Intensive Unit Care    Psychosis

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ICU syndrome A Dangerous Misnomer. Arch Intern Med/Vol.160Apr10 2000. What is ICU Psychosis ? . It is not a specific diagnosis, any more than term

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Intensive Unit Care Psychosis

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1. Intensive Unit Care Psychosis/ Syndrome/ Delirium By Intern ???

2. ICU syndrome A Dangerous Misnomer Arch Intern Med/Vol.160Apr10 2000

3. What is ICU Psychosis ? It is not a specific diagnosis, any more than term nosocomial infection, which simply means an infection contracted in a hospital. The Harvard Mental Health letter Dec.1999

4. Does ICU Psychosis really exist ? The prevalence of delirium in ICU varies considerably, ranging from 2% to 57% Acta anaesthesiol Scand 2002 46:726~731

5. Delirium DSM IV : and International classification of Disease, 10th 1.A disturbance of consciousness and attention 2.A change in cognition or perceptual disturbance, such as hallucinations 3.Rapid onset (and transient, lasting 24~48 hours) 4.Assumption of an underlying medical cause

6. Evaluation delirium in Mechanically Ventilated Patients : Confusion Assessment Method (CAM-ICU) JAMA,Dec 5,2001-vol286, no21

8. Incidence : Postoperative Delirium Arch Intern Med 1995;155:461-465

9. Survival Rate & With & Without Delirium JAMA, Feb 23, 1990-vol 263, No.8

10. Precipitating Factor Precipitating Factor Adjusted relative risks(95%CI) Use of Physical restraints (n=31) 4.4(2.5~7.9) Malnutrition (n=14) 4.0(2.2~7.4) >3 medication added (n=18) 2.9(1.6-5.4) Use of bladder catheter (n=50) 2.4(1.2~4.7) Any iatrogenic event (n=81) 1.9(1.1~3.2) JAMA, March 20, 1996-Vol275No11

11. Not the Cause : Sleep Deprivation : International diagnotic criteria list sleep disturbance as a necessary diagnotic symptom of delirium rather than being the cause of the disturbance ICU Environment : Social isolation, immobilization, unfamiliar surrounding, excessive noise --------may place a degree of stress on a person, but not documented causes of altered consciousness Psychological Factor : Not real personality profile has been developed that would allow one to predict postoperative outcome Arch Intern Med / Vol 160 Apr 10, 2000

12. Subtypes of the Delirium Hypoactive Delirium : characterized by withdrawal, lethargy apathy, total lack of responsiveness at time. Related to process such as infection, hypoxia, hypothermia, hyperglycemia, hepatic and renal insufficiencies and thyroid dysfunction. Hyperactive Delirium : Restlessness and agitation. Affected neurotransmitters are those associated with the adverse effects of drug intoxication, chemical withdrawl and anticholinergic agents. Critical Care NurseVol 20, No3 Jun2000

13. Etiology : The ICU Book 2nd Edi. Page 781

14. Common Drugs Associated with ICU Usage and Delirium Arch Intern. Med/Vol160 Apr10 2000

15. BedSide Evaluation : N/E Asterixis: Most specific sign of metabolic encephalopathy eg, from hepatic failure, hypercapnia, drug ingestion, esp.anticonvulsant medication Myoclonic Jerking or tremor in awake patient : uremic encephalopathy or use antipsychotic drug such as lithium, phenothiazines Myoclonus with coma : anoxic cerebral damage Septic Encephalopathy:a febrile infection in elder BeClouded Dementia : Harrison page 133

16. Etiology Analysis

17. Therapeutic Consideration Narcotis : the cornestone of analgesic therapy in ICU patients and for treatment of agitation associated with pain. Most common use :Morphine, fentanyl Haloperidol : Therapetic objective is to reverse the behavioral manifestation ICU delirium quickly without causing excessive sedation and hypotension Benzodiazepines Midazolam : short term therapy (48~96 hrs) Lorazepam : long term therapy (>48~96 hrs) Pharmacotherapy 1998;18(1) :113~129

18. Midazolam & Propofol

19. Midazolam & Propofol No major differences in 1. efficacy sedation 2. amount or number of supplemental CNS depressants 3. changes in O2 consumption rates 4. time from drug discontinuation to the time could follow simple command The difference from time of discontinuation to the time of successful weaning or total recovery favored propofol Pharmacotherapy Vol.18 No.11998

20. ICU syndrome A Dangerous Misnomer The End ~~~ Thanks You

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