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ICU psychosis

#1
Magical Realist Offline
https://www.medicinenet.com/script/main/...jhHzQM-UqQ

"A disorder in which patients in an intensive care unit (ICU) or a similar hospital setting may experience anxiety, become paranoid, hear voices, see things that are not there, become severely disoriented in time and place, become very agitated, even violent, etc. The condition has been formally defined as "acute brain syndrome involving impaired intellectual functioning which occurs in patients who are being treated within a critical care unit." ICU psychosis is a form of delirium, or acute brain failure. Organic factors including dehydration, hypoxia (low blood oxygen), heart failure (inadequate cardiac output), infection and drugs can cause or contribute to delirium.

The treatment of ICU psychosis depends on the cause(s). Family members, familiar objects and calm words may help. Dehydration should call for fluids. Heart failure needs treatment with digitalis. Infections must be diagnosed and treated. Sedation with anti- psychotics agents may help.

To prevent ICU psychosis, many critical care units now have instituted visiting hours, they try to minimize shift changes in the nursing staff caring for a patient, the lighting is coordinated with the normal day-night cycle, etc. ICU psychosis usually goes away when the patient leaves the ICU.

One patient in every 3 who spends more than 5 days in an ICU experiences some form of psychotic reaction, according to current estimates. As the number of intensive care units and the number of people in them grow, ICU psychosis is perforce increasing as a problem.

What causes ICU psychosis is not fully known. Something about the ICU causes some people, who are already experiencing great debility, stress and pain, to "lose their minds." Among the factors which are believed to play into ICU psychosis are:

Sensory deprivation (being put in a room often without windows, away from family, friends and all that is familiar),

Sensory overload (being tethered to noisy machines day and night),

Pain (which may not be adequately controlled in an ICU),

Sleep deprivation,

Disruption of the normal day-night rhythm, or simply

The loss of control over their lives that patients often feel in an ICU.

ICU psychosis often goes away with the coming of morning or sleep. Although it may linger through the day, severe agitation usually occurs only at night. (This phenomenon, called sundowning, is common in nursing homes)."
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#2
Magical Realist Offline
Finding out about this temporary insanity that can be triggered by just being in a hospital makes me wonder about other more traumatic circumstances humans may suddenly find themselves in. Jails and prisons, asylums and psych wards, boarding schools and hazing, being at sea, homelessness, joblessness, war, terminal illness, boot camp, crime victimization, rape, and assault, the death of someone close, being abducted or taken as a hostage, torture, cult situations, etc. If we are closer to psychosis than I thought, what major shift in our life situation--what complete loss of control over our life-- cannot but bring that sparkling darkness out in us?
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#3
C C Offline
Thanks. Didn't know they had a sub-category of delirium specifically for ICU (or have forgot). I've seen this first hand before with a relative who was recovering soon after heart surgery, and maybe other occasions. Patient closes the eyelids and they're in a completely different world -- each time they close them again it's the same place in progress. Seems more reliable at producing lifelike hallucinations than LSD, as it often sounds like half the latter users back in their heyday never got beyond flickering colors.
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#4
Magical Realist Offline
I got to experience psychosis once when I took one too many Paxil. I vaguely remember being in a state of sheer of terror over paranoid fantasies, like racists attacking my hispanic neighbors and menacing teenagers standing in the four corners of my apt. Then I remember being in the ER terrified that govt agents were about to ambush me from around a corner and being carted up to the MRI with fears of being imprisoned forever by evil doctors. By the time I finally came out of this delusional state I was in the ICU in my bed with an IV hooked up to me. The danger of serotonin syndrome which gave me an uncontrollable fever was over and after another day or so I was finally good enough to go home. It's not a fun experience, that's for sure.
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#5
Syne Offline
(Nov 16, 2019 09:52 PM)Magical Realist Wrote: I got to experience psychosis once when I took one too many Paxil. I vaguely remember being in a state of sheer of terror over paranoid fantasies, like racists attacking my hispanic neighbors and menacing teenagers standing in the four corners of my apt. Then I remember being in the ER terrified that govt agents were about to ambush me from around a corner and being carted up to the MRI with fears of being imprisoned forever by evil doctors. By the time I finally came out of this delusional state I was in the ICU in my bed with an IV hooked up to me. The danger of serotonin syndrome which gave me an uncontrollable fever was over and after another day or so I was finally good enough to go home. It's not a fun experience, that's for sure.

Explains a lot. Like maybe you don't recognize lesser such side effects.
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#6
Magical Realist Offline
Quote:Explains a lot. Like maybe you don't recognize lesser such side effects.

It just demonstrates the effects of overdosing on antidepressants, nothing else.
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