Delirium: patient characteristics that predict a missed diagnosis at psychiatric consultation

Kishi, Yasuhiro; Kato, Masashi; Okuyama, Toru; Hosaka, Tetsuya; Mikami, Katsunaka; Meller, William H.; Thurber, Steven; Kathol, Roger G.

doi:10.1016/j.genhosppsych.2007.05.006

Cited by 56 publications

(50 citation statements)

References 21 publications

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“…These include younger age; referrals outside of family practice service; orientation to person, place, and time; and a previous psychiatric diagnosis, particularly bipolar affective disorder. [29,30] Interestingly our study did not find any relationship between age and previous psychiatric diagnosis and the presence of delirium. This may reflect a comparative lack of contact with primary care or psychiatric services in Nigerian populations compared to their Western counterparts.…”

Section: Discussioncontrasting

confidence: 70%

Incidence and correlates of delirium in a West African mental health clinic

Ola

Crabb

Krishnadas

et al. 2010

General Hospital Psychiatry

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Objective:To determine the incidence of delirium in those patients presenting to a psychiatric clinic in Nigeria and to examine if any demographic or clinical variables were correlated with this diagnosis. Method:A prospective survey design. 264 consecutive new referrals to a psychiatric clinic in Nigeria were assessed for the presence of delirium using a standardised diagnostic scale. Data was analysed for normality and appropriate statistical test employed to examine the relationships between the presence of delirium and demographic and clinical variables. Results:18.2% of individuals presenting to the mental health clinics had delirium. No demographic variable was significant regarding the presence or absence of delirium. With regards to clinical variables duration of current symptoms, referral source, the presence of co-morbid physical illness and being rated as 'sick' (find out what this means) were significantly associated with the presence of delirium. Most delirium was due to infections. Nearly all patients with delirium were prescribed psychotropic medication (95.2%) and most attributed their symptoms to a spiritual cause. Conclusion(s)Delirium presents more commonly to psychiatry services in the less developed world compared to the West. Development efforts should focus on recognition and management of delirium to improve outcomes and maximise resources.

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Section: Discussioncontrasting

confidence: 70%

Incidence and correlates of delirium in a West African mental health clinic

Ola

Crabb

Krishnadas

et al. 2010

General Hospital Psychiatry

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“…For patients referred for psychiatric consultation, Kishi et al [8] found that delirium was missed in patients with a history of psychiatric diagnosis and pain. In a retrospective chart-review of a psychiatric consultation service [9], approximately 63% of patients with delirium were misdiagnosed; these patients were younger and had a history of bipolar or psychotic disorder.…”

Section: Introductionmentioning

confidence: 99%

Delirium Detection and Impact of Comorbid Health Conditions in a Post-Acute Rehabilitation Hospital Setting

et al. 2016

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Misdiagnosis and under-detection of delirium may occur in many medical settings. This is important to address as delirium clearly increases risk of morbidity and mortality in such settings. This study assessed whether Veterans who screened positive on a delirium severity measure (Memorial Delirium Assessment Scale; MDAS) differed from those with and without corresponding medical documentation of delirium in terms of cognitive functioning, psychiatric/medical history, and medication use. A medical record review of 266 inpatients at a VA post-acute rehabilitation unit found that 10.9% were identified as delirious according to the MDAS and/or medical records. Of the Veterans who screened positive on the MDAS (N = 19), 68.4% went undetected by medical screening. Undetected cases had a higher number of comorbid medical conditions as measured by the Age-Adjusted Charlson Index (AACI) scores (median = 9, SD = 3.15; U = 5.5, p = .003) than medically documented cases. For Veterans with a score of 7 or greater on the AACI, the general relative risk for delirium was 4.46. Delirium is frequently under-detected in a post-acute rehabilitation unit, particularly for Veterans with high comorbid illness. The relative risk of delirium is up to 4.46 for those with high medical burden, suggesting the need for more comprehensive delirium screening in these patients.

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“…In a point-prevalence study of delirium in 311 patients across a general hospital, doctors missed over half the delirium cases 1. In a study of general hospital referrals to liaison psychiatry, Kishi et al showed that 46% of delirium diagnoses were missed by the referring team 3. Detection rates are lower in older patients,4 those with premorbid dementia5 and in hypoactive cases 6…”

Section: Introductionmentioning

confidence: 99%

Attention! A good bedside test for delirium?

O’Regan

Ryan

Boland

et al. 2014

J Neurol Neurosurg Psychiatry

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BackgroundRoutine delirium screening could improve delirium detection, but it remains unclear as to which screening tool is most suitable. We tested the diagnostic accuracy of the following screening methods (either individually or in combination) in the detection of delirium: MOTYB (months of the year backwards); SSF (Spatial Span Forwards); evidence of subjective or objective ‘confusion’.MethodsWe performed a cross-sectional study of general hospital adult inpatients in a large tertiary referral hospital. Screening tests were performed by junior medical trainees. Subsequently, two independent formal delirium assessments were performed: first, the Confusion Assessment Method (CAM) followed by the Delirium Rating Scale-Revised 98 (DRS-R98). DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) criteria were used to assign delirium diagnosis. Sensitivity and specificity ratios with 95% CIs were calculated for each screening method.Results265 patients were included. The most precise screening method overall was achieved by simultaneously performing MOTYB and assessing for subjective/objective confusion (sensitivity 93.8%, 95% CI 82.8 to 98.6; specificity 84.7%, 95% CI 79.2 to 89.2). In older patients, MOTYB alone was most accurate, whereas in younger patients, a simultaneous combination of SSF (cut-off 4) with either MOTYB or assessment of subjective/objective confusion was best. In every case, addition of the CAM as a second-line screening step to improve specificity resulted in considerable loss in sensitivity.ConclusionsOur results suggest that simple attention tests may be useful in delirium screening. MOTYB used alone was the most accurate screening test in older people.

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Delirium: patient characteristics that predict a missed diagnosis at psychiatric consultation

Cited by 56 publications

References 21 publications

Incidence and correlates of delirium in a West African mental health clinic

Incidence and correlates of delirium in a West African mental health clinic

Delirium Detection and Impact of Comorbid Health Conditions in a Post-Acute Rehabilitation Hospital Setting

Attention! A good bedside test for delirium?

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