A Note to Families

Families need to understand what patients are going through, and what they can do to help. Here is an excellent article you should read about patient autonomy and ICU Psychosis.

Here are some tips for family members visiting patients:

Please Remember:

• Delusions are folded into real events, and the patient cannot distinguish between what is real and what is a hallucination. They may seem totally coherent and normal, then come out with something totally wacky. Be ready for this.


• The delusions cause anxiety and depression. They are often more depressed about the delusions than the underlying medical condition.


• All ICU patients want one thing more than anything else: Extubation. They want the tubes out. They will beg, plead, rip them out and lie to staff to get them removed. Go with the medical advice, and (as much as it pains me to say it) ignore the patient on this.

Do:

• Listen to the patient or always have a large piece of paper and marker for them to write (scrawl) on.


• Tell them you love them, and will protect them.


• Ask them if there is anything you can do to help.


• Emphasize "trust" in what they say.


• Work with them to develop an action plan to keep them safe (from whatever the delusions are telling them is a threat). This might be as simple as scheduling rotating visits so a family member is always "on duty" to "watch over" medical staff. Or maybe it means making sure a particular staff member who is the focus of a delusion is no longer scheduled to care for the patient. Or maybe it means moving an IV pole so they can see the read out, or removing an object that comes to life and attacks them. Often, the patient needs very simple things to bring great relief.


• When asked if you believe them, say you "trust them" and will do whatever you can to help. You do not need to "buy into the delusion" - just agree to trust them and act accordingly.


• Insist on psychiatric help. Hospitals have staff trained to deal with these situations.


• Agree to restraints. Because these delusions are real, they may harm someone or themselves (e.g. ripping the tubes out). Check the restraints to be sure there are no injuries.

Do Not:

• Tell them they are delusional, or directly challenge the accuracy of anything they say! Please, if there's one screw up you really, really need to avoid at all costs this is it. When someone told me I was delusional I would assume they were part of the conspiracy against me, and I no longer trusted them or wanted to see them.


• Breach their trust. If they have asked you to stay with them while they sleep (so as to protect them from murder), do NOT leave the room just because they have fallen asleep. They will wake up, see you're gone, and never trust you again.


• Stop visiting.