11:57pm October 27, 2012

ICU Psychosis

Is a term you should learn and be aware of if you or a loved one is in the hospital long-term.

It’s not really the same as psychosis, it’s more an aspect of delirium that can come to look a whole lot like a standard psychosis.

And it doesn’t just happen in ICUs. It happened to me on an ordinary ward. It’s not just ICUs in hospitals that tend towards creating this problem in people’s heads. (And it’s very much a part of the external circumstances, it’s not just from being sick internally.)

I actually had full-bore hallucinations and delusions. I thought I could hear the nursing staff talking about me at all times – saying things out of my worst nightmares, of course. And I had paranoid delusions about them all being against me and going to actually kill me. The worst point came when I heard what I thought was a young resident refer casually – with a joking name, even – (hallucinations are so fucking sneaky and realistic) a ward that my doctor supposedly had. And it was a ward for people my doctor had gotten tired of, and all the word was that supposedly I’d be sent to that ward. And then he would see me one more time, and then have them keep me there in a state that would result in my early death, if not worse. That part of the delusion showed up after I’d been asking for my doctor a lot because i knew he’d set the nurses straight… except the nurses didn’t need to be set straight, because they weren’t saying a fucking thing about me.

It got to where the lines they’d say were repetitive. It wasn’t a true hallucination either, not like other parts of my delirium. It was like my brain could take jumbles of white noise, conversations, and stuff, and then turn them into things that sounded like words. They used to wheel me around the unit to show me there was nobody talking about me, and I’d still hear them talking, but it would always be next to noisy air vents or something.

Finally my DPA told me basically “You’re delusional. And I am this close to making decisions on your behalf because of incompetence at this point. So… get a clue, please.”

And I did. I learned ways to shut out the voices and remember they were white noise. And I could even make them say anything in my head, which clinched the matter for me. And without the delusions there, the voices were just a nuisance.

I’ve never truly had an experience like this in my life before – I’ve been told to claim I have, and done so, but I’ve never truly actually really had it. And it increases my respect for people who have to deal with it 24/7, not just for the duration of a hospitalization.

But seriously. ICU psychosis. Look it up. Be aware of it. It’s important. (And I strongly suspect that anti-delirium treatment is far more effective on it than psychosis treatment. I mean I was on neuroleptics (for nausea) when all this was happening, and they had no effect at all. So I strongly suspect it’s “delirium-mimicking-psychosis” and needs to be treated as such. But it’s really fucking important. And really fucking terrifying if you’re the one going through it or anyone who cares about them. I’m just glad I had a good enough DPA to know what to do.

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