ICU psychosis: the patient's experience. An investigation of patients' understanding of hallucinations and delusions whilst in intensive care and post- discharge

This study explores how patients understand their hallucinatory and delusional type
experiences whilst in intensive care and how they feel about these experiences after
they have been discharged from hospital. The aims were to elicit their subjective
accounts in order to gain further insights into the phenomena and to improve clinical
practice.
The study employed a qualitative methodology and eight participants took part in the
research. Participants were interviewed using a semi-structured interview design and the
interviews were tape-recorded. The transcripts were analysed using an interpretative
phenomenological approach. The analysis revealed four super-ordinate categories:
awareness of self and surroundings, dream-like experiences, understanding of dreamlike
experiences and adjustment after hospital discharge. These contained several subordinate
categories.
Participants labelled their hallucinatory and delusional experiences as 'dream-like
experiences'. These consisted of various sequences that evoked torturous, threatening
and persecutory themes or less frightening themes such as escape and adventure. All
participants reported their experiences during intensive care as highly distressing. The
participants thought that their dream-like experiences were related to parts of
themselves that had been incorporated into their dream sequences. They also
acknowledged the role of medication and the intensive care unit context. These
experiences had a profound effect on some participants in that they felt it had altered
their sense of self whereas others felt they were not disturbed by these experiences. The
implications of these findings for future research and clinical practice are discussed.

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