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A detailed look at delirium, from the inside

16070214393_8b9ce40d42_zFrom the outside it looks scary enough: A patient so ill their connection to reality has frayed.

Now, a paper in the American Journal of Critical Care provides an inside look at the experiences of patients in intensive care who have suffered delirium, which is characterized by altered consciousness and disorganized thoughts. The work confirms that delirium is frightening, disorienting and can lead to long-lasting anxiety and post-traumatic stress disorder.

Delirium is a common symptom of the severe brain dysfunction caused by many serious disorders that send patients to the ICU. A team of Canadian researchers interviewed 10 patients who had suffered from the condition, distilling four main themes that characterize the experience:

  • Memory loss — Some patients reported feeling anxiety and shame because they couldn't recall what had occurred during some portions of their illness, the authors wrote.
  • Disconnection – Patients said they were frustrated and fearful when they were unable to communicate with family members and caregivers. One patient said, "It felt like I was living in a bubble; I couldn't move my arms or legs. And, ah, people all around me but no one answering me... I would be calling out to people but no one would even look up."
  • Processing – Both during and after the delirium, patients struggled to distinguish events that were real from hallucinations or other thoughts. Some of their hallucinations included, "frozen turkeys in a kitchen, car lights on the wall, large black birds, savage monkeys in the lights, fairies and a lady picking flowers." Patients also often did not know if they were asleep or awake.
  • Fear — Nearly all patients experienced the sense that they or their family members were in danger. These feelings were so strong several patients developed habits to try to prevent a reoccurrence, such as avoiding surgery or sleeping pills.

"Delirium puts additional emotional and physical stress on a patient whose health is already compromised and our findings demonstrate how potentially psychologically harmful ICU delirium can be," said lead author Karen Whitehorne, RN, a nurse therapist at Eastern Health in Newfoundland, Canada in a release. These findings add to existing knowledge about the condition and "can facilitate development of treatment plans," she and her colleagues conclude in the paper.

Photo by Dean Hochman

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