Anxiety is a common reaction to physical or psychological trauma and to treatment in intensive care units (ICUs). It can be seen as a transient reaction in a previously healthy individual or as a manifestation of a pre-existing anxiety disorder. The treatment team should make every effort to put the patient at ease to avoid potentially harmful reactions (e.g. pulling out intravenous lines, refusing treatment, and leaving against medical advice). Direct discussion of the patient's medical condition and a compassionate stance by the clinician are crucial in guiding the anxious patient. A psychiatrist, a calm family member, benzodiazepines, and neuroleptics can each be helpful in reducing anxiety; their uses are discussed below.
Pain, particularly if not reported by the patient because of limited communication in the intensive care setting, often leads to agitation and jeopardizes the patient's recovery. Insufficient amounts of analgesics may have been administered, for fear that the patient might become addicted. Addiction rarely develops unless the patient has a history of drug-seeking behavior or of chronic pain refractory to numerous interventions.
Patients with rigid, obsessive, and controlling styles or with poor regulation of affect (e.g. with irritability, anger outbursts, and manipulative or hostile attitudes) often decompensate in the critical care setting. Furthermore, they are uncooperative and may induce a rageful counterattack by members of the treatment team. A non-judgmental but firm stance, which gives the patient as much control as possible while ensuring his or her safety, is essential for the survival of both the patient and the caregiver. Pharmacological or mechanical restraints should be avoided if possible.
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