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

Delirium is a common mental disorder in the elderly. The Memorial Delirium Assessment Scale (MDAS) was developed in 1997 to assess delirium severity over time. The purpose of the current prospective study is to assess the clinical utility, diagnostic potential, reliability and validity of the Japanese version of MDAS in a psychogeriatric unit setting. Reliability was examined by testing 37 elderly patients; validity was examined concurrently by 16 patients with delirium. Two psychiatrists evaluated each patient simultaneously. Mean MDAS ratings differed among groups of patients with delirium, dementia, or no cognitive impairment. High levels of consistency within raters (Cronbach's alpha=0.92) and reliability between raters (0.98) were indicated. The correlation between MDAS scores and rating on the Delirium Rating Scale (r=.74, P=.0011), the Clinician's Global Rating of delirium severity (r=.67, P=.0047), and the Mini Mental State Examination (r=-.54, P=.029) was fair. The MDAS seems to be a reliable measuring instrument for assessing delirium in elderly patients.
Gen Hosp Psychiatry
PMID:Clinical utility and validation of the Japanese version of Memorial Delirium Assessment Scale in a psychogeriatric inpatient setting. 1122 56

The objective of this article was to estimate the incidence of delirium in a sample of patients undergoing elective surgery and to identify the preoperative factors most closely associated with developing this complication. Consecutive patients (n=500) underwent a full preoperative medical evaluation including assessment of cognitive and functional status. Daily evaluation on postoperative days 1 through 4 included medical record review and direct standardized patient interviews. Logistic regression was used to explore the associations between preoperative factors and postoperative delirium. Delirium was detected in 57 (11.4%) patients. Univariate factors associated with delirium included age> or =70 years (RR=3.1 [1.75,5.55]), preexisting cognitive impairment (RR=3.1 [1.73, 5.43]), greater preoperative functional limitations (RR=1.57 [1.27, 1.94]), and a history of prior delirium (RR 4.1 [1.98 to 8.27]. Adjusting for other factors, previous delirium (OR=4.08 [1.85, 9.0]), age> or =70 years (OR=3.2 [1.6, 6.0], and preexisting cognitive impairment (OR=2.16 [1.15, 4.0] remained predictive of delirium. Patients' perceptions that alcohol had affected their health (OR=6.53 [1.58 to 28.1]) and use of narcotic analgesics just prior to admission (OR=2.7 [1.37 to 5.3]) were also significantly associated with delirium postoperatively. Several easily obtained preoperative clinical factors can be used to identify patients at risk for postoperative delirium. This approach, when combined with specialized delirium teams using established guidelines, may be more effective in targeting patients at risk, thus reducing the number of episodes and days of delirium.
Gen Hosp Psychiatry
PMID:Preoperative risk factors for postoperative delirium. 1191 30

The referral pattern of neurological patients to 33 European psychiatric consultation-liaison (C-L) services in the general hospital was examined. Analyses were conducted on the ECLW CS data set, which consists of 14,717 psychiatric C-L referrals made in 56 European hospitals during 1991. Psychiatric referrals of patients admitted to neurological wards were compared to referrals from other wards. Information was obtained from 33 neurological wards, consisting of 34,506 neurological admissions. Of these admissions, 839 were referred to C-L psychiatry. The median consult rate among the hospitals was 1.8%. Compared to other hospital wards, patients referred from neurology were more frequently diagnosed as suffering from somatoform (P<.01) and dissociative disorders (P<.01), and less from substance abuse (P<.01) and delirium (P<.01). Referral to C-L psychiatry from neurological wards is characterized by an underestimation of psychiatric co-morbidity and a late detection, comparable to other medical specialties. An appeal is made for a standardized referral procedure including admission screening method, detecting patients at risk for nonstandard care during their hospital admission.
Gen Hosp Psychiatry
PMID:Referral pattern of neurological patients to psychiatric Consultation-Liaison Services in 33 European hospitals. 1142 48

This study explored factors associated with psychiatric morbidity in typhoid fever in a Nigerian general hospital. Information such as sociodemographic characteristics, symptom manifestations, results of investigations, neuropsychiatric symptoms, outcome and disposal were obtained from the case files of patients admitted for typhoid fever over a period of six years. The patients with psychiatric morbidity conspicuous enough to be documented by the attending physicians-mostly internists-were compared with those with no documented psychiatric morbidity on sociodemographic and clinical indices. Of the 136 cases, 26 (19.1%) had psychiatric morbidity. This included delirium (73.1%), generalized anxiety disorder (3.8%), depressive episode (3.8%), schizophrenia like disorder (3.8%) and monosymptomatic neuropychiatric manifestations such as apathy, hallucinations and irrelevant talking (15.5%). The clinical and sociodemographic indices that were significantly associated with psychiatric morbidity were diarrhea, blood biochemical imbalance and age (P<.05). Adolescents and young adults were more predisposed to developing psychiatric complications. Some factors potentially associated with psychiatric morbidity in typhoid fever have been identified. There is the need to prospectively assess the burden from psychiatric morbidity and identify interventions that may reduce it.
Gen Hosp Psychiatry
PMID:Correlates of psychiatric morbidity in typhoid fever in a Nigerian general hospital setting. 1142 49

The aim of this study was to identify psychiatric and somatic risk factors associated with the development, severity and duration of postoperative delirium after vascular surgery. Forty-seven patients underwent aortic, carotid artery and peripheral artery surgery. Both, surgeon and psychiatrist, monitored patients preoperatively with daily follow up. Preoperative psychiatric assessment included standardized psychopathological scales for the detection of psychiatric symptoms and cognitive deficits. We diagnosed delirium using DSM IV criteria. Delirium Rating Scale was used to estimate delirium severity. Surgical parameters included patient history, diagnoses, medication and laboratory parameters. A statistical analysis was performed using multivariate regression analyses to find factors significantly associated with delirium development, severity, and duration. Thirty-six percent of the patients developed postoperative delirium after surgery. Comparison of different parameters revealed that especially preoperative depression symptoms and perioperative transfusions/infusions had significant predictive value for the development as well as for the severity of postoperative delirium.
Gen Hosp Psychiatry
PMID:Risk factors for postoperative delirium in vascular surgery. 1181 31

The purpose of this investigation was to explore the psychiatric complications of liver cirrhosis in a Nigerian general hospital setting. The mental state of 31 consecutive patients with liver cirrhosis seen in a gastroenterology unit, from July 1996 to August 1998, was assessed using the 30-item General Health Questionnaire (GHQ-30) and Present State Examination (PSE) and compared with those of 20 hypertensive patients and 20 apparently healthy controls. The socio-demographic characteristics of patients with liver cirrhosis who developed psychiatric complications were compared with those without such complications. The mental status of the cirrhosis patients in the present study was also compared with those of Chronic Obstructive Pulmonary Disease (COPD) and hemodialysis patients in earlier studies. About fifty-five percent of all the liver cirrhosis patients developed diagnosable psychiatric morbidity. This was significantly higher than that of the hypertensive patients (15%) or healthy controls (5%) (P=0.0001). The psychiatric conditions were depressive episode, generalized anxiety disorder, delirium and adjustment disorder. No socio-demographic parameter had a significant effect on the mental state of the patients with liver cirrhosis. The same proportion (55%) of hemodialysis and a lower proportion (30%) of COPD patients compared with cirrhosis patients had psychiatric morbidity. We found a high rate of psychiatric morbidity in the patients with liver cirrhosis compared with those of hypertension and normal subjects. None of the socio-demographic variables considered was found to be associated with psychiatric complications in the liver cirrhosis patients. Poor medical conditions seem to be associated with high levels of psychiatric morbidity.
Gen Hosp Psychiatry
PMID:Specific psychiatric morbidity in liver cirrhosis in a Nigerian general hospital setting. 1249 Mar 47

This review is built upon a time-framed perspective to unfold the growth of evidence and the shifting of focus from primary affective short-term reactions to later findings of cognitive deficits and possible permanent impairment linked to steroid treatment. An incidence related to dosage has been documented and delirium and withdrawal symptoms have been reported in later studies. A hypothesis of sensitization process with multiple course of steroids has been proposed with the reporting of recurrent cases. The issue of individual risk appears unsettled while management of psychiatric reactions to steroids has shifted toward prophylactic use of lithium.
Gen Hosp Psychiatry
PMID:Steroid psychosis: a review. 1258 25

Delirium is a common psychiatric illness among medically compromised patients. There is an increasing opportunity to use atypical antipsychotics to treat delirium. The effects of these drugs on delirium, however, the most appropriate way to use them, and the associated adverse effects remain unclear. To clarify these points, a prospective open trial on risperidone was carried out in 10 patients with delirium. At a low dose of 1.7 mg/d, on average, risperidone was effective in 80% of patients, and the effect appeared within a few days. There were no serious adverse effects. However, sleepiness (30%) and mild drug-induced parkinsonism (10%) were observed; the symptom of sleepiness was a reason for not increasing the dose. One patient responded to a dose as low as 0.5 mg/d, so it is recommended that treatment start at a low dose, which may then be increased gradually. This trial is a preliminary open study with a small sample size, and further controlled studies will be necessary.
Gen Hosp Psychiatry
PMID:Treatment for delirium with risperidone: results of a prospective open trial with 10 patients. 1285 Jun 62

To determine the occurrence of delirium in oncology inpatients and to identify and evaluate admission characteristics associated with the development of delirium during inpatient admission, a prospective observational study was conducted of 113 patients with a total of 145 admissions with histological diagnosis of cancer admitted to the oncology unit over a period of ten weeks. At the point of inpatient admission, all patients were assessed for the presence of potential risk factors for development of delirium. During the index admission patients were assessed daily for the presence of delirium using the Confusion Assessment Method. Delirium was confirmed by clinician assessment. Delirium developed in 26 of 145 admissions (18%) and 32 episodes of delirium were recorded with 6 patients having 2 episodes of delirium during the index admission. Delirium occurred on average 3.3 days into the admission. The average duration of an episode of delirium was 2.1 day. Four patients with delirium (15%) died. All other cases of delirium were reversed. Factors significantly associated with development of delirium on multivariate analysis were: advanced age, cognitive impairment, low albumin level, bone metastases, and the presence of hematological malignancy. Hospital inpatient admission was significantly longer in delirium group (mean: 8.8 days vs 4.5 days in nondelirium group, P<.01). Delirium among hospitalized oncology patients is a common condition. Identification of risk factors to delirium at the time of inpatient admission can be used to recognize those patients at the greatest risk and may aid prevention, early detection and treatment.
Gen Hosp Psychiatry
PMID:Risk factors for development of delirium among oncology patients. 1297 26

Detection of cognitive impairment among hospitalized older individuals has shown to be insufficient. A point prevalence study in two geriatric hospitals in Helsinki, Finland, was performed among 219 acutely ill individuals over 70 years to assess the detection of dementia and delirium. Documentation of dementia and delirium in medical records, and recordings of confusional symptoms in nurses' notes were compared with the researchers' diagnosis made after a detailed assessment of cognitive status. The cognitive decline was mentioned in medical records in 70/88 (79.5%) of the cases. Cognitive testing was performed on 42/88 (47.7%) of the dementia patients, and the diagnosis of dementia was recorded in 47/88 (53.4%) of them. A specific etiological diagnosis was recorded in only 4/88 (4.5%) cases. Cognitive impairment in at least one of these four means was recorded in 80/88 (90.9%) of cases (sensitivity 0.93). Eight patients had a false-positive diagnosis of dementia (specificity 0.94). Delirium was diagnosed in 77 (35.2%) patients by the researchers, but it was recorded in only 31/77 (40.3%) in medical records. In 64/77 (83.1%) cases signs of confusion were recorded in nurses' notes. Poor detection and documentation may lead to undertreatment of both disorders.
Gen Hosp Psychiatry
PMID:Detection and documentation of dementia and delirium in acute geriatric wards. 1475


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