ICU psychosis: Understanding a hidden consequence of prolonged hospital stays

Hospitals are places of healing. However, for some patients – especially older people – long stays in hospitals in an unfamiliar environment, combined with fear of medical procedures, may leave them feeling anxious and confused. This phenomenon is often called ICU psychosis.

“That nurse is planning to steal my organs. You have to get me out of here.” That’s how Samantha’s* father greeted her when she came to visit him in the ICU, where he was recovering from severe pneumonia. His panic sparked her own, giving rise to concerns about his mental health and whether he was receiving adequate care.

In fact, Samantha’s father was experiencing ICU psychosis, a condition which may afflict patients experiencing critical illness or who have been in hospital for a prolonged period. “The ICU environment can be frightening,” points out Dr Shay Ganesh, Head: Innovation at Medihelp Medical Scheme. “The lack of familiarity can make patients feel depressed, confused, and anxious.”

Medication also plays a role: often, patients are put on an intense drug regime, which may have side effects. This places the kidneys under strain, and toxicity may build as the organs struggle to maintain their function of elimination.

The tiredness many patients experience as their bodies fight infections, combined with the weakness that can result from prolonged bed rest, may also contribute to symptoms such as an inability to focus, unclear thinking, and even delusions and hallucinations.

White coat syndrome

For other patients, the fear of medical procedures and personnel may lead to another phenomenon called white coat syndrome. Dr Clyde Green-Thompson, a GP and medical adviser at Medihelp, explains that this causes an elevated heart rate. “It doesn’t help that there is a glut of health-related information available online. Unfortunately, articles on medical conditions often highlight the worst-case scenario, increasing anxiety.”

Children may have an even more specific response to hospitalisation, or even a doctor’s visit, with many displaying regression (reverting to the behaviour associated with a younger age), aggression or withdrawal. Some children also experience fear of abandonment syndrome.

Unfortunately, these experiences may have a lasting impact on the patient, affecting them even after they are discharged from hospital. It’s not uncommon for sufferers to feel less confident about their abilities after they have been bed-bound for several days, or even weeks, and to worry if their body will regain its former functionality. Some people may even experience post-traumatic stress disorder, especially if further complications and infections set in.

Communication is vital

Hospital reactions can be challenging not only for patients, but for their loved ones, too; especially since people typically don’t understand what is happening or why.

This is why communication is crucial, says Dr Green-Thompson. “You have a right to ask your doctor as many questions as necessary,” he points out. He acknowledges that it often feels difficult to approach specialists, who may seem intimidating or appear pressed for time.

“It might be more comfortable to consult your GP or referring doctor, who can update you about the patient’s condition and treatment plan.” However, you should also be able to request information from any member of the treatment team – from the sister in charge of the ward to the specialist – any time you want more information (within the ambit of the Protection of Personal Information Act).

Communication may also help to allay some of the fears that exacerbate stress, fear and anxiety. “For example, someone who suffers from white coat syndrome may find the doctor’s visit less frightening if the practitioner explains what they’re doing, why, and how it will feel at every step,” says Dr Green-Thompson.

Put loved ones’ minds at ease

Doctors should also strive to pre-empt hospital reactions wherever possible. “For instance, the medical team needs to assess the likelihood of ICU psychosis developing by considering a patient’s age, co-morbidities, and medicine regime,” says Dr Ganesh. They may then try to mitigate risks by prescribing the lowest dose of medication possible, for the shortest possible time, to lessen side effects and reduce the chances of drug interactions.

It’s also important to formulate a comprehensive treatment plan at the outset, detailing every stage of treatment and securing input from all practitioners involved, from allied medical therapists and dietitians to specialists. This plan should be communicated to the patient’s family, so they have an idea of timelines and how their loved one is being treated.

Family, too, can get involved, making the patient feel more comfortable by bringing their familiar items from home; whether that’s the blanket and pillowcase from their bed, lotion with their favourite scent, or headphones so that they can play the music they love.

Hospital care at home

“Finally,” says Dr Ganesh, “it may be worth investigating options like Medihelp’s Post-hospitalisation Care Programme.” This programme, recommended especially for members who require palliative care, helps to make them more comfortable by providing hospital-quality care in their own home.

“We try to hold our members’ hands every step of the way, so that whatever they or their family needs is readily available, whether that’s specialist equipment like a ventilator or the assistance of a professional counsellor,” she concludes. “By bringing the hospital to our members’ homes, we have been able to allow them to heal in the comfort of their homes and with their loved ones by their side.”