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ICU PSYCHOSIS

Terminology. Psychosis: loss of reality testing

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ICU PSYCHOSIS

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    1. ICU PSYCHOSIS Ri ??? 91-10-26

    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 status:cognitive 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 Assessment:Admission 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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