Intensivists have been aware of the phe- nomenon of ICU psychosis within the ICU setting for many years (McKegney 1966). However, it has been suggested that the conva- lescence of patients at home is the most psy- chologically stressful phase of critical illness (Lloyd 1993). Little consideration has been given to how patients cope psychologically after intensive care treatment, or to whether their experience in ICU has had any long-term effect on their state of mind (Bertrand 1987). Of the patients studied, 16 patients had no recall of their ICU stay. However, further probing appeared to stimulate the sub-con- scious memories of a few and produced vague recollections, which the researcher could relate to the ICU. Diagnostic criteria for Post Traumatic Stress Syndrome (PTSD) include the effort to avoid thoughts or feelings associ- ated with the trauma (Bertrand 1987). Of the patients who had recollections, 27 referred to discomfort or psychological disturbance while in the ICU. Memories of discomfort centred around equipment, particularly endotracheal tubes, nasogastric tubes, pain and medical pro- cedures. The degree of psychological distur- bances varied in magnitude from one patient's perceived view of alterations in his circadian rhythms, to distressing recurrent dreams of a persecutory nature. Five patients were still able to remember vividly their own nightmare or
dream at 6 months after discharge from the ICU. The level of the persecutory nature of phenomena fluctuated; but all were terrifying to the patients at the time. POMS, which was used to assess the patients' psychological profile, correlated well with the patients' reactions and description of themselves conveyed at interview. Vigour/activity and fatigue/inertia were the factors which scored the highest, followed by anger/tension. Environmental factors are known to play an important role in acute functional psychosis which occurs in an ICU (Lloyd 1991). This particular study did not address this problem specifically, but high- lighted an area whereby follow-up could prompt alterations in practice. One family stated the need to improve the environment for children, producing a familiar setting for comfort and normal stimuli, as found by Coles (1987).
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