Page last updated at 00:57 GMT, Friday, 2 May 2008 01:57 UK
Delusions 'haunt' sick children
Paediatric intensive care
Children had few real memories of their time in intensive care
One in three children admitted to intensive care will suffer powerful and frightening hallucinations which stay with them, say UK researchers.
A study of 100 children found those who had hallucinations were more likely to show signs of post-traumatic stress disorder three months later.
The "delusional memories" may be linked to medication, such as painkillers and sedatives, the researchers said.
Some children may need psychological support after discharge, they added.
Although previous research has looked into adult memories of intensive care, very little has been carried out in relation to children.
It isn't clear, because the children are very ill, whether it's to do with the severity of their illness or the drugs used to treat it
Dr Reinout Mildner
Birmingham Children's Hospital
Study leader, Gillian Colville, a consultant clinical psychologist at St George's Hospital in London, said she had seen a considerable number of children in distress over the years.
She interviewed children aged 7 to 17 who had been treated at Great Ormond Street Hospital and found two-thirds could remember something factual about their time in intensive care although it was generally vague.
But 32% of children reported delusional memories, including hallucinations, the study in American Journal of Respiratory and Critical Care Medicine found.
It was these children who had significantly higher scores on post-traumatic stress screening tests.
Ms Colville said the children remembered the delusions vividly.
"The hallucinations children reported were overwhelmingly disturbing and frightening, similar to those reported by adult intensive care patients and heroin addicts going through withdrawal."
Dr Christine Pierce, consultant in paediatric intensive care at Great Ormond Street, said some children were having hallucinations about balloons in the shape of cartoon characters tied to the end of the bed and others reported having scorpions and spiders crawling on them.
"You're handing back a 'healthy child' but they are having difficulties going back to school or having nightmares.
"We now say to parents the hallucinations are a possibility and [the children] could have problems after they leave the unit and, if they do, please let us know and we can get them help.
"We bring in the psychologist very quickly now."
Dr Reinout Mildner, consultant in paediatric intensive care at Birmingham Children's Hospital, said the results definitely fit in with what he saw in the ward.
"It isn't clear, because the children are very ill, whether it's to do with the severity of their illness or the drugs used to treat it."
He said children may be very vocal about their hallucinations or withdraw into their own world - which can be very hard to recognise.
"It can be hard to follow children up so we need to make parents and other teams in the hospital aware of it."
Dr Bruce Taylor, honorary secretary of the Intensive Care Society, said: "What you do in intensive care, to give people a chance of survival, is not what nature intended so they have to be heavily sedated.
"Survival rates in paediatric intensive care are pretty good so it's a price that has to be paid and children are very good at bouncing back from these things."
Published ahead of print on January 31, 2008, doi:10.1164/rccm.200706-857OC
American Journal of Respiratory and Critical Care Medicine Vol 177. pp. 976-982, (2008)
© 2008 American Thoracic Society
Children's Factual and Delusional Memories of Intensive Care
Gillian Colville1, Sally Kerry2 and Christine Pierce3
1 Pediatric Psychology Service, St. George's Hospital, London, United Kingdom; 2 Community Health Sciences, St. George's University of London, London, United Kingdom; and 3 Pediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom
Correspondence and requests for reprints should be addressed to Gilian Colville, B.Sc., M.Phil., Consultant Clinical Psychologist, Pediatric Psychology Service, St. George's Hospital, London SW17 0QT, UK. E-mail: firstname.lastname@example.org
Rationale: Delusional memories are significantly associated with post-traumatic stress in adult patients after intensive care.
Objectives: In this study, we attempted to establish whether this relationship was found in children. We also examined the association between factual memory and distress.
Methods: One hundred two consecutive children, aged between 7 and 17 years, were interviewed about their pediatric intensive care unit (PICU) experience 3 months after discharge from a PICU. Principal measures were the ICU Memory Tool (a checklist of intensive care memories) and an abbreviated version of the Impact of Event Scale (a screen for post-traumatic stress disorder).
Measurements and Main Results: In total, 64 of 102 (63%) children reported at least one factual memory of their admission and 33 of 102 (32%) reported delusional memories, including disturbing hallucinations. Traumatic brain injury was negatively associated with factual memory (odds ratio, 0.23; 95% confidence interval [CI], 0.09–0.58; P = 0.002). Longer duration of opiates/benzodiazepines was associated with delusional memory (odds ratio, 4.98; 95% CI, 1.3–20.0; P = 0.023). Post-traumatic stress scores were higher in children reporting delusional memories (adjusted difference, 3.0; 95% CI, 0.06–5.9; P = 0.045) when illness severity and emergency status were controlled for. Factual memory was not significantly associated with post-traumatic stress.
Conclusions: This study indicates that delusional memories are reported by almost one-third of children and are associated both with the duration of opiates/benzodiazepines and risk of post-traumatic stress. More research is needed on the presence of delusional memories and associated risk factors in children receiving intensive care treatment.
Key Words: post-traumatic stress • hallucinations • memory • opiates • benzodiazepines
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