Intensive Care Unit: Psychosis | Insight Medical Publishing

A unique clinical phenomenon of “Sun-downing” in Intensive Care Unit (ICU) setting has been discussed inconsistently over the years despite many clinical observations documented in medical literature. Most healthcare professionals define the term “sun-downing” or “ICU psychoses” as late afternoon neuropsychiatric behavior changes such as agitation, confusion, disorientation, associated with or without delirium. There is an important relationship between alterations in biologic circadian rhythm and sun-downing in a chart review of demented patients. Increased shadows and low lighting were also shown to contribute to late-day agitation and confusion. Thus, it is hypothesized that behavioral symptoms emerge as the daylight levels decline during the evening/night hours. We suggest combination therapy of both bright light plus melatonin in the management of ICU or sun-downing psychosis for critically ill patients with agitation, confusion, disorientation, associated with or without delirium