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Query: UMLS:C0011206 (delirium)
 5,996 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors evaluated 73 cardiac transplant recipients 1 month to 6 years after transplantation to determine the prevalence of psychiatric disorders and psychosocial problems after cardiac transplantation. Affective illnesses had occurred in 51%, chiefly as a steroid-related syndrome, with mood lability, irritability, and grandiosity (22%). Major depressive episodes occurred in 11%. Postoperative delirium occurred in 4%. Anxiety symptoms were frequent (26%) but generally transient. Other frequent problems included cognitive, family, marital, and sexual dysfunction and inability to gain employment. Further effort is needed to reduce psychiatric morbidity and improve outcome for heart transplant recipients.
Gen Hosp Psychiatry 1989 Sep
PMID:Psychiatric outcome of heart transplantation. 279 46

Using explicit criteria, delirium was diagnosed in 15% of a cohort of 133 hospitalized patients. Following each patient's discharge or death, the length of stay was compared with the diagnosis related group-predicted length of hospitalization. An analysis of stay variations disclosed that delirious patients exceeded their predicted stay by an average of 13 days, while nondelirious patients exceeded theirs by 3.3 days. The mean (+/- SD) length of hospitalization for patients with delirium was significantly longer than for their nondelirious counterparts (21.6 +/- 23.7 days vs 10.6 +/- 10.1 days, respectively). Hospitals treating high proportions of patients with delirium as a comorbidity to a principal somatic diagnosis should institute measures for the early detection of and appropriate intervention in patients with this condition. These steps may help reduce prolonged hospitalizations and minimize financial risk under the current diagnosis related group reimbursement system.
Arch Gen Psychiatry 1988 Oct
PMID:A prospective study of delirium and prolonged hospital stay. Exploratory study. 313 60

Psychotropic drug use in the patient with cancer is reviewed from the perspective of the practicing oncologist and the consulting psychiatrist. Guidelines are offered for use of psychotropic agents for specific symptoms, such as nausea and vomiting, pain control, treatment of depression, delirium, anxiety, and psychosis. The importance of careful assessment and treatment of the causes of psychiatric symptoms is stressed. Recommendations for use of specific psychotropic agents are reviewed, including dosage range and route of administration as well as possible drug interactions and other factors affecting the use of these agents in patients. Anecdotal uses of these agents are also considered.
Gen Hosp Psychiatry 1987 Sep
PMID:Psychotropic medications in patients with cancer. 331 44

The assessment of suicide risk is a central activity of the general hospital psychiatrist for patients admitted following a suicide attempt and others who are identified after admission as being potentially suicidal. While biologic and psychosocial measures have some long-term predictive value, there is no valid measure to predict acute suicide risk. The lack of a valid measure does not, however, relieve the clinician of the obligation to perform an appropriate assessment. Pertinent appellate case law decisions not that the evaluation and record keeping must be "adequate," though no definition for adequate standards is provided. This paper presents issues that are considered so fundamental for suicide assessment that failure to obtain and record such information would potentially constitute inadequate practice. These areas include: the patient's statement regarding current suicidal ideation and planning, the presence or absence of delirium, psychosis and depression, what the patient says it makes sense to do, confirmation by a third party, and global formulation. The guidelines in this paper are presented with the intention of establishing the basis for optimal clinical care and for minimizing legal vulnerability in the evaluation of the potentially suicidal patient in the general hospital.
Gen Hosp Psychiatry 1987 Nov
PMID:The assessment of suicide risk in the general hospital. 369 51

With a psychiatrist's standardized clinical diagnosis as the criterion, the "Hand-Held Tachistoscope" was 100% sensitive, but only 45% specific in detecting delirium among hospital patients on a general medical ward. For each true positive in this sample of 97 patients, there were almost 5 false positives. The 10 patients with clinically diagnosed delirium could not see the stimulus. This was also true for 24 of the 87 nondelirious patients. Performance on the tachistoscope was related to age and education. This was not true for another method of delirium case detection, the global accessibility rating. This rating was 90% sensitive and 95% specific when compared with the psychiatric diagnosis, and was stable across two days of ratings. The global accessibility rating warrants further evaluation as a simple screening test for delirium.
Gen Hosp Psychiatry 1985 Jan
PMID:Screening for delirium on a general medical ward: the tachistoscope and a global accessibility rating. 396 22

The authors analyze 133 cases of organic mental disorders (OMDs) from a total of 771 patients who were referred for psychiatric consultation from a general hospital. The cases represent a 2-year referral period which began July 1, 1980, when DSM-III criteria were instituted. Delirium and dementia are most commonly diagnosed and features of these, particularly in the geriatric population, are described. Delirium was more frequent in patients with multiple medical problems, was an indicator of poor prognosis having the highest mortality rate, and was usually undiagnosed by the referring physician.
Gen Hosp Psychiatry 1985 Apr
PMID:Delirium and other organic mental disorders in a general hospital. 399 99

To examine the feasibility of using antidepressant medication to treat major depressive syndromes in the hospitalized medically ill, we reviewed a series of psychiatric consultations meeting the following criteria: the consultant diagnosed a major depressive syndrome, treatment with an antidepressant was advised, the consultee initiated the antidepressant, and hospitalization had been prompted by a major medical illness. The final sample of 50 consultations, representing less than 5% of the case reviewed, was assessed by retrospective study of entries in the medical record. Judgments regarding response were thus a function of routine clinical observation and care. Drugs were not randomly assigned; rather, the choices represented ongoing clinical usage patterns. Two major points emerge from the data of the study. First, 32% of the trials were terminated due to side effects judged to be unacceptable by the physicians or consultants. Delirium accounted for half of such side effects; cardiotoxicity, however, was not evident. Second, only 40% of patients with medical illnesses, including malignant neoplasm, insulin-dependent diabetes, and epilepsy, responded to treatment. The trials of antidepressants in medical-surgical inpatients did not achieve the pattern of therapeutic responses routinely characterizing comparable interventions in psychiatric patients with primary affective disorder.
Arch Gen Psychiatry 1985 Dec
PMID:The outcome of antidepressant use in the medically ill. 407 8

Acute delirious mania as a clinical state was first described over a century ago, yet it is often unrecognized in clinical practice. Typically, the presence of delirium has most often been viewed as organic rather than functional in origin. Three recent cases illustrate the rather dramatic presentation, course, and treatment of such patients. While most often diagnosed as having acute psychotic episodes of organic delirium, these patients generally meet the criteria for a diagnosis of mania with attendant delirium and respond to the standard treatments for mania. Lack of recognition of delirious mania can lead to mismanagement of the short- and long-term courses of the illness.
Arch Gen Psychiatry 1980 May
PMID:Recognition of acute delirious mania. 610 94

Sarcoidosis may involve the central nervous system (CNS) in approximately 5% of cases. Three levels of neurological involvement are possible and include cranial nerve abnormalities, peripheral neuropathies, and lesions of the brain, spinal cord, and meninges. In addition to abnormal neurological findings, psychiatric presentations of CNS sarcoidosis include symptoms of delirium, dementia, depression, personality changes, and psychosis. The diagnosis usually rests on neurological, psychiatry, and cerebrospinal fluid (CSF) abnormalities with a history of sarcoidosis in other organ systems. The CSF, however, may be normal in as many as 30% of cases. The complexities of the illness and the difficulties that may be encountered in making the diagnosis are illustrated with a case of suspected CNS sarcoidosis that presented with delirium and choreoathetosis. The use of steroids as the mainstay of treatment is also discussed.
Gen Hosp Psychiatry 1983 Jul
PMID:Central nervous system sarcoidosis. 661 71

To assess the psychiatric knowledge of medical housestaff, the authors devised an oral examination based on two simulated clinical encounters and administered it to 26 medical residents. The case material embodied those psychiatric problems known to be common in medical populations, namely depression, delirium, dementia, and "psychogenic" pain. The standardized simulations were punctuated by standardized "open" questions with followup probes. A panel of experienced clinicians developed rating criteria for each question such that responses could be categorized ad "good," "adequate," "inadequate," or "poor," in terms of "what an internist needs to know." Blind raters of the exam achieved an interrater reliability of 0.08. The results indicate major deficits in the knowledge needed for assessment and treatment of these common problems. Only 16% of answers were "good," where as 42% were "inadequate" or "poor". For example, 88% of the doctors could not name three factors that help distinguish organic from "functional" psychosis, and 88% could not list three side-effects of tricyclic antidepressants. The doctors' level of experience was not correlated with test scores, either overall or question by question. These results, together with measures of attitude and skill, have been used to develop a needs-based liaison psychiatry curriculum and to evaluate the effectiveness of that curriculum.
Gen Hosp Psychiatry 1982 Jul
PMID:An oral examination of the psychiatric knowledge of medical housestaff: assessment of needs and evaluation baseline. 711 26


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