Doctors feel hallucinations more common in ICU patients

NAGPUR: From imagining people around their ICU bed to hearing non-existent noise, hallucinations have long been a part of what doctors call “ICU psychosis”. But it has been hitting Covid-19 patients much earlier and more in numbers as compared to other patients. While it’s a myriad of reasons which lead to such hallucinations in Covid-19 ICU patients, the common theme among all is ‘being cut off’ from the outside world.
Dr Virendra Belekar, an intensivist at Kingsway Hospital said, “It’s usually after the fourth day that this (hallucination) starts. By this time the patient has been cut off from the outside world and has no idea whether it’s day or night. They haven’t seen a human face, as every medical staff is wearing PPE kit, and no chance of physically meeting relatives either. All these things start playing with their mind giving rise to hallucinations.”
A Covid-19 patient headed for the ICU already comes with a set notion about the disease, and that makes him/her prime candidate for “ICU psychosis”. Dr Sameer Arbat, leading interventional pulmonologist at KRIMS Hospital, said, “The patients have already heard and read about high Covid causalities before entering the ICU. So during admission to hospital itself they have preconceived notion about the prognosis. While ICU psychosis affects all patients, it’s true that Covid-19 patients are more vulnerable.”
The most common hallucination is imagining people, either known or strangers, around their bed. Patients’ reaction after such hallucinations, also varies. Dr Prashant Jagtap, senior interventional cardiologist at Viveka Hospital, said, “If the patient is an alcoholic then there’s a chance of him getting physically agitated, whereas others may be delusional and start mumbling words.”
He further said the treatment of such hallucinations require going right down to the root of the problem. “First, we have to look into natural causes like sodium level and how that’s affecting the patient’s behaviour,” Dr Jagtap said.
Dr Belekar said medical intervention includes use of sedative, but that too has certain limitations. “It’s given after checking multiple medical parameters and also with a special focus on not disturbing the biological sleep pattern,” Belekar said. Non-medical approach to deal with “ICU psychosis” includes moving the patient out to the rehabilitation bay, or to a window from where sunlight seeps. But this again, is not always possible for Covid patients. “For Corona patients, there’s high level of movement restriction so we arrange for video calls with their relatives to help them cheer up,” Dr Belekar said.
Apart from doctors, the second level of support comes from other patients. Dr Sandeep Mogre, director of Mogre Child Hospital, said, “These patients form strong friendships and constantly talk and guide each other. Nowadays, we are getting lot of related patients in ICU, and that also provides a psychological boost.”
For those who recover from the physical problem, the bigger danger still lurks ahead. Dr Arbat said, “In my experience in dealing with Covid, I can say that 50% of those who have recovered will require psychological counselling. And such counselling should only be done by qualified experts, not on social media through acquaintances and friends.”