Intensive Care Psychosis and How to Cope with it

During our marriage, my husband and I have faced many challenges but one of the most difficult was watching a parent's battle with liver failure, brought about as a result of scleroderma, an often baffling disease which can result in both liver and kidney failure. Because her liver was so badly affected by the scleroderma, my husband's mother had to undergo a liver transplant at a local medical center in Indiana. Although she entered the hospital in relatively good mental shape,the operation and her treatment in the intensive care unit (often abbreviated as ICU) resulted in a disoriented state known as ICU psychosis.

Intensive care psychosis - what is it?

ICU psychosis didn't seem to be getting much attention when my mother-in-law went through surgery. From what I've learned since then, it is clear that she was suffering from intensive care psychosis. Her symptoms included confusion about what day or year it was and trouble recognizing family members.. She became increasingly agitated and fearful, saw things that weren't there (hallucinations) and imagined conversations that had never happened.

This was extremely painful for my husband and other family members to watch, seeing the effects of intensive care psychosis. A formal definition of ICU psychosis can be seen here at Medicine Net: www.medterms.com/script/main/art.asp . Many of the same signs and symptoms listed there mirror ones we'd seen firsthand. In addition, my mother-in-law had altered liver enzymes and metabolic changes due to her liver condition, increasing her risk for intensive care psychosis.

As my mother-in-law struggled through what would be the first of two liver transplants, family members got a crash course in helping her cope with the disorientation, confusion and fear that are so often a part of recovering from surgery and a stay in intensive care. Along the way, we were told of ways to make the situation better - sometimes by trial and error and other times with the aid of experienced nurses and other hospital staff.

ICU psychosis - tips for coping and helping someone you love get through it

The nurses at the hospital were often very kind and helpful. They'd seen plenty of instances of this type of psychosis so they provided some excellent suggestions. At the same time, we also had to wing it, especially when it was late at night or there were few nurses around. They had many other patients under their care so we did what we could - as best we could. Here's what worked for my husband and family members:

Tip one - try to have plenty of familiar items in the ICU room.

I can't recall who suggested this tip - but it really did seem to help. Family photos, a favorite item or anything that can help jog the memory of someone suffering from intensive care psychosis can make a huge difference. While these objects and photos didn't always work miracles or guarantee an instant return to mental clarity, there were times when they helped a great deal in bring my husband's mother back to a more lucid state. She only had to open her eyes to see these items.

Tip two - have the same nurse or set of nurses care for the patient who has ICU psychosis

Luckily, the same basic set of nurses were available much of the time. They became very attached to my mother-in-law and even came to her funeral afterwards. This was a great comfort to the family and they had the extra experience to know how to handle my mother-in-law's confusion. They also supported our flagging spirits when things became tough, particularly important for my husband, his sisters and others in the family.

Tip three - be watchful and monitor conversations of medical doctors and staff. Speak up if you feel the need.

There was one point where we felt that my husband's mother overheard a conversation that convinced her she was doomed. It turned out that doctors and nurses may have said some alarming things about her medical condition within earshot. This did nothing to help her already disoriented mental state. When we learned about this, we spoke up - and quickly! This prevented the situation from getting worse.

Tip four -music or television, used properly, can help with memory problems for those with ICU psychosis.

Interestingly, we were encouraged to have the radio playing gently in the background 24/7. Although we didn't do this, we did try to find channels on both the radio and television that were familiar, even reassuring. This did help a great deal to offset the memory problems suffered by my mother-in-law.

Tip five- help someone with intensive care psychosis have as normal a day and night schedule as possible. Maintain daily rhythms.

As you can imagine (or know from personal experience, if you've been a hospital patient), an ICU room can be a noisy place. Medical equipment can have all sorts of alarms, elevator doors may be located near a particular room and create additional noise, and nurses and doctors can enter rooms at all times of day and night. None of this creates a normal daily rhythm. By keeping such interruptions to a minimum and trying to reduce noise at night, we helped to establish a more normal day to night transition.

Tip six - know how ICU psychosis can be affected by medicines that may interact with each other.

My mother-in law was on two medications that had the potential to react with each other and worsen intensive care psychosis. One was an anti-rejection drug and the other was a painkiller similar to morphine. We were told that both medications could interact with each other and affect the mind, making disorientation even more severe. When the painkiller was reduced to the smallest dose possible - one that would still kill pain- my mother-in-law was a bit less confused. Based on this, I'd suggest you do your research and be prepared for any drug interactions.

Tip seven - realize that intensive care psychosis can be worse in a windowless room and try to make adjustments.

It really helped to recognize that biorhythms or the usual patterns we all have to distinguish day from night can be severely disrupted. If your friend or family member is lucky enough to have a room with a window, try to open the curtains during the normal times they'd be open during the day. Close them at night. If the room has no window, there are ways to make the room lighter or darker - just as they would be during a normal day. Ask the nurses for help in making these adjustments.

Tip eight - minimize anything that disturbs sleep rhythms for patients with ICU psychosis

Controlling light and noise levels really made a difference. There were other steps we needed to take to help minimize sleep disruptions. Stronger medications were given at night, helping with sleep and less medication can sometimes be given during the day. Of course, situations will vary but aiming for a normal sleep pattern is a worthy goal.

Tip nine - try to speak calmly and be reassuring to those suffering from intensive care psychosis.

This might seem obvious but it can be hard to remain calm if a doctor has just taken you out in the hall or delivered terrible news. Taking a breath and remembering to try and speak calmly to someone in the ICU room can make a huge difference. Even someone who seems out of it may recall a particular worried tone or anxiety expressed by those around him or her.

Tip ten - think about clear guidelines about visits from those outside the family when someone is going through ICU psychosis.

This is a tough call because it can be so comforting to have friends nearby. However, it might be best to see them in special waiting rooms and limit how many people pop in during the day or night. The intensive care unit had strict visiting hours but friends were generally allowed to be in the waiting rooms. To avoid burnout for family members, it can be helpful to ask (gently, but clearly) that visits be limited during particularly stressful times. This is a very individual judgment call, of course, and some family members might want friends nearby.

The nurses told us of many patients who'd undergone terrible and difficult surgeries and recovered fully from ICU psychosis. I saw this with my own father after a heart surgery. My mother-in-law was not so lucky, dying after her second liver transplant. Even so, the steps taken to combat the mental confusion and anxiety that accompany this particular type of psychosis kept a bad situation from getting even worse.