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Complex Hallucinations in Hospitalized Rehabilitation Patients With COVID-19
Mari Tobita1,2, Shan-Pin Fanchiang1,2,3, Aida Saldivar1
1Rancho Los Amigos National Rehabilitation Center, Department of Health Services, County of Los Angeles, Downey, CA.
Insights
Over 20% of hospitalized COVID-19 rehabilitation patients experienced hallucinations, often visual and related to fear or comfort-seeking. These experiences impacted their rehabilitation participation and require awareness from multidisciplinary teams.
Area of Science:
- Neurology
- Infectious Diseases
- Rehabilitation Medicine
Background:
- COVID-19 (Coronavirus Disease 2019) can lead to neurological complications.
- Hallucinations are a potential, though not fully understood, symptom in hospitalized patients.
- Inpatient rehabilitation settings manage complex patient needs, including those with post-infectious sequelae.
Purpose of the Study:
- To characterize the types and themes of hallucinations in patients with COVID-19 admitted to an acute inpatient rehabilitation unit (ARU).
- To identify potential contributing factors and patient demographics associated with these hallucinations.
Main Methods:
- A retrospective review of medical records was conducted for patients admitted to the ARU between January 1st and April 30th, 2021.
- Inclusion criteria were confirmed COVID-19 diagnosis and the occurrence of hallucinations during their hospital stay.
- Data collected included patient demographics, clinical characteristics, intensive care unit (ICU) stay details, hallucination types, themes, and impact on rehabilitation.
Main Results:
- Out of 37 COVID-19 patients admitted to the ARU, 8 (21.6%) experienced hallucinations.
- Hallucinations were predominantly visual (7/8), consistent with peduncular hallucinosis, with themes of comfort-seeking, fear, and seeing deceased relatives.
- Patients with hallucinations had longer ICU stays (average 31.3 days), impaired cognition, and some experienced ICU delirium, depressed mood, or anxiety.
Conclusions:
- A significant percentage of COVID-19 patients in inpatient rehabilitation experienced hallucinations, impacting their recovery.
- The exact cause of these hallucinations in relation to SARS-CoV-2 infection remains unclear.
- Multidisciplinary rehabilitation teams must be vigilant for and prepared to support patients experiencing hallucinations during recovery.
Objectives:
To explore the characteristics of hallucinations in hospitalized rehabilitation patients with COVID-19.
Design:
Retrospective review using medical records of patients with COVID-19 and admitted to the acute inpatient rehabilitation unit (ARU).
Setting:
A public hospital in southern California, specializing in rehabilitation medicine. Participants: Patients with COVID-19 and hallucinations who were consecutively admitted from January 1st to April 30th, 2021.
Interventions:
Not applicable.
Main Outcome Measures:
Types and themes of hallucinations.
Results:
Eight of the 37 patients (21.6%) admitted to the ARU with COVID-19 exhibited hallucinations. All were Hispanic and 7 of them were men; their average age was 56.5 (range: 38-71). Seven patients had COVID-19 pneumonia and 1 developed respiratory distress secondary to Guillain-Barre Syndrome. One patient had posterior reversible encephalopathy syndrome. The average length of stay in the intensive care unit (ICU) was 31.3 days (range: 8-48). Most of the hallucinations occurred during their ICU stay and 2 continued to their ARU stay. All recalled details of hallucinations with 7 exhibiting visual hallucinations, consistent with peduncular hallucinosis with or without auditory and/or tactile components. One patient experienced tactile hallucinations. The themes of hallucinations identified to reflect the contents of the hallucinations were patients' comfort-seeking, fearfulness, and seeing deceased family members. All patients had impaired cognition at the ARU admission but improved at discharge. Four patients had depressed mood/anxiety and 1 had depressed mood alone but without a history of psychiatric illness. ICU delirium was documented in 5 patients. The negative experience of hallucinations seemed to affect their participation of the ARU stay.
Conclusions:
More than 20% of patients with COVID-19 who were transferred to attend inpatient rehabilitation exhibited hallucinations. It remains uncertain if these hallucinations were related to the SARS-CoV-2 infection. Multidisciplinary rehabilitation team should be aware to support patients with COVID-19 who experience hallucinations.
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