted to an intensive care unit (ICU) due to a medical emergency, such as a serious injury or illness. Due to a variety of factors associated with emergency hospital stays, some individuals may experience a phenomenon called “hospital psychosis” or ICU delirium involving symptoms like confusion, agitation, hallucinations, delusions, and memory deficits. In most cases, hospital psychosis resolves on its own after an individual is discharged from the hospital. However, some people may experience lingering symptoms, for which working with a licensed therapist may be beneficial.
What is hospital psychosis experienced by patients?
“Hospital psychosis” and “ICU psychosis” can be seen as colloquial terms used to refer to psychiatric symptoms experienced by hospitalized patients in critical care units. However, a more accurate and updated term for this disorder is “ICU delirium” or simply “delirium.”
Hospital psychosis (aka ICU delirium), defined by the DSM-V
Intensive care unit delirium, also known as “acute confusion” or “sudden brain dysfunction,” is generally defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) as a rapid change in attention and awareness, accompanied by memory loss, disorientation, or perceptual problems.
Prevalence and risk factors in hospitals and medical centers
It can be common in ICU patients, affecting anywhere from 20% to 70% of hospitalized individuals, with an increased risk for patients using mechanical ventilators. This condition tends to occur due to various factors associated with intensive care units, such as medication, underlying medical conditions, medical procedures, sleep deprivation, and the unfamiliar hospital environment.
Patient symptoms of psychosis in hospitals and medical centers
Symptoms of ICU delirium may vary in intensity, and they can come and go throughout the day.
Psychotic symptoms in patients
These symptoms may include the following:
Confusion: Patients may become disoriented and have trouble understanding their surroundings or situation.
Memory deficits: They may experience difficulties remembering recent events or forming new memories.
Disorientation: Patients may lose track of time, place, and the people around them.
Hallucinations: They may perceive things that are not present, such as seeing or hearing things that others do not.
Delusions: Patients may hold false beliefs or ideas that are not based in reality.
Agitation: They may display restlessness, agitation, or irritability.
Inattention: Patients may have difficulty focusing or maintaining attention on tasks or conversations.
Other symptoms a patient might experience
Sleep disturbances: They may experience disruptions in their sleep patterns, such as difficulty falling asleep or staying asleep.
Physical symptoms: Patients may exhibit signs of physical distress, such as sweating, rapid heartbeat, or tremors.
Emotional instability: They may experience sudden mood swings or emotional outbursts.
Difficulty communicating: Patients may struggle to express themselves verbally or have trouble understanding others.
Altered level of consciousness: They may appear drowsy, lethargic, or have periods of reduced responsiveness.
Behavioral changes: Patients may exhibit unusual or inappropriate behavior compared to their normal demeanor.
Heightened sensitivity: They may become overly sensitive to certain stimuli, such as light, sound, or touch.
Health and treatment of delirium in patients
What causes ICU delirium?
There are several possible causes of ICU delirium. The need for intensive care typically follows an emergency situation, such as a serious injury or another traumatic incident. Some patients might wake up in an ICU with no recollection or immediate explanation for how they got there.
Factors contributing to ICU delirium
Additionally, while updated research may be needed, the ICU usually introduces rapid changes to one’s environment. These factors are likely contributors to the development of ICU delirium.
Contributing factors
Other contributing factors could include those listed below:
Medications: Certain types of medicine, especially sedatives, painkillers, and medications that affect the central nervous system, can increase the risk of delirium.
Underlying medical conditions: Patients with pre-existing conditions, such as dementia, Alzheimer's disease, or neurological disorders, may be more susceptible to delirium.
Sleep deprivation: Disrupted sleep patterns in the ICU, due to noise, frequent monitoring, or medical interventions, can contribute to delirium.
Infections: Serious infections, such as sepsis, can trigger delirium in ICU patients.
Metabolic imbalances: Electrolyte disturbances, dehydration, or organ dysfunction can disrupt brain function and lead to delirium.
Other factors
Pain: Untreated or inadequately managed pain can contribute to agitation and confusion in ICU patients.
Environmental factors: The unfamiliar and highly stimulating environment of the ICU, with constant noise, bright lights, and frequent disruptions, can exacerbate delirium.
Mechanical ventilation: The use of ventilators and associated sedatives can increase the risk of delirium in critically ill patients.
Stress and anxiety: The traumatic experience of being in the ICU, combined with uncertainty about one's health, can contribute to emotional distress and delirium.
Older age: Advanced age may be a risk factor for delirium, as older adults may have decreased cognitive reserves and could be more susceptible to the effects of illness and medication.
Mental health treatment for hospital psychosis and delirium
While many patients who develop delirium due to ICU psychosis experience symptom relief upon leaving the ICU, some individuals experience post-intensive care syndrome, in which symptoms can persist for months after their initial development.
Seek pharmacological interventions
Seeking pharmacological interventions, like antipsychotic or anti-anxiety medications, could be beneficial for managing prolonged symptoms. These medications must be prescribed and monitored by a licensed medical professional, such as a doctor or psychiatrist.
Therapy as a treatment option
Additionally, therapy may present another potential approach to symptom management and relief. Although no single therapy method has been conclusively shown to shorten delirium duration, options like online therapy can offer flexibility and affordability, enabling individuals affected by ICU psychosis to engage with licensed professionals from the comfort of their own homes.
Effectiveness of online therapy
A large body of research suggests that online therapy and in-person therapy tend to produce the same client outcomes, showing that either option can be effective for individuals looking for professional help with their mental health.
Takeaway
What causes hospital psychosis?
Hospital psychosis can be caused by many factors. The majority of them are environmental and medical causes, such as:
- disruption of the normal day/night cycle from being in the hospital ICU
- metabolic disturbances such as an electrolyte imbalance
- medication side effects
- constant medical monitoring that causes a sensory overload
- high stress levels
- head trauma
- sensory deprivation such as being in a windowless hospital room
- extreme pain
How long can hospital psychosis last?
The length of hospital psychosis usually lasts from a couple days to several weeks. On occasion it can last a few months.
Can you recover from hospital delirium?
Hospital psychosis typically goes away when a patient leaves the ICU setting. However, for some patients, symptoms associated with the psychotic reaction may continue for a few weeks or months after they are discharged from the hospital. Occasionally, hospital delirium results in lifelong challenges.
How common is hospital psychosis?
Delirium occurs in at least 40% of ICU patients.
How to avoid hospital psychosis?
Family members can help prevent delirium or reduce the serious psychiatric symptoms associated with the mental state by taking a few actions.
- Ensure patients have complete access to their hearing aids, dentures, glasses, and other items that provide sensory engagement.
- Bring familiar objects to the hospital room, such as a favorite blanket or family photo.
To help prevent ICU psychosis, many critical care units are now allowing visiting hours in the ICU and trying to minimize shift changes that occur with the nursing staff caring for patients receiving intensive care.
What can cause psychosis?
Patients are at a greater risk of developing hospital psychosis if they are:
- on breathing machines
- being treated for heart failure
- recovering from major surgery
- older patients over the age of 65
One meta-analysis found that some of the top risk factors also included sleep deprivation, use of physical restraints, and pain.
How to help someone with hospital psychosis?
If someone is experiencing hospital psychosis, visiting family members and hospital staff should speak to them using calm words. Keeping a regular schedule and providing access to sunlight when possible can help keep patients’ bodies and minds in a natural rhythm. Patients should be encouraged to work with therapists who are available, such as a physical therapist or occupational therapist.
Why do ICU patients hallucinate?
Two major factors can contribute to the hallucinations that ICU patients experience. Medical factors include causes such as high pain levels and medication side effects. Environmental causes include factors related to being in a hospital setting, such as being in a windowless room with no differentiation between day and night.
What does hospital delirium look like?
Also known as hospital psychosis, acute brain failure, or ICU syndrome, hospital delirium may look like:
- confusion and disorientation
- perceptual disturbances
- trouble sleeping
- abnormal behavior such as hallucinations and delusions
- a fluctuating level of consciousness
While many of these symptoms are similar to symptoms exhibited by dementia patients in nursing homes and memory care facilities, a diagnosis of ICU psychosis has one major differentiator. Delirium occurs very quickly, while dementia develops gradually over years.
How is hospital psychosis treated?
The Society of Critical Care Medicine recommends against frequently using antipsychotics to reduce delirium in adults. It’s suggested that hospital staff treat psychosis by:
- taking steps to ensure pain is adequately controlled
- offering medications such as painkillers and sedatives
- encouraging patients to start moving after surgery as soon as possible
- supporting and engaging families of patients
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