DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20160543

Prevalence, phenomenology and etiology of delirium in medically ill patients

Susan Solomon, Pradeep Thilakan, Jesudas Jayakar

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.

 


Keywords


Delirium, Medically ill, Confusion, Hyperactive

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References


Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/ Clinical Psychiatry. 11th ed. Philadelphia, Pa: Wolters Kluwer;2015: 697-704.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

Trzepacz P, Breitbart W. Practice guidelines for the treatment of patients with delirium. DOI : 10.1176/ appi.books. 9780890423363.42494.

Sagawa R, Akechi T, Okuyama T, Uchida M, Furukawa TA. Etiologies of delirium and their relationship to reversibility and motor subtype in cancer patients. Jpn J Clin Oncol. 2009;39(3):175-82.

Laurila JV, Pitkala KH, Strandberg TE, Tilvis RS. Confusion assessment method in the diagnostics of delirium among aged hospital patients: would it serve better in screening than as a diagnostic instrument? Int J Geriatr Psychiatry. 2002;17(12):1112-9.

Grover S, Subodh BN, Avasthi A, Chakrabarti S, Kumar S, Sharan P, et al. Prevalence and clinical profile of Delirium: a study from a tertiary care hospital in north India. Gen Hosp Psychiatry. 2009;31(1):25-9.

Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic litearture review. Age Ageing. 2006;35(4):350-64.

Kelly KG, Zisselman M, Cutillo- Schmitter T, Reichard R, Payne D, Denman SJ. Severity and course of delirium in medically hospitalized nursing facility residents. Am J Geriatr Psychiatry. 2001;9(1):72-7.

Keily DK, Bergmann MA, Murphy KM, Jones RN, Orav EJ, Marcantonio ER. Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity. J Gerontol A Biol Med Sci. 2003;58(5):M441-5.

Inoyue SK. The dilemma of delirium: Clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients. Am J Med. 1994;97(3):278-88.

Inoyue SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horowitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941-8.

Mitchell AJ. Confusion Assessment Method is the most appropriate tool to quickly detect delirium in hospitalised patients at the bedside. Evid Based Ment Health. 2011;14(3):88.

Trzepacz PT, Baker RW, Greenhouse J. A symptom rating scale for delirium. Psychiatry Res. 1988;23(1):89-97.

Trzepacz PT, Mulsant BH, Dew MA, Pasternak R, Sweet RA, Zubenko GS. Is delirium different when it occurs in dementia? A study using the delirium rating scale. J Neuropsychiatry Clin Neurosci. 1998;10(2):199-204.

Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N. Validation of the Delirium Rating Scale revised- 98: comparison with the delirium rating scale and cognitive test for delirium. J Neuropsychiatry Clin Neurosci. 2001;13(2):229-42.

Liptzin B, Levkoff SE: An empirical study of delirium subtypes. Br J Psychiatry. 1992;161:843-5.

American Psychiatric Association. Diagnostic and Manual of Mental Disorders. 4th ed. Text rev. Washington, DC: American Psychiatric Association. 2000.

Elie M, Cole MG, Primeu F, Bellavance F. Delirium risk factors in elderly hospitalized patients. J Gen Intern Med. 1998;13(3):204-12.

Schor JD, Levkoff SE, Lipsitz LA, Reilly CH, Cleary PD, Rowe JW, et al. Risk factors for delirium in hospitalized elderly. JAMA. 1992;267(6):827-31.

Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA. 1990;263(8):1097-101.

Levkoff SE, Evans DA, Liptzin B, Cleary PD, Lipsitz LA, Wetle TT, et al. Delirium. The occurrence and persistence of symptoms among elderly hospitalized patients. Arch Intern Med. 1992;152(2):334-40.

Premarajan KC, Danabalan M, Chandrasekhar R, Srinivasa DK. Prevalence of psychiatric morbidity in an urban community of Pondicherry. Indian J Psychiatry. 1993;35:99-102.

Meagher DJ, O’Hanlon D, O’Mahony E, Casey PR, Trzepacz PT. Relationship between symptoms and motoric subytpe of delirium. J Neuropsychiatry Clin Neurosci. 2000;12(1):51-6.

Meagher DJ, O’Hanlon D, O’Mahony E, Casey PR. The use of environmental strategies and psychotropic medication in the management of delirium. Br J Psychiatry. 1996;168(4):512-5.

Olofsson SM, Weitzner MA, Valentine AD, Baile WF, Meyers CA. A retrospective study of the psychiatric management and outcome of delirium in the cancer patient. Support Care cancer. 1996;4(5):351-7.

Camus V, Gonthier R, Dubos G, Schwed P, Simeone I. Etiologic and outcome profiles in hypoactive and hyperactive subtypes of delirium. J Geriatr Psychiatry Neurol. 2000;13(1):38-42.

Singh PM, Shrestha DM, Tajhya RB, Shakya S. Delirium at Nepal Medical College Teaching Hospital: reason for referral and subtypes. Nepal Med Coll J. 2009;11(1):28-30.

Cole MG, Primeau FJ. Prognosis of delirium in elderly hospital patients. CMAJ. 1993;149(1):41-6.