What is hospital psychosis?

A hospital environment can be extremely stressful for patients; they are often sick or in pain, or both, feel helpless and find themselves in an unfamiliar environment with people they don't know. The combination of this, combined with inadequate sleep and sensory deprivation caused by lack of sunlight and movement can lead to a condition known as hospital psychosis, ICU psychosis, or ICU syndrome. This is a form of delirium, a combination of symptoms that indicate a state of severe mental confusion. Those who experience it often report having hallucinations, slurred speech or confusion, and memory loss.


Disorientation, paranoia, anxiety, and restlessness can be signs of hospital psychosis. The patient may also experience hallucinations, confusion, and nightmares. Sometimes people behave in uncharacteristic ways; for example, a sociable and talkative person may withdraw from others, or a kind and polite individual may become difficult, irrationally angry, and even combative. Patients may also pull out catheters or intravenous (IV) lines, fight with nurses and other caregivers, and try to leave the hospital. In severe cases, the patient may even believe that their medical team is trying to hurt, rather than help, them or other patients.

Risk factors and prospects

Critically ill patients, especially those in an intensive care unit (ICU), are more likely to develop hospital psychosis, as are older patients. Research indicates that more than 80% of patients on a ventilator, which helps them breathe, can experience delirium, and people with acute respiratory distress syndrome (ARDS) seem particularly susceptible. Patients who develop delirium may also have a lower rate of recovery; they often have to stay in hospital longer and have higher death rates after six months.


Hospital psychosis may be diagnosed when a patient's symptoms cannot be explained by other medical causes. It is possible that some or all of the symptoms may be caused by the effects of medications or anesthesia, or by medical conditions such as blood infections, dehydration, and reduced heart activity. Low oxygen levels can also cause disorientation and slurred speech. Doctors are sometimes uncomfortable saying that a patient has hospital psychosis, as it means that other possible causes, some of which could be life-threatening, might not be fully explored.

A Link to Sleep Disruptions

While in the hospital, many patients complain that they do not get adequate restful sleep due to unfamiliarity with the surroundings and constant activity in the environment. Regular check-ups by nurses to check vital signs or administer medications can also impede a patient's ability to get enough rest. Lack of restful sleep can lead to hallucinations or slurred speech that resembles early Alzheimer's disease more than an actual psychotic break.

People who don't get normal signals of daylight and nighttime, because they stay in a windowless room for days, can develop another condition called sunset syndrome. It is especially common in older people. As its name implies, it is caused by abnormal sleep and wake cycles, and is reported to be common not only in hospitals but also in nursing homes and long-term care facilities. Its symptoms include agitation, anxiety, and even delirium.

Hospital psychosis is not a mental illness

Medical professionals generally agree that hospital psychosis is not necessarily evidence of a more serious psychiatric condition. It is best described as a state of mind triggered primarily by being in the hospital environment over time, not a mental illness. Visitors and caregivers may notice a significant change in the patient's behavior after a few days; in rare cases, it may take even less time for symptoms to develop.

It can be frightening to see a loved one act irrationally or completely out of touch with reality, but it's important for family members to know that sufferers cannot control their behavior. Many sleep-deprived or anxious patients may not realize that they are confused or delusional, much less why. However, during more lucid moments, they may regret what they did or said while experiencing an episode.

Management and treatment

Sometimes the presence of familiar people and even things can help someone with this condition focus on the "real world" for a few minutes. Visits from friends and family can help patients stay in touch with the world outside the hospital and feel less isolated and anxious. For some patients, regular contact like this can keep them grounded in reality, but others may require more intervention.

If medications or treatments are contributing to the psychosis, they may be changed to reduce some of the symptoms. However, many times the specific treatment is medically necessary and cannot be changed. Keeping the patient well hydrated and managing pain levels can also help alleviate delirium. In some cases, a patient may be given antipsychotic medications to counter her disconnection from reality. Sedatives may also be given, although their use should be carefully monitored as such medications can only cause more confusion for the patient.

Reducing noise and interruptions during the night can help patients with sleep problems. Establishing a regular day and night schedule can also reduce symptoms; This may include making sure the patient knows the day of the week and the time of day, along with visual cues such as having the lights coordinated with the day and night cycle. In some cases, simply moving the patient to a room with windows can cause symptoms to lessen or even go away.

a temporary state

Even without treatment, most symptoms of psychosis in the hospital disappear and the victim's personality returns to normal shortly after he or she goes home. A third or more of ICU patients report some long-term cognitive decline after leaving the hospital, including problems with attention and memory, and many people experience depression. After a hospital stay that included episodes of delirium, visits from family and friends can help the patient feel calm and return to normalcy.

Any change in a patient's behavior or cognitive abilities during a hospital stay should be reported to their health care team. These changes may be caused by a serious medical condition and should not be attributed to hospital psychosis until all other causes are ruled out. Even if a doctor diagnoses a patient as having this condition, she may choose not to treat mild to medium cases so as not to overmedicate the patient.

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