woman sitting on hospital bed in ICU, surrounded by medical equipment

Hallucinations in the ICU: COVID-19 and its toll on the mind

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For all the effects COVID-19 has on the body, its unsettling impact on the mind can’t be ignored. 

For years, doctors have reported patients experiencing “ICU delirium,” a sometimes intense mental state marked by hallucinations and paranoia. Research suggests that up to 80% of patients in intensive care suffer from such delusions.

A recent report in the Critical Care medical journal suggests that COVID-19 patients may be more at risk from ICU delirium because of the coronavirus’ effect on the central nervous system and the lengths doctors must go to manage it.

Couple that with the fact that quarantined patients can’t have family members at their bedside, it’s no wonder they lose touch with reality.

“Keeping away family members is a huge issue,” says Peter Rappa, MD, physical medicine and rehabilitation physician on the medical staff at Methodist Dallas Medical Center. “One of the key aspects of healing and recovery gets abandoned because of the fear of contagion.”

How delirium sets in

Delirium causes patients to feel confused and disoriented. They may imagine impossible scenarios, Dr. Rappa says.

“They might be visiting with loved ones who have already died, or they are in a different time period,” he says of patients’ perceptions.

The Atlantic recently featured several COVID-19 patients who suffered ICU delirium.

One Florida man told the magazine,  “One day I was in D.C., the next I was in Chicago, riding motorcycles with friends of mine I hadn’t seen in years. I was putting my shoes on, walking out of the hospital to have barbecue and a beer.”

He was even video chatting with his friend telling him he had a puppy keeping him company in the ICU and that President Trump just finished giving him a tour of Mar-a-Lago.

What triggers delirium?

Several factors are linked to delirium, Dr. Rappa explains, including a lack of oxygen getting to the brain.

The condition is more commonly seen among patients on ventilators, according to an article published in the Annals of Intensive Care.

“There are also some sedative medications that might contribute to the delirium, including benzodiazepines and opioids,” Dr. Rappa says.

But for COVID-19 patients who experience acute respiratory distress syndrome, a ventilator may be the only option, and it requires strong sedatives. These patients may also develop other risk factors during their stay in the ICU, including immobility, dehydration, and nutrition deficits.

Managing delirium

Dr. Rappa helps guide many critically-ill patients back to recovery. When it comes to improving their cognitive abilities, he has some tried-and-true methods.

“You need to restore the sleep-wake cycle because patients’ circadian rhythms can get really messed up in the ICU,” he explains.

Rehydrating with water and other fluids is crucial. It’s also a good idea for these patients to start moving around once they regain mobility.

“Aerobic exercise is the best way to increasing neurorecovery,” Dr. Rappa says.

Finally, Dr. Rappa says, it’s important to slowly wean patients off medications “that can cause some of the problems,” namely pain medications, benzodiazepines, and even sleeping medications.

Follow-up care matters

Even after leaving the hospital, some people might grapple with nightmares and the memories of frightening hallucinations. It can even turn into post-traumatic stress disorder or depression.

“All of that can be very frightening, and there’s a gap in their memory,” Dr. Rappa says. “There’s a bit of a panic that can happen with that.”

Consulting a counselor and reaffirming healthy relationships with friends and family members play an important role in improving patients’ mental health.

“If you really want to help somebody heal and recover,” Dr. Rappa advises, “mindset, belief systems, attitudes, and emotions have to be addressed — and those have a lot to do with the primary relationships in your life.”

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