NEW YORK (Reuters Health) - About one of every three children treated in pediatric intensive care units (PICUs) subsequently report delusional memories of the experience, including disturbing hallucinations, resembling symptoms of post-traumatic stress, according to a study in the American Journal of Respiratory and Critical Care Medicine.
"Our results indicate that post-traumatic stress symptoms are associated with delusional memories rather than factual ones," lead author Gillian Colville comments in a press statement from the American Thoracic Society. "The hallucinations children reported were overwhelmingly disturbing and frightening, similar to those reported by adult intensive care patients and heroin addicts going through withdrawal."
Because there are no data on the rates of delusional memory or their effects on children in critical care units, Colville, a clinical psychologist at St. George's Hospital in London, and colleagues interviewed a consecutive series of 102 children, ages 7 to 17 years, about 3 months after they were discharged from a PICU.
Thirty-three children recalled at least one delusional memory, which included visual, auditory, and tactile hallucinations and delusional thoughts. In all but two children, the delusions "were experienced as highly disturbing," Colville and her associates write, "particularly in relation to their persistence and threatening content."
For example, patients reported "a cat bleeding on the ceiling," "rats in cups moving across the wall," "someone dropped a van on my head," "loads of massive spiders," and "people were getting killed."
The likelihood of having delusions was increased five-fold among children treated with opiates (strong pain killers, such as morphine) and/or benzodiazepines (tranquilizers, such as Valium) for 2 or more days, the authors report. Post-traumatic stress scores were higher among children with delusional memories.
The investigators suggest taking measures to reduce the likelihood of delusions and delirium, including changes in sedation regimens, simplifying the physical surroundings, and providing PICU patients with reassurance and information to re-orient them.
"Because these children are at increased risk of developing post-traumatic stress disorder, by virtue of the circumstances leading up to admission as well as the invasive nature of their treatment, improved psychological monitoring of this group is advisable, so that timely support can be made available," Colville's team recommends.
SOURCE: American Journal of Respiratory and Critical Care Medicine, May 1, 2008.
