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ICU PSYCHOSIS

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Psychosis: loss of reality testing & impairment of mental functioning ... surroundings, excessive noise, sensory monotony, absence of diurnal light variation. ... – PowerPoint PPT presentation

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Title: 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.
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