Hospital Psychosis

Have you ever had a loved one, who had no previous mental problems, or only slight dementia, go into the hospital or ICU?  Once there, did their entire personality and behavior take a 180 degree turn for the worse?  Did their grasp on reality go out the window?  Normally polite and mild mannered, did the person begin yelling at you and the staff?  Did they try to rip out their IV line, climb out of bed or think bugs were crawling all over them?  If you are nodding your head to any of this, more than likely your loved one had an episode of “Hospital Psychosis”….

First of all, what is hospital psychosis and how can the hospital or ICU cause it?  We all know the hospital is a stressful place to be.  It feels foreign.  It’s noisy.  Different and unfamiliar people are coming and going at all times of the day and night.  It is impossible to get a good nights sleep in the hospital.  So you have extreme stress exacerbated by sleep deprivation very early on.  Adding sedatives or anesthesia into the mix can also make the person more vulnerable.

Other possible causes:

Constant light from machines and staff entering in and out can disrupt normal biorhythms
Stress from being ill, away from home, loss of control of normal life
Unfamiliar people coming and going at all times
Away from loved ones or usual caregiver
Pain, metabolic disturbances and dehydration can be huge factors
Disorientated to time, day and what is going on in the world

Hospital psychosis is related to the length of stay in the hospital.  Family members may comment that the person seemed “not quite himself” the first day or two.   But by day three there was hallucinating, his speech was slurred with profound memory loss.  Some people develop the psychosis more abruptly.  Within hours of being admitted they may begin talking gibberish or try to climb over the rails out of bed. They may continuously brush at the bed thinking there are bugs everywhere.

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Hospital psychosis is real and it can be very dangerous when it’s severe.  Especially ICU psychosis where there are no windows, very limited contact with family and noisy machines.  These agitated patients have been known to begin ripping out vital tubes and IV catheters with disastrous results. So it’s important to remember that hospital psychosis can be life threatening.

Hospitals, doctors and nurses should first and foremost be aware of what hospital psychosis is and just as importantly what it isn’t.  In the past there seems to have been some reluctance on the part of the medical establishment to acknowledge that hospital psychosis exists.  Many times it remains untreated.  This is unacceptable! Frustrated and scared family members are told that its  just medication reactions, or the person has dementia, etc.
Hospital staff should understand that in most cases, the person has no history of dementia or mental problems.  The patient and family can be helped tremendously by a staff that:

Watches for and is alert to symptoms of possible hospital psychosis
Knows importance of taking immediate action,
Is capable of explaining it fully to everyone involved, including patient
All staff informed and committed to managing and treating early on
Can empower family members by informing them what they can and should do, as well as behaviors to avoid
Offer reassurance that the condition is temporary, will subside once the person goes home, and should fully resolve.

If you are in the medical field, can you imagine the peace of mind you can give by having this conversation with a patient or family member?  If you work in an ALF or Nursing Home your client has to go to the hospital, take it upon yourself to educate the patient and family.  This prepares them and reassures them.  If you are a patient’s primary doctor and have to admit him-take the time to educate your patient and family about hospital psychosis and the possibility it could occur.

What things can be done to  prevent hospital psychosis?

Encourage family and friends to conduct very frequent low key visits!  The patient needs to be surrounded by familiar faces.
If the person had a caregiver assisting them at home, make sure their caregiver continues to come and be with the patient as MUCH as possible-talking, reading, just sitting together.  Clients who utilize their caregiver when the family can’t be there have smoother sailing!
Protect the patient from unnecessary excitement, noise, chaos or arguments
Insist staff do all they can to coordinate lighting with day and night
Insist your loved one have blocks of dark, quiet uninterrupted sleep each night.
Disorientation worsens symptoms so make sure patient has his glasses to see, his hearing aid to hear
Having their caregiver there to answer simple questions, without waking the patient, when staff comes in to ask endless questions .
Doctor may use anti-psychotic or antidepressants to treat symptoms but w/ extreme caution-it’s possible their side effects could worsen the situation.