Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient

Drews, Tanja; Franck, Martin; Radtke, Frank‐Olaf; Weiß, Björn; Krampe, Henning; Brockhaus, Wolf Rüdiger; Winterer, Georg; Spies, Claudia

doi:10.1097/eja.0000000000000107

Cited by 56 publications

(23 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To our knowledge, peritraumatic nausea has not yet been described as a predictor for PTSD. However, postoperative nausea and vomiting has been associated previously with PTSD diagnosis 3 months after surgery in a prospective observational clinical study of elderly patients undergoing general anesthesia [16]. While the mechanism by which nausea may influence PTSD development remains unclear, increased autonomic nervous system activity is common to both conditions.…”

Section: Discussionmentioning

confidence: 99%

“…A multicenter cross-sectional study reported GI complaints were prevalent in one-fourth of patients diagnosed with PTSD [15]. In a previous prospective observational investigation of delirium in elderly surgical patients, postoperative nausea, and vomiting was associated with PTSD 3 months following surgery [16]. While PTSD is comorbid with GI somatic symptoms following trauma exposure, little is known regarding the relationship between such symptoms in the peri-traumatic period and subsequent PTSD symptom development.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nausea in the peri-traumatic period is associated with prospective risk for PTSD symptom development

Michopoulos

Maples‐Keller

Roger

et al. 2018

Neuropsychopharmacol

View full text Add to dashboard Cite

While nausea often develops following exposure to trauma, little is known regarding the relationship between peri-traumatic nausea and prospective risk for developing posttraumatic stress disorder (PTSD). We examined the association between peritraumatic nausea and PTSD symptom development in three independent cohorts. Participants were recruited from (1) the Emergency Departments (ED) at Grady Memorial Hospital (GMH) in Atlanta, GA, (2) from multiple other ED sites in the TRYUMPH Research Network, and (3) from the ED during evaluation for suspected acute coronary syndrome in the REACH cohort. Administration of IV ondansetron, the most predominant antiemetic used at GMH, was used as a surrogate marker for nausea in the initial GMH cohort; nausea was then directly assessed in the internal validation at GMH, and within the replication TRYUMPH Research Network and REACH cohorts. In the GMH cohort (N = 363), ondansetron administration was associated with increased 1and 3-month posttrauma PTSD symptoms in adjusted models (all p's < 0.05). In the GMH internal validation, nausea significantly predicted 1 month (p = 0.009; n = 68) and 3 month (p = 0.029; n = 54) PTSD symptoms. In the TRYUMPH cohort (N = 1846), patient reported nausea in the ED was significantly associated with increased PTSD symptoms (p = 0.009) in adjusted models. In the REACH cohort (N = 758), peri-traumatic nausea was associated with PTSD symptom severity at the 1-month follow-up in adjusted models (p's ≤ 0.008). The current prospective data from three independent cohorts suggest that peri-traumatic nausea is a prospective predictor of PTSD symptom development. Further studies are needed to determine the mechanistic role of nausea as an intermediate phenotype of PTSD risk.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nausea in the peri-traumatic period is associated with prospective risk for PTSD symptom development

Michopoulos

Maples‐Keller

Roger

et al. 2018

Neuropsychopharmacol

View full text Add to dashboard Cite

show abstract

“…7 This distress may result in long-term psychological sequelae, such as prolonged anxiety, or post-traumatic stress disorder. 13 However, no previous study has evaluated the experience of delirium specifically in patients with dementia. It is recognized that delirium superimposed on dementia is associated with worse outcomes compared to delirium alone.…”

Section: Introductionmentioning

confidence: 99%

Delirium superimposed on dementia: A quantitative and qualitative evaluation of patient experience

Morandi

Lucchi

Turco

et al. 2015

Journal of Psychosomatic Research

View full text Add to dashboard Cite

Objective Delirium superimposed on dementia is common and is associated with adverse outcomes. Yet little is known about the patients’ personal delirium experiences. We used quantitative and qualitative methods to assess the delirium superimposed on dementia experience among older patients. Methods We conducted a prospective cohort study among patients with delirium superimposed on dementia who were admitted to a rehabilitation ward. Delirium was diagnosed using DSM-IV-TR criteria. Delirium severity and symptoms were evaluated with the Delirium-O-Meter (D-O-M). The experience of delirium was assessed after delirium resolution (T0) and one month later (T1) with a standardized questionnaire and a qualitative interview. Level of distress was measured with the Delirium Experience Questionnaire. Results Of the 30 patients included in the study, 50% had mild dementia; 33% and 17% had moderate and severe dementia. Half of the patients had evidence of the full range of D-O-M delirium symptoms. We evaluated 30 patients at T0 and 20 at T1. At T0, half of the patients remembered being confused as part of the delirium episode, and reported an overall moderate level of related distress. Patients reported high distress related to memories of anxiety/fear, delusions, restlessness, hypokinesia, and impaired orientation. Qualitative interviews revealed six main aspects of patients delirium experiences: Emotions; Cognitive Impairment; Psychosis; Memories; Awareness of Change; and Physical Symptoms. Conclusions The study provides novel information on the delirium experience in patients with dementia. These findings are key for health care providers to improve the everyday care of this important group of frail older patients.

show abstract

“…No association between delirium and symptoms of PTSD after delirium was reported. The prevalence of PTSD symptoms after delirium has been more closely studied in ICU inpatients, and a recent report identified postoperative delirium as a risk factor for PTSD symptoms in elderly surgical patients who were admitted to ICU . Despite both studies assessing postoperative delirium as a risk factor for PTSD symptoms in elderly surgical patients, variations in baseline patient characteristics between studies may be pertinent.…”

Section: Evaluation Of the Literaturementioning

confidence: 99%

Psychiatric symptomatology after delirium: a systematic review

et al. 2017

View full text Add to dashboard Cite

Delirium is an acute and usually transient severe neuropsychiatric syndrome associated with significant long-term physical morbidity. However, its chronic psychiatric sequelae remain poorly characterized. To investigate the prevalence of psychiatric symptoms, namely anxiety, depressive, and post-traumatic stress disorder (PTSD) symptoms after delirium, a systematic literature search of MEDLINE, EMBASE and PsycINFO databases was performed independently by two authors in March 2016. Bibliographies were hand-searched, and a forward- and backward-citation search using Web of Science was performed for all included studies. Of 6411 titles, we included eight prospective cohort studies, including 370 patients with delirium and 1073 without delirium. Studies were heterogeneous and mostly included older people from a range of clinical groups. Consideration of confounders was variable. The prevalence of depressive symptoms was almost three times higher in patients with delirium than in patients without delirium (22.2% vs 8.0%, risk ratio = 2.79; 95% confidence interval = 1.36-5.73). There was no statistically significant difference between the prevalence of anxiety symptoms between patients with and without delirium. The prevalence of PTSD symptoms after delirium was inconclusive: only one study investigated this and no association between PTSD symptoms after delirium was reported. There is limited published evidence of the prevalence of psychiatric symptoms after non-ICU delirium and the strongest evidence is for depressive symptoms. Further longitudinal studies are warranted to investigate the prevalence of anxiety and PTSD symptoms.

show abstract

Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient

Abstract: ISRCTN Register: 36437985. http://www.controlled-trials.com/ISRCTN36437985/

Cited by 56 publications

References 30 publications

Nausea in the peri-traumatic period is associated with prospective risk for PTSD symptom development

Nausea in the peri-traumatic period is associated with prospective risk for PTSD symptom development

Delirium superimposed on dementia: A quantitative and qualitative evaluation of patient experience

Psychiatric symptomatology after delirium: a systematic review

Contact Info

Product

Resources

About