Just as there are possible causes of ICU psychosis, there are also different schools of thought on treating the disorder with the main objectives to keep the patient safe, return the patient to baseline cognitive functioning, and prevent or mitigate long-term effects. The treatments looked at here are not exhaustive by any means.
The first line of treatment is medications to produce a calmer state in the patient. These meds may include Haldol, which is considered a first-generation antipsychotic. However, more recently, second-generation antipsychotics such as olanzapine are gaining approval due to the lack of extrapyramidal side effects (Carcella et al., 2019). The other medication that shows promise in treating ICU psychosis is Melatonin and the Melatonin receptor agonist Ramelteon. These medications have been shown to reduce the incidence of ICU psychosis by helping to regulate the sleep-wake cycle that is so often out of rhythm when in the intensive care unit (Carcella et al., 2019).
The use of Precedex shows excellent promise in the treatment of ICU psychosis in both ventilated and non-ventilated patients. This promise is possibly due to Precedex producing both a sedative and analgesic effect, thereby decreasing the need for medications such as morphine and benzodiazepine class drugs connected with ICU psychosis (McLaughlin & Marik, 2016). Another medication class that may prove useful, especially if anticholinergic drugs cause the psychosis, is cholinesterase inhibitors; an example of this class of medication is physostigmine (Arumugam et al., 2017).
In looking at medications that may be of use in the treatment of ICU psychosis, certain medications should be avoided or discontinued to prevent or reduce the symptoms. These medications to avoid are certain antibiotics, steroids, Reglan, opiates, benzodiazepines, antihistamines, and anticholinergic medications (Arumugam et al., 2017). The class of antibiotics most associated with ICU psychosis is the cephalosporins (Grahl et al., 2018). But, cephalosporins are not the only class of antibiotics that may cause delirium. Beta-lactams, Carbapenems, Metronidazole, Macrolides, Fluoroquinolones, Oxazolidinones, and Sulfonamides may also cause delirium. The reason for the antibiotics as the cause can range from toxicity, supratherapeutic levels, antagonistic action of Gaba-A, or the inhibition of monoamine oxide (MAO), with the symptoms of the psychosis resolving once the antibiotic is discontinued.
The non-pharmacologic treatment of ICU Psychosis includes measures that are labeled as multicomponent. These measures include orientation, engaging the patient in therapeutic activities and pet therapy, assisting with early mobilization, hearing/vision assistance, ensuring proper sleep, rehydration, and physical therapy. Of particular note are the things like the presence of a clock in the patients' room, ensuring their glasses or hearing aids are there, and aiding in a sound sleep by the reduction in ambient noise will go a long way in the reduction of and prevention of ICU psychosis (Arumugam et al., 2017).