Psychosis in the Intensive Care Unit: Diagnostic and Therapeutic Dilemmas

Intensive care unit is a particular medical environment, sometimes creating particular stress to patients prone to psychological and psychiatric phenomenology. ICU psychosis, delirium and depression have been originally diagnosed in patients undergoing cardiac surgery. There is a large casuistic of case reports with patients presenting ICU psychosis, actually not strictly related with a recent history of major cardiac intervention, but with other types of surgery as well. Continuous and systematic attempts are made to formulate etiological explanations, together with the search of ways to prevent or to treat ICU psychosis. We describe in this paper two cases, presenting the features of post-operative ICU psychosis. A review of the history of this syndrome is made, and the controversies related to terminological discussions are mentioned. We include a short pharmacological description of the drugs imputed as causative factors of ICU psychosis, as well as of the available therapeutic options. Non-pharmacological factors probably related to the presence of this syndrome are summarized, with a brief commentary of the relative importance of each of these factors vis-à-vis this particular psychiatric syndrome.