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During their stay in the hospital, patients often confront more than just their physical ailments. According to a study published in the British Medical Journal, delirium affects approximately 20% of all hospitalized adults, with higher rates in intensive care units (ICU). This state of confusion, known as hospital psychosis or ICU syndrome, can be exacerbated by factors such as constant pain, anxiety, and the disorienting hospital environment.
The National Institutes of Health reports that lack of sleep and sensory input, including reduced exposure to natural light, significantly contribute to the onset of this condition. Patients with hospital psychosis may experience disturbing hallucinations, disordered speech, and memory disturbances, signaling a profound disruption in their mental well-being. Addressing this issue is crucial for patient recovery, as it not only affects their mental state but can also impede their overall healing process.
Disorientation, paranoia, anxiety, and restlessness can all be signs of hospital psychosis. The patient may also suffer from hallucinations, confusion, and nightmares. Sometimes people behave in uncharacteristic ways; for example, a sociable and talkative person may withdraw from others, or a kind, well-mannered individual could become difficult, irrationally angry, and even combative. Patients may also pull out catheters or intravenous (IV) lines, struggle with nurses and other caregivers, and try to leave the hospital. In severe cases, the sufferer may even believe that his medical team is trying to hurt, rather than help, him or other patients.
Risk Factors and Outlook
Critically ill patients, especially those who are in an intensive care unit (ICU), are more likely to develop hospital psychosis, as are older patients. Research indicates that more than 80% of patients on a ventilator, which helps them breathe, may experience delirium, and people with acute respiratory distress syndrome (ARDS) seem particularly susceptible. Patients who develop delirium may also have a lower recovery rate; they often have to stay in the hospital longer, and have higher mortality rates after six months.
Hospital psychosis may be diagnosed when a patient's symptoms cannot be explained by other medical causes. It is possible that some or all of the symptoms could be caused by the effects of medications or anesthesia, or by medical conditions like blood infections, dehydration, and reduced heart activity. Low oxygen levels can also bring on disorientation and slurred speech. Physicians are sometimes uncomfortable saying that a patient has hospital psychosis, since it means that other possible causes — some of which could be life threatening — might not be fully explored.
A Link to Sleep Disruptions
While in the hospital, many patients complain that they do not get adequate restful sleep due to the unfamiliarity of the setting and the constant activity in the environment. Periodic bed-checks by nurses to monitor vital signs or to administer medication can also impede a patient's ability to get enough rest. Lack of restful sleep can lead to hallucinations or confused speech that appear more like early Alzheimer's disease than an actual psychotic break.
People who do not receive normal day and night light cues — due to being in a windowless room for days — may develop another condition called sundowners syndrome. It is especially common in elderly individuals. As its name suggests, it is caused by abnormal sleep and waking cycles, and is reportedly common not only in hospitals but also nursing homes and long-term care facilities. Its symptoms include agitation, anxiety, and even delirium.
Hospital Psychosis Is not a Mental Illness
Medical professionals generally agree that hospital psychosis is not necessarily evidence of a more serious psychiatric condition. It is better described as a mental state triggered primarily by the act of being in the hospital environment over time, not a mental illness. Visitors and caregivers may notice a significant change in the patient's demeanor after a few days; in rare cases, it can take even less time for symptoms to develop.
It may be frightening to see a loved one act irrationally or completely disconnected from reality, but it is important for family members to know that sufferers cannot control their behavior. Many sleep-deprived or anxious patients may not realize that they are confused or delusional, much less why. During more lucid moments, however, they may regret what they did or said while experiencing an episode.
Management and Treatment
Sometimes, the presence of familiar people and even things can help someone with this condition focus on the "real world" for a few minutes. Visits from friends and family members may help patients stay in touch with the world outside of the hospital, and feel less isolated and anxious. For some sufferers, regular contact like this can keep them connected to reality, but others may require more intervention.
If medications or treatments are contributing to the psychosis, it may be possible to change them to reduce some of the symptoms. Many times, the specific treatment is medically necessary, however, and cannot be altered. Keeping the patient well hydrated and pain levels under control can also help alleviate delirium. In some cases, a patient may be given anti-psychotic drugs to counteract his or her disconnection with reality. Sedatives may also be given, although their use should be carefully monitored since such medications may only cause the patient more confusion.
Reducing noise and disruptions during the night may help patients with sleep problems. Establishing a regular day and night schedule may also reduce the symptoms; this can include making sure the patient is aware of the day of the week and the time of day, along with visual cues like having the lights coordinated with the day and night cycle. In some cases, simply moving the patient to a room with windows can cause the symptoms to lessen or even disappear.
A Temporary State
Even without treatment, most symptoms of hospital psychosis disappear and the sufferer's personality returns to normal soon after he or she goes home. One-third or more of ICU patients do report some long-term cognitive impairment after leaving the hospital, including problems with attention and memory, and many people experience depression. After a hospital stay that included episodes of delirium, visits from family and friends may help a sufferer to feel calm and back to normal.
Any changes in a patient's demeanor or cognitive skills during a hospital stay should be reported to his or her health care team. These changes could be caused by a serious medical condition, and should not be attributed to hospital psychosis until all other causes are ruled out. Even if a doctor diagnoses a patient as having this condition, he may opt not to treat mild to medium cases in order to not over-medicate the sufferer.
FAQ on Hospital Psychosis
What is hospital psychosis and who is most at risk?
Hospital psychosis, also known as ICU delirium or acute confusional state, is a condition characterized by cognitive disturbances that can occur in patients during hospitalization. Symptoms include confusion, disorientation, and hallucinations. Patients most at risk include the elderly, those with pre-existing cognitive impairments, individuals undergoing major surgery, and patients in intensive care units, particularly if they are mechanically ventilated or sedated for long periods.
What causes hospital psychosis?
Hospital psychosis can be triggered by a combination of factors such as the unfamiliar hospital environment, sleep deprivation, medication side effects, prolonged stress, pain, infection, or withdrawal from alcohol or drugs. According to the American Delirium Society, up to 80% of ventilated ICU patients may experience some form of delirium, which is a key component of hospital psychosis (https://americandeliriumsociety.org/delirium).
How is hospital psychosis diagnosed?
Diagnosis of hospital psychosis involves clinical assessment by healthcare professionals. They may use tools like the Confusion Assessment Method for the ICU (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC) to evaluate symptoms. Diagnosis is based on the presence of features such as acute onset of symptoms, fluctuating course, inattention, and either disorganized thinking or altered level of consciousness.
What are the treatments for hospital psychosis?
Treatment for hospital psychosis focuses on addressing the underlying causes and may include adjusting medications, managing pain, ensuring proper hydration and nutrition, and providing a calm and reorienting environment. Non-pharmacological interventions are preferred, but in some cases, antipsychotic medications may be used. Early mobilization and physical therapy can also help in recovery.
Can hospital psychosis be prevented?
Prevention of hospital psychosis involves a multi-faceted approach that includes minimizing the use of sedatives, providing adequate pain management, promoting sleep hygiene, and ensuring early mobilization. Environmental modifications such as maintaining a day-night cycle with natural light and reducing noise can also help. Family involvement and reorientation techniques are crucial in helping to prevent and manage the condition.