Psychology
Traumatic flashbacks after a spell in ICU have been linked to excessive medication.
Traumatic flashbacks after a spell in intensive care have been linked to excessive medication.
write this overlooking Lake Wanaka, where I’m at the biennial Innovations in Health Psychology conference. To steal an Aussie-ism, it has been hard yakka. There have been lots of thought-provoking talks – more on that shortly – and some bonding activities. Jetboating on the waters supplying the lake, for instance.
At one point, my conference group had to take off our shoes and socks and hop out of our boat to lighten it. “Don’t worry, the water’s good,” said skipper Ben, nonchalant and thigh-deep in the river.
He was lying. It was not just cold, but “oh, my God, I am in pain and every fibre of my being just wants to get out, but it’s metres to the shore” cold. Admittedly, Ben had mentioned the waters came directly from a glacier.
The funny thing was the moment my feet hit the sand, they didn’t just register the cessation of pain but actually felt good. This is an example of what’s called pain offset.
If I get you to hold a metal bar with an element inside, you would report a consistent increase in discomfort and pain as I raised the temperature degree by degree. Imagine you’ve reached the point where you say you can’t hold it any longer, then I lower the heat by one degree. The pain would not just lessen, but would lessen much more than adding that single degree had hurt.
When you take away a pain-eliciting stimulus, you don’t just get less pain – the relief can actually feel good.
Another place characterised by a fair bit of discomfort, pain and uncertainty is a hospital intensive-care unit (ICU). This was the topic of the first talk of the conference, “The intense scare of intensive care”, presented by UK professor John Weinman.
ICUs, Weinman told us, are stressful places. He and his research group have reported that more than 80% of people coming out of ICUs experience post-traumatic stress disorder (PTSD), in the form of intrusive thoughts and images from their time in intensive care.
Normally, the intrusive experiences that come with PTSD have their roots in verifiably true events, and that was the case for 12% of Weinman’s ICU survivors. But the others reported PTSD symptoms that might include “true” memories but also others that were hallucinatory or delusional – they involved experiences and thoughts that didn’t connect with their actual experience. Imagine believing your nurse is an alien or seeing faces in the ICU curtains.
The why of this isn’t a mystery. If you’re in intensive care, you’re either there as someone whose system is full of potent drugs or you’re there with someone who is drugged to the eyeballs. Traditionally, one way to help patients who became distressed when in ICU was to give them more drugs to sedate them. Unfortunately, but predictably, it appears that this is implicated in the weird hallucinatory experiences.
I didn’t need to hear Weinman’s talk to know that ICUs can be stressful, but I’m sold on the efforts by him, his students and his colleagues to develop protocols and help staff to identify and intervene with people who would otherwise experience even more distress.
They have developed Poppi, or provision of psychological support for people in intensive care, a protocol that’s been introduced in more than 20 UK hospitals. It’s pretty simple and involves helping ICU nurses spot patients getting distressed and, rather than doping them up, potentially reducing their drugs and providing stress support for those at risk of developing further trauma.
So far, the evidence is promising, with Poppi making a difference to the lives of people after they’ve come out of intensive care.
Imagine believing your nurse is an alien or seeing faces in the intensive-care unit curtains.