ICU Psychosis -- Can anyone give me the scoop on this?

[calypso*a*go-go]

Way, way, way OT I know, but my DMIL (still hospitalized) has been exhibiting some very strange behavior...an unwillingness to cooperate, paranoia (thinks hospital staff is "experimenting" on her), begs friends and relatives to get her out, etc. At first we thought maybe one of the surgeries might have caused some kind of brain damage or something...but a neighbor mentioned ICU Psychosis and what little I've found out about it sounds like the symptoms we're seeing. What type of treatment is available? She is 76 and had excellent health prior to being admitted over 40 days ago due to a bowel obstruction. It's very painful to see her in this condition and not know what to do to help her.

 

[warpdarkmatter]

i don't know anything about icu psychosis but the same thing happened to my grandmother after a colon cancer operation and it turned out to be a adverse reaction to morphine hope that helps

 

[churchpilot]

The elderly are very suseptible to ICU psychosis or "sundowners" syndrome. When you are in a unit like the ICU, you are sleep deprived and sensory deprived. Someone is in your room every hour or several times an hour and your routine is messed up. You may get a bath at 2AM and you don't have the regulation of sun up and sun down. Also you are not normally taking meals 3 times a day which is another way our body tries to regulate itself. If the psychosis is bad, they may try and treat it with sedatives or even a medication called Haldol. The best thing is to try and get her into a routine which usually doesn't happen until they are moved to the floor. Reorient her everytime you are in the room. Mention the time, what the weather is, etc, "Mom its lunch time and the sun is shining very brightly" or Mom I have to leave now because it is bedtime and it is dark outside". Ask the nurses to try and do her normal daily care during the morning or early evening and not in the middle of the night. If this is an open unit, try and be with her as much as you can. Hope this helps.

 

[calypso*a*go-go]

i don't know anything about icu psychosis but the same thing happened to my grandmother after a colon cancer operation and it turned out to be a adverse reaction to morphine hope that helps

Thank you for mentioning this -- I didn't even think about it possibly being from meds she might be on. Did your grandmother's behavior return to normal after the morphine was out of her system?

 

[princess&her4princes]

The same weird behaviour started with DH's grandfather last fall, in excellent health for 90, fell and broke his hip and because of all the meds he was on for months, he is still not right. They say it's very common, he's living on his own still but with a visiting nurse as before was okay with a check in every other day or so. Best wishes, it's a sin to watch!!!

 

[calypso*a*go-go]

Ask the nurses to try and do her normal daily care during the morning or early evening and not in the middle of the night. If this is an open unit, try and be with her as much as you can. Hope this helps.

Thank you for this advice as well. My MIL lives 3 hours north of us and we can't be up there everyday, I'll have my husband ask the nursing staff to try and have as normal a routine as possible. She was actually moved to a regular bed and out of ICU almost a week ago. Our biggest problem is that her surgeries have finally begun to heal but she can't eat or drink due to rapid, shallow breathing -- the respiratory therapist is afraid she will aspirate whatever is in her mouth, into her lungs. It's almost like she's having a panic attack anytime she's awake. And what's really sad is that her body has deteriorated so much during her hospital stay that she will need to be transferred to a rehabilitation facility next -- when all she wants to do is just go home.

 

[jlynne01]

i don't know anything about icu psychosis either but my dad also thought the staff was out to get him when he was in icu on a vent. He was highly drugged but obviously semi councious because he later told us that the staff was giving his his bank information out over the intercoms and other personal information in codes... My dad was only in his mid 50's so I dont really relate it to age, once all the drugs wore off he never mentioned anything strange again. Though he did tell my mother that he didnt ever want to be vented again!

 

[calypso*a*go-go]

Kristen -- That's amazing that your grandfather was able to continue living on his own after a broken hip!

It's seems as though what my MIL is going through is not uncommon at all. I think my husband and his brother should ask her doctor if there's something more they can do for her. It just doesn't seem right to let someone lay there, scared to death.

 

[calypso*a*go-go]

My dad was only in his mid 50's so I dont really relate it to age, once all the drugs wore off he never mentioned anything strange again. Though he did tell my mother that he didnt ever want to be vented again!

Wow -- the mind can sometimes really play some crazy tricks on us, can't it? I'm sure the nursing staff in hospitals have probably seen and heard it all. Plus it must be hard on them as well when they're trying to help someone that thinks of them as the enemy.

 

[doconeill]

I am not a doctor, but I am staying at the Beach Club next weekend.

There can be many causes, and they can be cumulative. Sleep deprivation because you are constantly being checked on, having tests, etc. is a start. I sent a night in an ICU down in NC as I was having weird chest pains (not really heart attack like symptoms, but disconcerting), along with shoulder/back pain (which can mask more serious things), etc. I also have an unusual EKG signature, so they admitted me just in case.

It turned out to just be exhaustion (I got car sick for the first time driving down), wasn't sleeping well (it was incredibly hot and the AC wasn't working), and the shoulder problem was from bowling without my custom equipment, but during the night, when what I REALLY needed was sleep, I was woken up every two hours for tests, I had a really bad headache (the nitro paste they gave just in case), and I couldn't get comfortable (I'm a side sleeper, but they wanted to keep me inclined and I had lots of wires attached to me).

Sensory deprivation also contributes, from several sources. One, a lot of ICU rooms are isolated - both from the outside world and even internally. The room I was in lacked any windows, and no clock I could see. So I had no sense of the passage of time.

In addition, for those on pain meds, aside from possible side effects, also affect your general senses of touch and pain. You lose some of the natural stimuli your body is used to feeling, and you can begin to feel detached over the long term.

 

[LakeAriel]

My 56 year old brother suffered from this after heart surgery at Columbia Presbyterian a few years ago. Total paranoia and agitation. There had been complications after surgery from the anesthesia and he remained in ICU longer then expected or recommended..The Dr sent him to a step down unit just for his mind..I have a link, I will paste in a moment..He fully recovered though the memory loss lasted several weeks.


http://www.medicinenet.com/icu_psychosis/article.htm

Good luck, I know it is very frightening to watch!

 

[IWISHFORDISNEY]

Well as a former ICU nurse I have seen this with patients of all ages. It is because it is daytime all the time in ICU. Usually no windows and people bugging them around the clock. Most patients see improvement once they are moved to a regular floor. Also meds play a huge role. Esp pain meds. I once had a 50 year old CEO standing in his bed "driving" a tug boat and screaming at the top of his lungs. He thought we were holding him hostage. This really is very common. I hope she can move out of ICU soon. ((HUG)) to you and your family. Let me know if you have any questions. I will try to help if I can.

 

[DVCsince02]

I was hoping you saw this Liz.

Lisa - Hugs to you and your MIL.

 

[adsrtw]

Oh no, I hope she is better soon! Hang in there!

 

[SamSam]

I'm so sorry this is happening. I am also glad that you posted this, it is something I was not aware of and will definitely spread the word that this can happen. I'm at an age (along with many friends) where are parents are going through hospital stays, surgeries, etc., so knowing about this could be very helpful.
Wishing the best for you and your family.

 

[calypso*a*go-go]

Thank you to everyone for your replies and well wishes. I am definitely more hopeful that DMIL's condition is only temporary and will improve with time. The only thing I can't understand is why none of her doctors/care-givers ever mentioned this condition to us. They have been first-hand witnesses to the drastic change in her behavior.

I agree with SamSam -- this is a good thing for everyone to keep in the back of the heads in case it comes up in the future. It's extremely stressful to think your loved one is going insane before your eyes.

 

[LakeAriel]

We weren't informed of this either....It always happened at night and my daughter, an RN, mentioned that it was similiar to what happened in Alzheimers patients who became disoriented in the evening, hence the name sundowning. That led me to research and find the site I posted, which is VERY informative..We thought he had been deprived of oxygen in surgery. Frankly, I don't think most medical professionals are familiar with it. (ICU psychosis) One doctor asked us if he had a drug history!

I hope she makes a complete recovery and soon..

 

[DLBDS]

My grandfather (late 70's I think) was like this for a good while. My dad said he was just loopy and doing odd things and talking out of his head crazy. Turned out to be the meds he was on. He returned to normal once he recovered and they tweaked his dosages. This may sound awful, but we laughed about it later. Grandpa was trippin' BAD. Of course, my dad had a way of telling stories that cracked you up. Yeah, even his own son (my dad), who was taking care of him a lot during this bad time, found humor in it. I hope your DMIL also has a simple fix like this. I don't remember my grandfather having paranoia issues. That can be stressful for family members to have to witness. I hope she recovers soon. Good luck!

 

[Launchpad11B]

Sorry your MIL is having such a tough time. It's so hard to watch loved ones go through this. Your family is in our thoughts.

 

[DrmWvr1299]

I hope things are going better for her. As a nurse I completely agree with IWISHFORDISNEY , people are coming and going at the very least every hour checking vital signs and such. There is no differentation between day and night. There are usually some sort of lights on and continuous noise from outside sources (heart monitor other machines etc) The body is literally messed up without some sort of normal pattern. Thankfully this usually passes when they are moved from ICU to a step down unit. Hang in there.