Palliative and Supportive Care

Case Reports

Surgical intensive care unit (ICU) delirium: A “psychosomatic” problem?

Michel Reicha1 c1, Regis Rohna2 and Daniele Lefevrea2

a1 Psycho-Oncology Team, Centre Oscar Lambret, Lille, France

a2 Department of Anesthesiology, Centre Oscar Lambret, Lille, France

Abstract

Objective: Intensive Care Unit (ICU) delirium is a common complication after major surgery and related among other potential medical precipitants to either pre-existing cognitive impairment or the intensity and length of anesthesiology or the type of surgery. Nevertheless, in some rare situations, an organic etiology is not always found, which can be frustrating for the medical team. Some clinicians working in an intensive care unit have a reluctance to seek another hypothesis in the psychological field.

Method: To illustrate this, we report the case of a 59-year-old woman who developed a massive delirium during her intensive care unit stay after being operated on for a left retroperitoneal sarcoma. Interestingly, she had had no previous cognitive disorders and a somatic explanation for her psychiatric disorder could not been found. Just before the surgery, she was grieving the recent loss of a colleague of the same age, and also a close friend, and therefore had a death anxiety.

Results: With this case report, we would like to point out the importance of psychological factors that might precipitate delirium in a predominately somatic environment such as an intensive care unit.

Significance of results: ICU delirium can sometimes be considered as a “psychosomatic” problem with either a stress response syndrome after surgery or a defense mechanism against death anxiety. Clinicians should be aware of the possibility of such psychological factors even if they always must first rule out potential somatic causes for delirium and encourage thorough investigation and treatment of these medical causes. A collaboration with the psycho-oncologist is recommended to better manage this “psychosomatic” problem.

(Received September 29 2009)

(Accepted October 17 2009)

Correspondence:

c1 Address correspondence and reprint requests to: Michel Reich, Psycho-Oncology Team, Centre Oscar Lambret, Lille, France. E-mail: m-reich@o-lambret.fr