Just as there are possible causes of ICU psychosis, there are also different schools of thought on how to treat 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 the use of medications to produce a calmer state in the patient. These meds may include Haldol, which is considered a first-generation antipsychotic. However, more recently, the second-generation antipsychotics such as olanzapine are gaining approval due to the lack of extrapyramidal side effects.11 The other medication that shows promise in the treatment of 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.11
The use of Precedex shows excellent promise in the treatment of ICU psychosis in both ventilated and non-ventilated patients. The reason for 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.12 Another medication class that may prove useful, especially if the psychosis is caused by anticholinergic drugs, is cholinesterase inhibitors; an example of this class of medication is physostigmine.13
In looking at medications that may be of use in the treatment of ICU psychosis, certain medications should be avoided or discontinued in the prevention of or reduction of the symptoms. These medications to avoid are certain antibiotics, steroids, Reglan, opiates, benzodiazepines, antihistamines, and anticholinergic medications.13 The class of antibiotics that may be most associated with ICU psychosis is the cephalosporins.14 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)15, 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 are interventions such as 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.13,16,17