What Is ICU Psychosis?

ICU delirium: symptoms and recovery

When an individual finds themselves in an intensive care unit (ICU), this typically entails at least a temporary loss of mobility and independence, as well as a disturbance to one’s daily routine and sleep schedule. Due to the environmental factors associated with being admitted to a critical care unit, individuals sometimes experience a phenomenon known as “ICU psychosis.” This can be more accurately described as “ICU delirium” and usually involves symptoms like confusion, lethargy, slow motor function, agitation, and hallucinations. In most cases, ICU delirium subsides when patients leave the hospital, but some may experience lasting effects for which therapy with a licensed professional may be helpful.

What is ICU psychosis and what are its hallucinations?

ICU psychosis can be seen as a mental health condition experienced by critically ill patients who have been admitted to an intensive care unit. In general, this condition isn’t frequently discussed or widely known by the general public. This could be because the term “ICU psychosis” is largely considered an outdated phrase that can be more accurately referred to as “delirium.”

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines delirium as “an impairment in attention and awareness that develops over a relatively short time interval that is associated with additional cognitive deficits.” Delirium often includes symptoms such as confusion, disorientation, and hallucinations, where patients may see, hear, or feel things that are not present.

This is a serious condition and ICU delirium can be a common occurrence for individuals in the ICU, with 20% to 70% of hospitalized individuals in the ICU experiencing this condition. There’s typically an even greater likelihood (approximately 80%) of ICU psychosis or delirium occurring in patients on mechanical ventilation.

Overview of ICU psychosis and confusion

Delirium can also be called an “acute confusional state” or “acute brain failure.” While there are generally three main types of delirium observed in individuals experiencing the condition, only two of these are typically observed in patients in the ICU. 

Symptoms of ICU psychosis: Confusion, agitation, disorientation, and hallucinations

Hyperactive delirium, which isn’t commonly seen in ICU patients, typically involves symptoms like restlessness, agitation, and hallucinations. In many cases, psychotic symptoms can interfere with an individual’s care.

Meanwhile, hypoactive delirium tends to be associated with confusion, decreased response time, lethargy, slowed motor function, and other symptoms. Hyperactive delirium may account for approximately 24.5% to 43.5% of ICU delirium cases.

Frequency of ICU delirium

Mixed delirium is usually the most common type of ICU psychosis, involving a combination of elements of both hyperactive and hypoactive delirium. Mixed delirium is estimated to account for 52.5% of cases.

Types of delirium

If an individual is experiencing symptoms of delirium while in an intensive care unit, early detection can be helpful in ensuring one’s mortality and morbidity rates are not affected, although updated research may be needed. If one is experiencing a particularly severe case of ICU delirium, pharmacological measures might be a necessary option to explore. 

What causes ICU psychosis?

Individuals experiencing delirium induced by ICU admission have likely developed a type of environmental delirium. When a patient is in the ICU, they usually have an increased likelihood of experiencing certain environmental factors, such as sleep deprivation, excessive noise, poor communication, separation from family and loved ones, and a lack of mobility. 

Patients are often in an intensive care unit due to a traumatic situation or emergency scenario, and many wake up in the ICU with no recollection or immediate explanation as to how they got there. This sort of confusion can be another factor contributing to the development of ICU delirium.  

Risk factors for ICU delirium

How therapy and sedation can help with ICU delirium and agitation

While many individuals who experience delirium during their stay in an intensive care unit report that their symptoms go away when they leave the hospital, some severe cases of ICU delirium can have lasting effects. In these cases, seeking a pharmacological solution, such as antipsychotic medication, may be beneficial to treat symptoms like hallucinations. Please note that these medications must be prescribed by a doctor or psychiatrist, and you can communicate with them about any side effects you may be experiencing to ensure the best results.

Online therapy options for ICU psychosis and disorientation

Another potential avenue to explore is therapy. While there is no specific therapy method that has been proven to shorten the duration of delirium, the flexibility and affordability of a method like online therapy can help those who have experienced ICU delirium talk to a licensed professional from the comfort of their homes at a time that works for them. 

Often, methods like cognitive behavioral therapy (CBT) can be useful in treating other mental health disorders involving psychotic symptoms, and studies suggest that online CBT can be just as effective as its in-office counterpart. However, people experiencing acute psychosis may need to seek in-person treatment.

Experiencing lingering symptoms from ICU delirium?

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