"I Can Remember Sort of Vivid People…but to Me They Were Plasticine." Delusions on the Intensive Care Unit: What Do Patients Think Is Going On?
BACKGROUND
Patients who develop intensive care unit (ICU) acquired delirium stay longer in the ICU, and hospital, and are at risk of long-term mental and physical health problems. Despite guidelines for patient assessment, risk limitation, and treatment in the ICU population, delirium and associated delusions remain a relatively common occurrence on the ICU. There is considerable information in the literature describing the incidence, suspected causes of, and discussion of the benefits and side-effects of the various treatments for delirium in the ICU. But peer-reviewed patient-focused research is almost non-existent. There is therefore a very limited understanding of the reality of delusions in the intensive care unit from the patient's point of view.


METHODS
A secondary analysis of the original interviews conducted by the University of Oxford Health Experiences Research Group was undertaken to explore themes relating specifically to sleep and delirium.


RESULTS
Patients describe a liminal existence on the ICU. On the threshold of consciousness their reality is uncertain and their sense of self is exposed. Lack of autonomy in an unfamiliar environment prompts patients to develop explanations and understandings for themselves with no foothold in fact.


CONCLUSIONS
Patients on the ICU are perhaps more disoriented than they appear and early psychological intervention in the form of repeated orientation whilst in the ICU might improve the patient experience and defend against development of side-effects.
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
Julie L
http://orcid.org/0000-0002-7655-1963
JL
Darbyshire
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
Paul R
PR
Greig
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
Sarah
S
Vollam
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.|Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom.
J Duncan
JD
Young
Department of Primary Care, University of Oxford, Oxford, United Kingdom.
Lisa
L
Hinton
D000328:Adult; D000368:Aged; D003422:Critical Care; D003693:Delirium / Q000453:epidemiology*; D003702:Delusions / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013850:Thinking; D055815:Young Adult