An evaluation of cases with delirium in a training hospital / Bir eğitim hastanesinde deliryumlu olguların değerlendirilmesi (original) (raw)
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European Psychiatry, 2008
Background and Aims: To study the long term effects of delirium in elderly hip-surgery patients on cognitive outcome. Methods: Prospective matched controlled cohort study. Medical school-affiliated general hospital in Alkmaar, The Netherlands. Hip-surgery patients (n¼112) aged 70 and older who participated in a controlled clinical trial of haloperidol prophylaxis for delirium, were followed for an average of 30 months after discharge. Patients with a diagnosis of dementia or mild cognitive impairment (MCI) were identified based on psychiatric interviews. Proportions of patients with dementia or MCI were compared across patients who had postoperative delirium and selected control patients matched for preoperatively assessed risk factors who had not developed delirium during hospitalization. Other outcomes were mortality rate and rate of institutionalization. Results: During follow-up 54.9% of delirium patients had died compared to 34.1% controls (relative risk ¼ 1.5, 95% CI ¼ 1.04-2.1). Dementia or MCI was diagnosed in 77.8% of the surviving patients with postoperative delirium and in 40.1% of control patients (relative risk ¼ 2.7, 95% CI ¼ 1.2-5.8). Group differences for rate of institutionalization were not significant. Conclusion: The risk of dementia or MCI at follow-up is more than doubled in elderly hip-surgery patients with postoperative delirium compared with patients without delirium.
Frontiers in Medicine, 2020
Background: The aim of the study was to assess the occurrence rate of delirium among elderly hospitalized patients in the medicine wards of a large tertiary hospital, to identify risk factors, and to evaluate the diagnostic rate for delirium among the medical teams. Methods: A 3-month prospective study of patients 65 years of age and above in three medicine wards: in two wards patients were examined by trained study team members using the Confusion Assessment Method (CAM), while the third was a control ward where CAM was not administered. The third ward served to control for the effect of the presence of investigators in the other wards as a potential confounding factor. Based on the results of this assessment patients were defined as suffering from subsyndromal delirium, full delirium (these two groups were later combined into an "any symptoms of delirium" group), and no delirium. The rate of diagnosis by the medical team was obtained from the electronic medical records. Results: The full delirium rate was 5.1%, the rate of subsyndromal delirium was 14.6%, and the rate of any symptoms of delirium was 19.6%. Absence of a partner, pain, anemia, hyponatremia, hypocalcemia, and the use of drugs with an anticholinergic burden were factors for any symptoms of delirium as well as for subsyndromal delirium. Subsyndromal delirium and any symptoms of delirium were associated with a reduced chance of being discharged to home and a higher 3-month mortality rate. A diagnosis of delirium was found in only 19.4% of the patients with any symptoms of delirium in the medical records. Conclusions: Delirium is a common problem among elderly hospitalized patients, but it is diagnosed sub-optimally by the medical team. There is a need for further training of the medical teams and implementation of delirium assessment as part of the ward's routine.
Delirium: Guidelines for general hospitals
Journal of Psychosomatic Research, 2007
Objective: Delirium is highly prevalent in general hospitals but remains underrecognized and undertreated despite its association with increased morbidity, mortality, and health services utilization. To enhance its management, we developed guidelines covering all aspects, from risk factor identification to preventive, diagnostic, and therapeutic interventions in adult patients. Methods: Guidelines, systematic reviews, randomized controlled trials (RCT), and cohort studies were systematically searched and evaluated. Based on a synthesis of retrieved high-quality documents, recommendation items were submitted to a multidisciplinary expert panel. Experts scored the appropriateness of recommendation items, using an evidence-based, explicit, multidisciplinary panel approach. Each recommendation was graded according to this process' results. Results: Rated recommendations were mostly supported by a low level of evidence (1.3% RCT and systematic reviews, 14.3% nonrandomized trials vs. 84.4% observational studies or expert opinions). Nevertheless, 71.1% of recommendations were considered appropriate by the experts. Prevention of delirium and its nonpharmacological management should be fostered. Haloperidol remains the first-choice drug, whereas the role of atypical antipsychotics is still uncertain. Conclusions: While many topics addressed in these guidelines have not yet been adequately studied, an explicit panel and evidence-based approach allowed the proposal of comprehensive recommendations for the prevention and management of delirium in general hospitals. D
The Indian Journal of Medical Research, 2010
Delirium is a complex neuropsychiatric syndrome characterized by disturbances in consciousness, orientation, memory, thought, perception, and behaviour due to one or more structural and/or physiological abnormalities directly or indirectly affecting the brain. It is quite prevalent in medical and surgical settings and is associated with high rates of death and healthcare costs. We review its prevalence, clinical features, risk factors, pathogenesis, assessment instruments, differential diagnosis, management, prognosis and prevention. Special emphasis is given on the Indian research, which is quite meagre.
Delirium: patient characteristics that predict a missed diagnosis at psychiatric consultation
General Hospital Psychiatry, 2007
Objective: This study evaluates patient characteristics that might predict a missed diagnosis of delirium prior to being seen by a psychiatric consultant. Method: Study participants were assessed using quantitative standardized scales of cognitive function, delirium and physical impairment. Results: Referring service personnel missed the diagnosis of delirium in 46% of psychiatric consultations. Two factors were associated with their failure to identify delirium accurately: use of a past psychiatric diagnosis to explain delirium symptoms and the presence of pain. Symptoms of delirium and quantitative scale scores did not distinguish between patients with whom diagnosis had been missed and those with accurate diagnoses. Conclusion: The consulting physicians of patients with delirium often incorrectly turn to past psychiatric diagnoses and/or are distracted by the presence of pain and, thus, fail to accurately diagnose delirium.
Delirium in the primary care setting
Psychiatry and Clinical Neurosciences, 2011
Delirium is a complex multifactorial neuropsychiatric syndrome with a broad range of cognitive and neurobehavioral symptoms. It is associated with major adverse events and poor outcome. Little is known about delirium in the primary care setting. A retrospective chart review was carried out for the identification of ICD-10 delirium cases presented in the regional medical office of a rural area in central Greece. Nine cases of delirium, mostly the hyperactive subtype, had been recorded. The patients tended to be elderly and suffering from dementia; infections were the underlying cause in most cases. All but one patient had been successfully treated in the primary care setting.
Delirium in hospitalized patients: Cohort observational in infirmary of medical clinic
Open Journal of Preventive Medicine, 2012
Objectives: To determine prevalence, incidence and risk factors of delirium in hospitalized patients in the infirmary of medical clinic of the Lauro Wanderley University Hospital. Method: An observational cohort study evaluating 140 patients over 18 years between admission and discharge. The survey instrument was the Confusion Assessment Method. Results: The prevalence of delirium was 5.7% (8/140) and the incidence, 2.1%. In patients with delirium were observed alteration of sleep-wake cycle (6/75%), altered level of consciousness (6/75%), disorganized thinking (5/62, 5%) and psychomotor retardation (5/62 5%). There was a significant association of delirium and age, mechanical restraint in bed, prior history of cognitive impairment, auditory and visual sensory deficit, psychiatric hospitalization, poor health status and mortality. Conclusions: The prevalence of delirium at admission was lower than that found in other studies, but it was a predictor factor of hospital mortality.
Delirium: Predictors of delay in referral to consultation-liaison psychiatry services
Indian Journal of Psychiatry 2014; 56: 171-175
Objective: To evaluate the predictors of delay in psychiatry referral for patients with delirium. Materials and Methods: The consultation liaison psychiatry registry and case notes of 461 patients referred to psychiatry consultation liaison services and diagnosed as having delirium were reviewed. Data pertaining to sociodemographic variables, clinical variables, Delirium Rating Scale‑Revised 98 version, etiologies associated with delirium were extracted. Results: Older age, presence of and higher severity of sleep disturbance, presence of and higher severity of motor retardation, presence of visuospatial disturbances, presence of fluctuation of symptoms, being admitted to medical ward/ medical intensive care units, and absence of comorbid axis‑1 psychiatry diagnoses were associated with longer duration of psychiatric referral after the onset of delirium. Of these only four variables (presence of sleep disturbance, presence of motor retardation, being admitted to medical ward intensive care units and absence of comorbid axis‑1 psychiatry diagnoses) were associated with longer duration of psychiatric referral in the regression analysis. Conclusion: The variables associated with delay in psychiatry referral for delirium suggest that there is a need to improve the understanding of the physicians and surgeons about the signs and symptoms, risk factors, and prognostic factors of delirium.
Occurrence and outcome of delirium in medical in-patients: a systematic literature review
2006
Background: Despite the acknowledged clinical importance of delirium, research evidence for measures to improve its management is sparse. A necessary first step to devising appropriate strategies is to understand how common it is and what its outcomes are in any particular setting. Objective: To determine the occurrence of delirium and its outcomes in medical in-patients, through a systematic review of the literature. Method: We searched electronic medical databases, the Consultation-Liaison Literature Database and reference lists and bibliographies for potentially relevant studies. Studies were selected, quality assessed and data extracted according to preset protocols. Results: Results for the occurrence of delirium in medical in-patients were available for 42 cohorts. Prevalence of delirium at admission ranged from 10 to 31%, incidence of new delirium per admission ranged from 3 to 29% and occurrence rate per admission varied between 11 and 42%. Results for outcomes were available for 19 study cohorts. Delirium was associated with increased mortality at discharge and at 12 months, increased length of hospital stay (LOS) and institutionalisation. A significant proportion of patients had persistent symptoms of delirium at discharge and at 6 and 12 months. Conclusion: Delirium is common in medical in-patients and has serious adverse effects on mortality, functional outcomes, LOS and institutionalisation. The development of appropriate strategies to improve its management should be a clinical and research priority. As delirium prevalent at hospital admission is a significant problem, research is also needed into preventative measures that could be applied in community settings.
Mental Disorders - Theoretical and Empirical Perspectives, 2013
Delirium is categorized in the cognitive disorders, characterized by acute onset, global impairment in cognitive, emotional, mental, and behavioral functioning, fluctuating level of consciousness, attention impairment, decreased or increased psychomotor activity and the disturbance of sleep-wake cycle. Emotional and behavioral abnormalities are common presented with some neurological manifestations, e.g., tremor, asterixis, nystagmus, incoordination, urinary incontinence. Delirium is a behavioral disturbance and serious complication commonly found in consultation-liaison psychiatry. Its prevalence and incidence rates are varied, possibly depend on severity of illness, patient population, the method of assessment and the diagnostic criteria. Prevalence of delirium ranges from 10% to 30% and its incidence is between 3% and 29% for patients admitted in general hospitals (Siddiqi et al., 2006, Maneeton et al., 2007a, Praditsuwan et al., 2012). High prevalence and incidence are noted in elderly and severely ill patients. For instance, the prevalence of delirium in elderly and ICU patients are up to 40% and 80%, respectively (Bledowski and Trutia, 2012, Praditsuwan et al., 2012). An occurrence of delirium is associated with miserable clinical outcomes. It often increases morbidity, mortality, length of hospitalization, institutionalization, and poor functional outcome (Siddiqi et al., 2006, Cole et al., 2009, Fong et al., 2012). The mortality rate is higher in patients with hypoactive subtype of delirium (Yang et al., 2009). Delirium is often under recognized by health professionals. There are many faces for the clinical presentation of delirium. It can be caused by a variety of etiology. To prevent and minimize the consequences of delirium, physician should prompt intervenes for this condition (Attard et al., 2008).