Hospital Psychosis

by Theanna Zika on January 20, 2011

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.

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 an in home caregiver, 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.

Please call our office if you have any other questions or would like to discuss this further with Heavenly Helpers Senior Home Care!

{ 21 comments… read them below or add one }

Linda Dunnihoo February 15, 2011 at 5:22 pm

EXCELLENT!!!! Thank you for such a great article on hospital psychosis… my father is recovering from a 6 day hospital stay. By the end he was calling in the middle of the night begging to be rescued from the warehouse he was (in his mind) being held! He also escaped the aide and ran down the hall before being apprehended by hospital security… He has often suffered from hallucinations in the hospital but it was never called “hospital psychosis” before– and it was never this bad. You describe the problem well. Now I have some tools to use when the inevitable next visit occurs. THANK YOU from the bottom of my heart.

carol shaylor June 24, 2011 at 10:43 am

My husband was hospitalized with double pneumonia, and a silent heart attack and dehydration. after about 3 days of being in ICU he became very confused. Tried to pull out Catheter, IV and climb over bed rails. Would not close his eyes or sleep. They tried sleeping pills, shots (DRUGS) which didn’t work. He imagined he was in snowstorm, (90 degree ) trains going through and very confused. Even after he was moved to his own room, he was still very confused. He was sent to a Rehab for 5 days to help him get stronger after 2 weeks of hospital stay. He was much better in a different setting and more sleep and more a natural setting. Confusion was 80% better when he returned home and is doing much better. He was in the hospital one year prior to this incident and also was very confused. Now I partially understand why and will be more aware if he has another hospital stay.

Mr. Brice September 7, 2011 at 6:08 pm

My father-in-law has been saying that he’s in a dungeon full of broken machines. Because we noticed a big change and the hospital staff at Saddleback Memorial Medical Center were so bad at letting us know what is going on, he’s now undergoing a battery of brain MRIs, ultrasounds, etc. We were told it was dementia, they saw it on his chart and then they saw it in his behavior. We explained that he only had previously exhibited light dementia and now he’s off the rails. My wife was crying when she saw the behavior changes, which were profound, and we had to go to the Internet to understand what could be going on. SOMETHING HAS TO CHANGE IN THE WAY HOSPITALS COMMUNICATE WITH FAMILY MEMBERS!!!!

matthew mee March 9, 2012 at 7:21 am

AWESONE EDUCATION. . . . For real this is exactly what happened to my father, and the longer he stayed in the hospital, the worse it got.
But we had an angel come to our house, a real angel and her name was Theanna Zika, she shared with us so many things that she knew that were all just so foreign to us as our parents were just geting older and confused. She said that we have to live in their world, listen to them, love them and care for them. She was awesome as well as her caregivers. We do believe in angels as they help us out every night and tell us everything is going to be ok, but Theanna was the real angel, and for that, we cant say thank you enough, we can only pass it on to the next person, and tell them what how blessed we were to have met the people and staff at Heavenly Helpers.

Chelley July 29, 2012 at 6:09 pm

I found the effects of Hospital Psychosis to be present
for approximately one month. I notice some signs
, although not nearly as severe, to have remained
five months on. Is it possible to have some
symptoms remain permanently? Or could they be
signs of another disorder/problem?

HeavenlyHelpers August 2, 2012 at 12:21 am

Chelley, First, I want to apologize for the delay in response to your great questions. As you know, I am not a physician and before I answered your question incorrectly, I wanted to review all my research of hospital psychosis. As I thought, all of the research shows that once a patient leaves the hospital and is at home, the symptoms should improve dramatically. You have indicated that your symptoms have in fact NOT gone away leading me to believe that perhaps there is another underlying cause of your sypmtoms.
In your comment you did not state why you were in the hospital but what I do know is that heart surgery and heart attack patients have a much higher rate of depression. Many patients develop an underlying depression while in the hospital and it isn’t discovered until after they are at home. You can read more about depression and heart attacks in my blog “Depression Following a Heart Attack”.
This being said, I urge you to speak with your physician to get a professional opinion about what may be causing your symptoms. We wish you well and ask that you please keep us posted on how you are doing.

HeavenlyHelpers August 2, 2012 at 12:40 am

Matt,
Thank you for such a beautiful response! Your comment is truly heartfelt and wonderful! What you have described in your comment is EXACTLY how we treat each and everyone of our clients. Like they are our own family, treating them no less than how we would want our own parents, grandparents, etc to be treated. This way of thinking is instilled into our caregivers from day one. I can not thank you enough for sharing your story, your thoughts. We continue to wish you and your family only the best!

Theanna

Nancy Gutkowski September 11, 2012 at 1:10 pm

Thanks for this information. I thought my husband was going crazy.

HeavenlyHelpers September 11, 2012 at 3:45 pm

Nancy, You are welcome! Most people do not realize that such a condition exists. It is a very real “syndrome” and can be unnerving to everyone including the patient. It is our hope that your husband is doing much better! Theanna

Richard Luna October 12, 2012 at 8:28 pm

Dear Heavenly Helpers,
Thank you so, so much for this incredibly helpful information. I too had an experience with a loved one
who was in the hospital for a weekly transfusion and had a psychotic episode. I am speaking of my 74 year old aunt who has aplastic anemia. I am her primary caregiver. I have been taking her to the same hospital for at least 10 consecutive months. However, on the last occasion she had a terrible episode. She thought she had been committed to an asylum after a severe car accident. She also believed the hospital staff had tied her to the bed. Needless to say she was screaming and cursing at the staff while flailing her arms and legs. One of the nurses wouldn’t even get close to my aunt in fear that she may cause her harm. Once I arrived at the hospital the next morning, she immediately calmed down and followed all of my directions.
She had a similar episode about a year prior during a 3 day hospital stay but, not as severe. It is apparent to me that unfamiliar faces, lack of sleep and being on a different floor of the hospital triggered her severe confusion and disorientation. I realize now just how much my physical presence means to my aunt in terms of her feeling safe. Thank you for allowing me to share this. I hope my experience encourages others to remain calm and carry on.

HeavenlyHelpers October 14, 2012 at 1:51 am

Richard,
Thanks for your comment. I agree completely that lack of sleep combined with a new environment and new faces contributes to this phenomenon. And of course age seems to be a factor. Are our brains just not as “flexible” with new experiences as when we were younger? And it makes sense that your aunt seeing something familiar and comforting which was you, calmed her down and made the psychosis go away. That is just so powerful! Its like she was adrift at sea until she saw you-an anchor-and things got better for her.

Tarah January 14, 2013 at 9:44 am

Dear Heavenly Helpers,
My stepmother had taken Xanax (up to a miligram 10x a day) for approximately 9 years, along with that, drinking alcohol and smoking heavily. She was also taking Prozac. She quit Xanax cold turkey in September of 2011. A few months after that, she had gained a little bit of weight. Soon after, her legs and ankles began to swell, and the swelling got so severe that she was unable to bend her legs. My sister, dad and I made repeated attempts and requests for her to see a doctor. She refused. Then, on December 21, 2012, she fell off the couch at night, in her sleep and couldn’t get back up because she could not bend her knees (due to the swelling). It was only at that point, that she went to the ER, and was transferred to a hospital over an hour away. She was diagnosed with congestive heart failure, COPD, and sever liver damage. Because she hadn’t seen a doctor in god knows how long, and she was diagnosed with so many things all at once, the doctors are kind of at a loss. They gave her lasix to drain the fluid and reduce the swelling. This dropped her blood pressure. They pumped fluid into her heart to make it beat faster to bring her blood pressure back up. But they had to be careful because of the CHF. She was fine, mentally a few days in, she even asked for help sitting up and swinging her legs over the side of the bed. By the end of week one, her blood pressure kept dropping, and she was brought to the ICU. Day 2 she had to be taken off of solid food and be put on a feeding tube, because she could not swallow. Her confusion wasn’t too bad. She just had really bad congestion, couldn’t talk very well, and was in and out of sleep. She was well enough at the end of week two and brought back up to the 6th floor. The first day was okay, mentally..she said a few confusing things. However, the last two days EVERYTHING she says is nonsense, confusing. She brings up people from the past, but can’t remember my dad in pictures. She says she knows she in a hospital, but she says she sees another bed “over there” or her purse “over there, that she just saw that morning.” but her purse has not been with her…it’s been 50+ miles away with my dad. Her MRI came back fine. They had her on Seroquel, but took her off. We’re not sure if taking that (it’s a drug to treat bipolar/schizophrenic patients, none of which is my stepmom) made this situation worse, or if her being in the hospital 3+ weeks is what’s causing it. Shes in a room with a window, but for some reason the clock was removed before she came to that room and hasn’t been replaced. i’m sure that can’t help things.

Tarah January 14, 2013 at 9:47 am

(i hit submit too soon!)…The situation we are facing is this: They won’t do physical therapy because of her mental state, so they can’t get her up and walking. They can’t remove the feeding tube because they say, mentally, she’s not strong enough or lucid enough to pass the swallow test. So, if this is indeed “hospital psychosis”, how can she get better, if she can’t go home yet TO get better??? i’m at a loss. I heard in some patients, this never goes away. Any advice?

Tarah January 14, 2013 at 9:49 am

I should also add that my step mother is only 62 years old.

Michelle February 14, 2013 at 2:21 pm

What about hospital psychosis causd by the drugs given to a patient? Very common!

Deborah Cronin March 22, 2013 at 3:02 pm

My father is currently in the hospital. He was admitted after having a TIA (which he has been having from time to time but always makes a full recovery w/no residual effect). This time they kept him overnight for an MRI and CT scan, both of which came back normal. As he was dressed and waiting for the doctor to discharge him the next day, he became agitated and combative. Now he is restrained in the bed for a week, being treated w/ activan and halloo, and is in and out of lucidity. The hospital wants to transfer him to a psych hospital or rehab center. They have run blood tests, done a spinal tap and cannot find anything medically wrong with him. I don’t think transferring him to a rehab center or psych hospital will fix this. My Mom is afraid to take him back home because when he is combative he is dangerous to deal with. We are at a loss! Any suggestions? My parents live in the Gonzales, Louisiana.

Melinda April 1, 2013 at 11:04 pm

I have been searching the internet for a reason to my mother’s “craziness”. I feel so relieved to read this article.
My mother is 46 years old and was admitted to the hospital due to COPD. After being in the hospital overnight, she lost touch with reality. She called me to say that there were people in her closet, she thought she was still at home, I listened to her have conversations with my nephew who wasn’t even there. I live 6 hours away and I didn’t know what to do. Her doctor thought it was due to the lack of oxygen because of the COPD but it was too severe for that. They then thought she was going through withdwals of some type. We spoke with her doctor and nurses and she was on no type of medication, only the oxygen and inhaler.

She has been wanting to leave and go home to care for my nephew that lives with her. I think being away from him has caused so much stress and thats part of the reason she is experiencing this. I am so thankful I found this!!

HeavenlyHelpers April 2, 2013 at 11:02 pm

Melinda,
I am a bit shocked to hear that Drs. and nurses are STILL not recognizing this? Shame on them! By not recognizing it quickly the medical staff is delaying treating what the real problem is as well as potentially putting the patient through unnecessary tests and procedures (as well as the family). I believe there is SO much we can do to help alleviate the fear and misery our loved ones are going through. We are scared witnessing it, but can you imagine deep down how scared they must be? There are some things that can’t be changed like the fact the patient is in a very foreign environment in which they now have no control. But there are other things that hospitals could look at such as the bright lights, nurses talking loudly or moving around abruptly, the medical staff talking in “elderspeak” to elderly patients…I believe these things contribute to a patient feeling depressed, confused, “rattled” and so scared. Not getting a good stretch of sound, restorative sleep also exasirbates the problem. If a nurse or Dr. would take the time just to take someone’s hand and hold it while they talk or look into their eyes and reassure them they are not going “crazy”, etc. If only western medicine would “get” that 5 minutes of human connection is more healing sometimes than any “state of the art” medical procedure…

Ally May 23, 2013 at 1:20 am

Hello,

My father has been in the ER, the PCU and the ICU for a month this Friday (always alternating)- too many nurses, too many rooms, unusual sleep patterns. He drinks a lot of alcohol and smokes cigarettes endlessly. He had a number of falls in one week and is on anti-seizure medicine. Many times he has fallen, and hit is head which landed him in the hospital. Thankfully, no head trauma was found. However, he is diagnosed incompetent with delirium and he is not his usual self. He tells crazy stories and our family is very worried about him. He tries to escape the hospital, worries about his money & now thinks someone wants to sell his home. He also talks about escaping police and thinking hospital attendants are trying to hurt or kill him. Any suggestions as to what I can do to re-stimulate his mind or get him into a healthy mental state? Currently, he is on a PEG tube, his nutrition is getting better, but I’m sure even with the IV he was dehydrated. His skin is pealing all over the place and his tongue had dry flakes of skin all over it. He had two bouts of pneumonia on top all of this. Currently his voice is barely a whisper and he forgets things sooner than what we tell him. I hope this is not permanent. In a few days, the hospital intends on sending him to a rehab facility to help him walk on this legs again (1 week to a month). I do not know what will happen with his mind while there either. Might it prolong his psychosis? I could really use some advice (even mild advice), since I am POA and his only child.

Thank you in advance for anything you may suggest.

Ally

HeavenlyHelpers June 22, 2013 at 4:27 am

Michelle
Absolutely! A huge cause! Thanks for mentioning that as something that should be explored as well.

Ellen Thompson June 28, 2013 at 10:03 pm

We had the same experience with my husband and had the same decisions to make. The Hospital staff strongly said he need rehab – He could not walk.
His hospital psychosis was horrible – he was restrained. Knowing rehab would make it worse because of the new environment, we spoke to a psychiatrist
and he STRONGLY advised us to take him home. We provided re-hab at home. After one week, he is much improved. Still has some episodes at night
but the is ” coming back” Good Luck!

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