Diagnostic and treatment practices of delirium in a general hospital.

Abstract

BACKGROUND:

Despite the increase in research on delirium, it remains underdiagnosed and difficult to manage, and the outcome is poor especially in older people.

AIMS:

To identify the clinically diagnosed rates of delirium, the possible aetiologies, to describe treatment, number and type of psychotropic medication used and to investigate the reasons for referral to a liaison psychiatric team.

METHODS:

Retrospective study of medical records of inpatients admitted to Sligo Regional Hospital during an 18-month period.

RESULTS:

One hundred and fifty-six files had a documentation of delirium (time prevalence 2%). Mean age of the sample was 82 years (SD = 7.2), 66 (42%) were male. Sixty-nine (44.2%) of the total sample had a previous history of dementia, and 57 (36.5%) had a previous history of delirium. In 67 (43.2%) samples, the cause was infection, while in 4, no specific cause was identified. Ninety (58%) were referred to the liaison service, but only in 26 (28.9 %), the reason for referral was "acute confusion" or "delirium". In a majority of referrals, the reason was an affective disorder more often depression. There were no significant differences between delirium subtypes and referrals (χ(2) = 3.868, df 3, p = 0.28). Examination of the amount of antipsychotics prescribed before, during and after delirium shows that there was a significant increase in use during the delirium (χ(2) = 17.512, df 8, p = 0.025) and decrease in z-hypnotics medication (zopiclone/zolpidem), (χ(2) = 20.114, df 4, p < 0.001), while benzodiazepines and antidepressants remained the same.

CONCLUSIONS:

Delirium is often misdiagnosed and unrecognized in hospital settings; however, when identified the pharmacological management is appropriate.

• Authors: Siobhan Rooney, Munir Qadir, Dimitrios Adamis, Geraldine McCarthy
• Journal: Aging clinical and experimental research (Aging Clin Exp Res) Vol. 26 Issue 6 Pg. 625-33 (Dec 2014) ISSN: 1720-8319 [Electronic] Germany
• PMID: 24789220 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antipsychotic Agents
• Benzodiazepines

Topics

• Aged, 80 and over
• Antipsychotic Agents (therapeutic use)
• Benzodiazepines (therapeutic use)
• Delirium (diagnosis, drug therapy)
• Depression (diagnosis, drug therapy)
• Depressive Disorder (drug therapy)
• Female
• Hospitals, General
• Humans
• Male
• Retrospective Studies