ICU PSYCHOSIS

1
ICU PSYCHOSIS

• Ri ???
• 91-10-26

2
Terminology

• Psychosis loss of reality testing impairment
  of mental functioningmanifested by delusions,
  hallucinations, confusion, and impaired memory.
  (social withdrawal/ego regression
  organic/non-organic)
• ICU Psychosis acute psychotic symptoms related
  to ICU setting? (postoperative delirium,Sundown
  syndrome)
• Delirium 1015 hospitalized people, 40
  postoperative patient (esp. ICU, elderly)

3
Delirium

• Greek de-lira means off the track
• D/D dementia, depression, acute functional
  psychosis.
• A diagnosis of psychosis alone is dangerous!!
• Delirium in ICU is associated with longer
  admission, reduced functioning level in elderly
  and increased mortality

4
Etiology of Delirium (I)
5
Etiology of Delirium (II)
6
Etiology of Delirium in ICU (I)

• Physiological causes metabolic disturbance,
  electrolyte imbalance, drug intoxication/
  withdrawal synd., acute infection (intracranial
  systemic), seizure,head trauma, CVA, intracranial
  lesion, postcardiac surgery?
• Premorbid cognitive statuscognitive level age
• Sleep deprivation not correlated with
  fluctuating cognitive impairment of delirium, but
  maybe a stressor that increase anxiety

7
Etiology of Delirium in ICU (II)

• ICU Environment social isolation,
  immobilization, unfamiliar surroundings,
  excessive noise, sensory monotony, absence of
  diurnal light variation.
• Psychological Factors threat to life, the awe of
  medical procedure, inability to communicate
  needs, loss of personal control.
• Inappropriate Pain Control

8
Diagnosis of Delirium
9
Management of Delirium in ICU

• Goals
• 1.Find and reverse the underlying medical
  problems.
• 2.Control behavioral disturbance if applicable
• Initial AssessmentAdmission and pre-op mental
  and physiology status
• Nonpharmacological management reorientation,
  distraction, stimulation of vision/hearing,
  monitor, family care and teaching, safety
  intervention, freedom of movement, good sleep,
  adequate analgesia

10
Management of Delirium in ICU

• Pharmacological therapy
• 1.Haloperidol (beware of arrhythmia, neuroleptic
  malignant syndrome, EPS)
• 2.Lorazepam
• 3.Benzodiazepine (seizure, withdrawal form
  alcohol or sedatives)

11
Conclusion

• Recognize delirium is the first important point
  in treating ICU patient with psychotic symptoms.
• Environment treatment is free of adverse effect
  but lack of evidence and usage.
• Pharmacological treatment is carefully given
  considering underlying disease and drug dosage.

12
Reference

• Kaplan Sadock's Comprehensive Textbook of
  Psychiatry
• McGuire BE. Basten CJ. Ryan CJ. Gallagher J.
  Intensive care unit syndrome a dangerous
  misnomer. Review 42 refs Journal Article.
  Review. Review, Tutorial Archives of Internal
  Medicine. 160(7)906-9
• Justic M. Does "ICU psychosis" really exist?.
  Review 48 refs Journal Article. Review.
  Review, Tutorial Critical Care Nurse.
  20(3)28-37 quiz 38-9, 2000 Jun
• Meagher DJ. Delirium optimising management.
  Review 39 refs Journal Article. Review.
  Review, Tutorial BMJ. 322(7279)144-9, 2001 Jan
  20.