Relationship Between Symptoms and Motoric Subtype of Delirium

Meagher, David; O'Hanlon, Donal; O’Mahony, Edmond; Casey, Patricia; Trzepacz, Paula T.

doi:10.1176/jnp.12.1.51

Cited by 210 publications

(153 citation statements)

References 21 publications

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“…Other studies have also found mixed subtype as the most common. 23,24 It has been suggested that the subtypes differ in the underlying pathology, response to therapeutic intervention and outcome, with hypoactive delirium having a notably poorer prognosis although some studies have not found such an association. 25,26 Hypoactive delirium is likely to go undiagnosed thereby resulting in poorer prognosis.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, phenomenology and etiology of delirium in medically ill patients

2016

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INTRODUCTIONDelirium is characterized by an acute decline in the level of consciousness and cognition with particular impairment in attention. Other associated features include abnormal psychomotor activity, sleep cycle impairment and psychiatric symptoms such as abnormalities of mood, perception and behaviour.1 It develops over a short period of time and fluctuates during the course of the day. It is a common neuro cognitive disorder which heralds an increase in morbidity and mortality.2 It is also known by other terms such as acute confusional state, toxic psychosis and metabolic encephalopathy. 1 Delirium is usually rapid in onset with a diurnally fluctuating course and duration of less than six months. Based on the etiology, DSM 5 classifies delirium as substance intoxication delirium, substance withdrawal delirium, medication-induced delirium, delirium due to another medical condition and delirium due to multiple etiologies.2 It is also further specified as hyperactive delirium, hypoactive delirium and mixed delirium based on the level of psychomotor activity.2,3 The cause of ABSTRACT Background: Delirium is one of the most common causes of referral of medically ill patients for psychiatric management and is associated with significant morbidity and mortality. The aim of the study was to determine the prevalence and etiology of delirium among medically ill patients and to describe its phenomenology. Methods: A cross-sectional descriptive study was conducted in the general medical ward of a tertiary care hospital. Four hundred patients were screened for delirium using the confusion assessment method. The delirium rating scale revised-98 was used to further characterize the severity and phenomenology of delirium. Descriptive statistics such as frequencies, means and standard deviation were used. Chi square test was applied to compare categorical variables and Fisher's exact test was used to test associations. Student t test was used to compare the means of independent groups. Results: The prevalence of delirium was 9.75%. Male gender (69.23%) and age above 60 years (66.67%) were significantly associated with delirium (p values of 0.04 and <0.001 respectively). Mixed delirium was the most common motor subtype (46.15%). The most common cause of delirium was metabolic encephalopathy (43.59%). There was significant association between hyperactive delirium and psychotic symptoms. Delirium went undiagnosed in 61.64% of the cases. Conclusions: Delirium is a common problem among medically ill patients and runs the risk of being undiagnosed. Clinicians should routinely screen patients at high risk for delirium to decrease the morbidity and mortality associated with this dreaded, yet potentially reversible entity.

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Section: Discussionmentioning

confidence: 99%

Prevalence, phenomenology and etiology of delirium in medically ill patients

2016

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“…These include unawareness of the environment, lethargy, apathy, decreased level of alertness, psychomotor retardation, decreased speech production, and episodes of unresponsiveness or staring. Patients with hypoactive delirium often endorse depressive symptoms, such as low mood (60%), worthlessness (68%), and frequent thoughts of death (52%) [30]. Regarding our study, hyperactive delirium was the most common subtype, accounting for 81% of total cases of delirium.…”

Section: Discussionmentioning

confidence: 44%

“…Others have confirmed the presence of these motoric subtypes. According to these studies, there are at least three types of delirium based on their clinical manifestations: hyperactive, hypoactive, and mixed [29,30].…”

Section: Discussionmentioning

confidence: 99%

Study of Delirium on Psychiatric Referrals at Helping Hands Community Hospital, Kathmandu, Nepal

Bhattarai

Joshi²

2018

Janaki Med. Coll. J. Med. Sci.

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Background and Objectives: Delirium is one of the most important neuro-psychiatric disorders in Consultation liaison psychiatry. There is a dearth of studies in this subject in Nepalese context. The objective of this study was to find out the demographic profile, source of referral, reason for referral and possible risk factors for delirium and association between risk factors and subtypes of delirium.Material and Methods: This is a descriptive cross-sectional study carried out in a tertiary care center over a period of six months. Delirium was diagnosed by psychiatrist based on International Classification of Disease, 10th revision, Diagnostic Criteria for Research (ICD-10 DCR) and was classified into subtypes using the Liptzin and Levkoff criteria. Data analysis was done using SPSS version 16 and chi- square test was applied to find the association between risk factors and subtypes of delirium.Results: A total of 52 cases of delirium were included in the study. Majority of cases were aged 65 years and above with male preponderance. The most common cause for referral was disturbed behavior and disorientation. Hyperactive delirium was the most common subtype of delirium. Most of the referred cases of delirium were from Medical ward and Intensive Care Unit/Critical Care Unit (ICU/CCU). Infection / Inflammation, Drug/alcohol intoxication or withdrawal and those with multiple etiologies were the most common possible causes of delirium. There was no significant difference in terms of associated risk factors between the clinical subtype (p = 0.8023).Conclusion: The presence of delirium warrants prompt intervention to identify and treat the underlying causes and consultation liaison psychiatric services should be enhanced to achieve this goal.Janaki Medical College Journal of Medical Sciences (2017) Vol. 5(2): 19-26

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“…Delirium in this context is referred to as hypoactive delirium, and is characterised by decreased mental and physical activity and inattention. 16 Physicians and nurses frequently overlook this quiet or hypoactive delirium. Features also include lethargy, confusion and sedation.…”

Section: Subtypes Of Deliriummentioning

confidence: 99%

Delirium in the Intensive Care Unit: A Narrative Review of Published Assessment Tools and the Relationship between ICU Delirium and Clinical Outcomes

Waters

2008

Journal of the Intensive Care Society

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Delirium is defined as an acute change or fluctuation in mental status, plus inattention, and either disorganised thinking or altered level of consciousness at the time of evaluation. Increasing numbers of studies confirm that delirium is very common in intensive care unit patients. This review summarises current knowledge about ICU delirium and offers some avenues for future research. This is a summary of Dr Waters' dissertation for the DICM.

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Relationship Between Symptoms and Motoric Subtype of Delirium

Cited by 210 publications

References 21 publications

Prevalence, phenomenology and etiology of delirium in medically ill patients

Prevalence, phenomenology and etiology of delirium in medically ill patients

Study of Delirium on Psychiatric Referrals at Helping Hands Community Hospital, Kathmandu, Nepal

Delirium in the Intensive Care Unit: A Narrative Review of Published Assessment Tools and the Relationship between ICU Delirium and Clinical Outcomes

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