Psychological problems after critical care
Disturbed sleep – vivid dreams, flashbacks, remembered hallucinations
It can take a long time to get back into a normal sleep-wake cycle. Under sedation this is lost and it can take a while to readjust to normal. Going to bed and getting up at a regular time are helpful, and having something ready to do if you wake at night if useful and can stop worries taking over your thoughts. Some patients fall asleep and have vivid dreams or nightmares very quickly, and this makes them fearful of sleeping. This will get better over time and talking about experiences and knowing they are common and temporary will be help overcome the worry.
Night-time is when many patients remember hallucinations or delusional thoughts that they had during their ICU stay. They remain very real and frightening even after the patient realises they were disordered thoughts due to sedatives or illness and are just imaginary. Again talking about these with someone can be very helpful, particularly someone with a critical care background, as often the memory is based on some actual events, and understanding what happened helps the patient rationalise and accept the thoughts. Reviewing a diary of the patient’s ICU stay can be very helpful at this time of reflection and acceptance.
The thoughts may never go away but if accepted and understood they can become part of the patient’s own story of their illness. Sometimes, however, referral to a counsellor or psychologist is required to help the patient cope with their feelings, which are a form of post-traumatic stress disorder.
It is common to have mood swings, some days are good when you realise that you survived being so ill, others bad when you feel exhausted, and fearful of something similar happening again. Feelings of anxiety are common as are those of low self-esteem, particularly if the patient was previously independent, healthy and working.
Libido and affection are reduced by tiredness, mood and worry about physical appearance.
As a result of many factors depression can develop and it is important for this to be recognised and treated early, otherwise recovery can be further delayed.
The whole experience of a stay in critical care is stressful to everyone involved and this can continue into the recovery phase. If both the patient and the family talk about their feelings and concerns this often helps reduce their stress.