Guillain-Barre Syndrome

[kathy_rn]

I'm an ICU nurse and for the last 2 days I had a GBS pt. Neuro is not our specialty and they may transfer the pt to another hospital; however, until that happens we have to take care of this person.
I have a question regarding the pt's mental status.
In agree w/ the daughter, the pt is a normal, coherent person. There is no underlying dementia, no mental problems of any kind, pt has never taken any antidepressants, was in good health until hospitalization. In spite of being elderly, the person is a very lucid person who lives a normal life, walks, talks, cooks, plays w/ grandchildren and so on. The confusion apparently started (in agree w/ daughter's perception) right after we started given immune globulin to the pt. I had this person as my pt for the last 2 nights and it was a nightmare. The person had visual hallucinations, pulled out tubes and lines that had to be reinserted, was completely restless, there was no comfort measure that would sooth her, no pain medication or nerve pain medication that would work, nothing. The pt would grab the gown and chew on it, would grab monitoring equipment and take it out, would scratch the skin to the point that I had to put mittens on or there would be blood everywhere. It was terrible. Nothing would help the pt. As a nurse I was really frustrated (and exhausted beyon belief) because I just hate when my pts are uncomfortable and I feel powerless. I called the doctor and we tried to switch meds and comfort measures but nothing. Last night the daughter stayed to help and having a familiar face helped a little but the pt continued to be agitated, restless, hallucinating.

I'm trying to research about the meds like immune globulin and see if there is/are side effects that would justify this change of mental status in my pt. As an ICU nurse, I'm aware of ICU psychosis and sundowners and I know that it can be the case w/ this pt. Also it may be that the daughter did not notice mental changes in her parent (which I honestly doubt because for the most part, family members know their family and the daughter would be aware if any signs of dementia would be present in a daily basis)....but it may be something that just started or came up because the hospitalization... I don't know. I was just wondering if GBS has anything to do with the change in mental status on my pt.
Any ideas/suggestions are welcome.
Thank you everyone.

[damaxta]

I know this was a long time ago now, but I'm sure this question will come up again.

Extreme hallucinations are common in GBS and there are a number of schools of thought as to the reasons why.

1) Central nervous system demyelination
2) Extreme exhaustion
3) Opiate pain relief
4) Neuropathic pain relief

I have heard of cases of people forgetting the names of loved ones, and I myself had real problems with hallucinations - sensory, auditory and visual in nature. I distinctly remember thinking I was a Transformer at one stage!

If the cause is in fact CNS demyelination, then the remyelination process is more complicated and less effective.

I know several people who feel like their ability to 'think' in an academic and learning sense is impaired, and although I seem to be improving... I am nowhere near where I should be (I was quite clever once!).

In addition, I had considerable behavioural changes. I was moody, aggressive and not a nice guy. I have since stopped things like Gabbapentin, carbomazapine, zopiclone and feel a lot better for it. (But please don't stop taking these things without speaking to your Doctor!).

[mariono]

I am a 63 year old female and I am recovering from GBS. I had my first symptoms on 23rd December, 2008, was admitted to hospital and was discharged on January 18th 2009 to continue my recovery at home. I did not receive IVIG treatment, as my Neurologist said the dangers of Renal failure was greater than the benefit of the treatment. He considered my case to be "mild" as the only area of paralysis was my upper legs and trunk area. He would, no dount, have given the treatment had my lungs/trachea been affected, as the risk is worth it in these serious cases. However, my whole body was affected by the tingling/numb/itchy sensations. From my experience, I don't think the mental confusion arises from the treatment, as I was also very confused at times. People need to realise that the suffering is immense, there is no way to describe it. You experience terrible pain, and painkillers don't always seem to help. My stomach and back made me feel as if I was in constant last stage labour and my hands felt as if they were being dipped in boiling water. The psychological effect on a person is also huge, imagine going from totally healthy to paralysed in a short time. The only thing I can liken to it is the same as if a person had a sudden accident and emerged a paraplegic. And the worst is, no-one can tell you if you are going to improve or worsen, and so you lie in bed in terror at every single little symptom. All of this physical and mental suffering is enough to drive you mad, never mind confused!! All I can say is that patients need and of TLC when going through this disease.

[gord]

for what it is worth, you may want to reads my posts " do I have a story for you" may shed some insight in regards to psycological impact.
gord

[Truth Seeker]

I felt compelled to reply to this post, because based upon personal experiences a lot of advanced scientific knowledge is missing as it relates to hallucinations and to label a pt with such terminologies can have lasting affects.
There are no doubts that hallucinations do occur, however I have yet to hear of anyone who fully understands the dualism within the human brain organ and all of its complexities.
There are vast differences between the left and right side of brain which are literally worlds apart.
The left side is the primitive part of the brain where we store a lot of clutter as it relates to unfinished thoughts and emotions which have never been confronted, dealt with or filed into memory.
We know of course, that in a healthy well balanced system, nerves spin to the right, but we need to understand that there are triggers that can change the spinning to counter clock spinning which is destructive, counter clock spinning will increase the speed, electricity and heat, obviously signals will change and the pt will feel paralysing fear or fear of the unknown, consequently the pt will react, become irritated, agitated or even aggressive based upon defense mechanisms which we clearly all have.
The right side of brain does not provide us with hallucinations because it is not based upon timed mechanisms or negative emotions, but rather is based upon speed and light which does transcend time, therefore photo imagery is based upon genetics.

[seaangel2364]

Plasma pheresis worked for me, twice. Good luck. Shawn