[Delirium in a consultation liaison psychiatry unit of a general hospital] (original) (raw)
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Delirium en la interconsulta psiquiátrica de un hospital general
Resumen Introducción: El delirium es un síndrome mental orgánico caracterizado por una alteración del nivel de conciencia, déficit de atención y trastorno del funcionamiento cognoscitivo global. La instauración es relativamente aguda y el curso fluctuante. Las causas subyacentes son numerosas, mayoritariamente patología médica y efectos adversos de medicaciones. Sujetos y método: Se presenta un estudio transversal y descriptivo de 62 pacientes atendidos por una Unidad de Psiquiatría de Enlace de un Hospital General que fueron diagnosticados de delirium según criterios ICD-10 a lo largo de un año. Se analizan variables demográficas, médicas y psiquiátricas. Resultados: La prevalencia de delirium en nuestro Hospital fue del 0,2%. No se hallaron diferencias significativas en cuanto al sexo de los pacientes. La media de edad correspondía a 64,46 años. Los servicios que más interconsultas realizaron fueron Cirugía General (19,4%) y Medicina Interna (17,7%). El diagnóstico médico más frecuente fue el de cáncer (25%) y fallo respiratorio (15,9%). El tratamiento psiquiátrico más pautado fue haloperidol. La impresión clínica del estado de los pacientes fue catalogado como grave en la mayoría y un 23,9% de ellos fallecieron. Conclusión: Los resultados apoyan que este diagnóstico se presenta con mayor frecuencia en pacientes con cáncer e insuficiencia respiratoria, y que se asocia a mortalidad en una cuarta parte de los pacientes. Además, este estudio sugiere un incremento de los costes hospitalarios, dado que la estancia media se incrementa notablemente con respecto al resto de pacientes ingresados. Palabras clave: Delirium. Epidemiología. Psiquiatría de Enlace. Hospital general. Summary Introduccion: Delirium is an organic mental disorder defined as a confusional state, attention deficit and disorganized thinking, with a fluctuanting course and acute development. Underlying causes are numerous, but the most common are multiple medical problems and drug side effects. Subjects and method: We present a descriptive and transversal study of 62 inpatients with delirium diagnosis (ICD-10 criteria) attended by a Liaison Psychiatric Department in a General Hospital during a year. The data included demographic, somatic and psychiatric variables. Results: The overall referral rate from the general hospital was 0.2%. No significant differences, were found in sex distribution. The age average was 64.46 years. The majority of patients were referred by Surgery (19.4%) and Medicine (17.7%). The most common medical diagnosis was cancer (25%) and respiratory failure (15.9%). Haloperidol was the most frequent psychiatric treatment. The greatest number of referred patients were included in the serious medical state and the 23.9% of patients with delirium diagnosis deceased. Conclusion: Data supports the statement that delirium is most often found in hospitalized patients with a diagnosis of cancer and respiratory failure, and that this diagnosis is associated with mortality in a hight proportion. Furthermore, this study suggest an increase in cost-containment since the average stay are increased in comparison with the rest of hospitalized patients.
[Delirium: the clinical confusion]
Revista medica de Chile
Delirium or acute confusional state is a condition that lies within the boundaries of psychiatry and other medical specialties. It is defined as a syndrome characterized by a fluctuating cognitive impairment of acute onset. The pathogenesis is multifactorial and it frequently appears in elderly patients admitted to general hospitals. Delirium carries a high mortality and it prolongs hospital stay. Its diagnosis if often overlooked and the treatment is inadequate or belated. This article discusses the most efficient procedures to diagnose and treat delirium. The review was based on a systematic search in the literature using the key words delirium, acute mental syndrome, acute confusional state and organic mental syndrome. Articles were selected according to their relevance and methodological accuracy (Rev Méd Chile 2003; 131: 1051-60). (
Delirium: Incidence and Clinical and Epidemiological Characteristics in a Teaching Hospital
Revista …, 2009
Introducción: El delírium es un trastorno neuropsiquiátrico frecuente en el hospital. Es un estado de conciencia anormal que altera la cognición, en especial la orientación y la atención. Se considera una complicación del cuidado hospitalario susceptible de prevención. Objetivos: Determinar la incidencia y el perfil clínico y epidemiológico del delírium en un hospital universitario en Medellín, Colombia. Método: Se realizó un estudio descriptivo prospectivo de corte transversal. Se evaluaron pacientes mayores de 18 años de edad para determinar la presencia de delírium y las variables sociodemográficas y clínicas relacionadas. Resultados: Se evaluaron 421 pacientes, de los cuales 29 cumplieron con los criterios diagnósticos de delírium según la CAM y los criterios diagnósticos del DSM-IV-TR. La proporción de incidencia de delírium fue 6,9%. El 62,1% de los pacientes con delírium eran hombres y la edad promedio fue de 64 años. Los subtipos motores fueron mixto, hiperactivos, hipoactivos, y el 6,9% no tuvo alteración motora. En el 86,2% de los pacientes el delírium fue debido a múltiples etiologías. El promedio de días de hospitalización fue de 37. El delírium fue identificado por los médicos tratantes en el 75,9% de los pacientes. Hubo mejoría en el 59%, y 13,8% de los identificados fallecieron durante la hospitalización. Conclusiones: El delírium es una condición clínica frecuente en el hospital general que se asocia con mayor estancia hospitalaria y mortalidad elevada.
2009
Dr. Franco Peverelli Residente de Clínica Médica. Facultad de Medicina. UdelaR. Hospital Maciel. Montevideo. ReSuMen: Arch Med Interna 2009 XXXI;4:93-98 Objetivos: conocer la prevalencia de sindrome confusional en pacientes internados en un hospital general. Identificar los factores de riesgo y factores precipitantes más frecuentes. Comparar la estadía hospitalaria y mortalidad en pacientes con o sin sindrome confusional. Material y métodos: estudio observacional, transversal de pacientes internados en hospital general. La herramienta utilizada para el diagnóstico de síndrome confusional fue assessment method for the intensive care unit (CAM-ICu). Se compararon los factores de riesgo en pacientes con y sin síndrome confusional. Los factores precipitantes fueron categorizados según los criterios DSMIV-TR. Resultados: se enrolaron 505 pacientes, se excluyeron 40. Se analizan 465 pacientes. La prevalencia de síndrome confusional fue de 7,5%. en el análisis bivariado los factores de rie...
Delirium in elderly inpatients: An 18 month follow-up
MEDICINA (Buenos …, 2010
Delirium usually hardens care during hospitalization and increases morbidity during hospital stay and after discharge. The objective of this study was to describe the prevalence of delirium in elderly inpatients in a Buenos Aires hospital, its morbidity and mortality during ...
[Delirium in Chilean elderly inpatients: an overlooked problem]
Revista médica de Chile, 2005
Delirium is a common underdiagnosed and undertreated problem in elderly inpatients, associated to higher morbidity, mortality and health cost. To evaluate the prevalence of delirium at hospital admission in medically ill elderly patients and the attending physician's diagnosis and treatment of delirium. In a prospective and descriptive study, consecutive patients aged 65 years or more, admitted to an internal medicine ward were evaluated by independent physicians, during the first 48 h of admission, to asses the presence of delirium. Diagnosis of delirium was based on the Confusion Assessment Method. Medical and nurse records were reviewed. Family was interviewed when necessary. One hundred eight patients (52% women, age range 65-94 years) with an APACHE II score of 11.6+/-5, were evaluated. Fifty seven patients (53%) had delirium (32% hyperactive, 72% hypoactive and 5% mixed). Delirium prevalence was significantly higher in older patients (66% among those aged 75 years or older...
[Liaison psychiatry in two public hospitals of Santiago]
Revista médica de Chile, 2004
Medical and surgical teams consult psychiatrists when abnormal behavior or psychopathological traits are observed in their patients. To describe the experience of liaison psychiatry teams in public hospitals. Analysis of 128 consultations, involving 110 patients. Eighty eight patients were subjected to the structured Clinical Interview for DSM-IV-TR Axis I Disorders--Patient Edition, the Mini Mental State score and to a search for personality disorders. The most commonly consulted problems were depression in 44 patients, substance abuse in 29 and suicidal behavior in 21. The psychiatric study detected that 8% of patients were asymptomatic, 8% had stress reactions, 16.5% had substance abuse, 14.6% had alcohol abuse, 11% had a major depression, 10% had delirium or dementia, 9% had anxiety disorders, 4% schizophrenia, 18% personality disorders and 19% had suicidal behaviors. Psychiatric consultations in medical and surgical services are common and have a wide variety of severity.
Delirium: la confusión de los clínicos
Revista médica de Chile, 2003
The clinical confusion about delirium Delirium or acute confusional state is a condition that lies within the boundaries of psychiatry and other medical specialties. It is defined as a syndrome characterized by a fluctuating cognitive impairment of acute onset. The pathogenesis is multifactorial and it frequently appears in elderly patients admitted to general hospitals. Delirium carries a high mortality and it prolongs hospital stay. Its diagnosis if often overlooked and the treatment is inadequate or belated. This article discusses the most efficient procedures to diagnose and treat delirium. The review was based on a systematic search in the literature using the key words delirium, acute mental syndrome, acute confusional state and organic mental syndrome. Articles were selected according to their relevance and methodological accuracy (