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Barra BJ, Barahona M, Varela LF, Calvo P, Bastidas A, Carreño J, Pintor L. A Cross-Sectional, Retrospective, and Comparative Study between Delirium and Non-Delirium Psychiatric Disorders in a Psychogeriatric Inpatient Population Referred to Consultation-Liaison Psychiatry Unit. Medicina (B Aires) 2023; 59:medicina59040693. [PMID: 37109651 PMCID: PMC10141533 DOI: 10.3390/medicina59040693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Background and objectives: Delirium is the most prevalent psychiatric disorder in inpatient older people. Its presence is associated with higher rates of institutionalization, functional disability and mortality. This study aims to evaluate delirium in a hospitalized psychogeriatric population, focusing on which factors predict the appearance of delirium, the impact it generates and the diagnostic concordance between non-psychiatric physicians and psychiatrists. Material and methods: This is an observational, cross-sectional, retrospective, and comparative study. We obtained data from a sample of 1017 patients (≥65 years) admitted to general hospital and referred from different services to the consultation-liaison psychiatry (CLP) unit. Logistic regression was performed using delirium as the dependent variable. To estimate the concordance of the diagnoses, the Kappa coefficient was used. To assess the impact of delirium, an ordinal regression, Wilcoxon median test and Fisher’s test were performed. Results: Delirium is associated with a higher number of visits, OR 3.04 (95% CI 2.38–3.88), longer length of stay and mortality, OR 2.07 (95% CI, 1.05 to 4.10). The model to predict delirium shows that being >75 years old has an OR of 2.1 (95% CI, 1.59–2.79), physical disability has an OR of 1.66 (95% CI, 1.25–2.20), history of delirium has an OR of 10.56 (95% CI, 5.26–21.18) and no use of benzodiazepines has an OR of 4.24 (95% CI, 2.92–6.14). The concordance between the referring physician’s psychiatric diagnosis and the psychiatrist CLP unit showed a kappa of 0.30. When analysing depression and delirium, the concordance showed Kappa = 0.46. Conclusions: Delirium is a highly prevalent psychiatric disorder, but it is still underdiagnosed, with low diagnostic concordance between non-psychiatric doctors and psychiatrists from CLP units. There are multiple risk factors associated with the appearance of delirium, which must be managed to reduce its appearance.
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Affiliation(s)
- Bernardo J. Barra
- Department of Psychiatry, Hospital Clinic i Provincial of Barcelona, University of Barcelona, 08036 Barcelona, Spain (L.P.)
- Mental Health Service, Clínica Universidad de los Andes, Santiago 7591047, Chile
- Department of Psychiatry, Medicine School, Universidad Andrés Bello (UNAB), Santiago 8370146, Chile;
- Correspondence: ; Tel.: +56-9-9139-9020
| | - Maximiliano Barahona
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
| | - Luis F. Varela
- Department of Psychiatry, Medicine School, Universidad Andrés Bello (UNAB), Santiago 8370146, Chile;
| | - Pilar Calvo
- Medicine School, University of Chile, Santiago 8330015, Chile
| | - Anna Bastidas
- Department of Psychiatry, Hospital Clinic i Provincial of Barcelona, University of Barcelona, 08036 Barcelona, Spain (L.P.)
| | - Jorge Carreño
- Department of Psychiatry, Medicine School, Universidad de Santiago de Chile, Santiago 8380456, Chile
- Department of Psychiatry, Medicine School, Universidad Mayor, Santiago 8330015, Chile
| | - Luis Pintor
- Department of Psychiatry, Hospital Clinic i Provincial of Barcelona, University of Barcelona, 08036 Barcelona, Spain (L.P.)
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
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Mishra S, Kar S. Patterns of Practice and Attitudes to Referral for Mental Health Needs among Practitioners in Northern India. Psychiatry 2022; 85:433-434. [PMID: 34723756 DOI: 10.1080/00332747.2021.1989855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Prajapati NK, Parikh NC, Shah ND, Darji VM, Jariwala HB, Miroliya MT. Evaluation of Psychiatric Morbidity in COVID-19-Positive Inpatients Referred to Consultation Liaison Psychiatry in a Tertiary Care Hospital. Indian J Psychol Med 2021; 43:330-335. [PMID: 34385727 PMCID: PMC8327862 DOI: 10.1177/02537176211022146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to the risk of common mental illnesses. Consultation liaison psychiatry has been one of the most requested services in the face of this pandemic. We aimed to assess (a) the prevalence of psychiatric illness, (b) different types of psychiatric diagnoses, (c) presenting complaints, (d) reasons for psychiatric referrals, and (e) psychiatric intervention done on COVID-19 positive inpatients referred to consultation liaison psychiatry at tertiary care hospital. METHOD This was a retrospective study of data collected from April 1, 2020, to September 15, 2020. Total 300 patients were referred and diagnosed with clinical interview and Diagnostic and Statistical Manual for Mental Disorder Fifth Edition criteria. Analysis was done using chi-square test, Kruskal-Wallis test, and fisher exact test. RESULTS Out of 300 patients, 26.7% had no psychiatric illness. Adjustment disorder was the commonest psychiatric diagnosis (43%), followed by delirium (10%). Statistically significant differences were found for parameters like Indian Council of Medical Research Category 4 of the patient, (hospitalized severe acute respiratory infection) (P value < 0.001), medical comorbidity (P value = 0.023), and past history of psychiatric consultation (Fisher exact test statistic value <0.001). Behavioral problem (27.6%) was the commonest reason for psychiatric referral. Worrying thoughts (23.3%) was the most frequent complaint. A total of 192 (64.3%) patients were offered pharmacotherapy. CONCLUSIONS Psychiatric morbidity was quite high (73.3%) among them and adjustment disorder was the commonest (43%) psychiatric diagnosis followed by delirium (10%). Pharmacotherapy was prescribed to 64.3% patients and psychosocial management was offered to most of the referred patients.
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Affiliation(s)
- Nisha K Prajapati
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
| | - Nimesh C Parikh
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
| | - Nilima D Shah
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
| | - Vinodkumar M Darji
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
| | - Heena B Jariwala
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
| | - Manthan T Miroliya
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
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Abstract
Delirium is the most common psychiatric diagnoses encountered in patients with various medical-surgical illnesses, in all the treatment set-ups, with relatively higher incidence and prevalence in the intensive care units. As delirium is encountered in multiple specialties, it is important to understand the research on this diagnosis. This study aims to assess the research output involving patients of delirium from India. A comprehensive search was undertaken using Medline (PubMed) and other databases. Search words included were “delirium,” “delirious,” “delirium tremens” AND “India.” No filters were used. Internet and hand searches yielded 305 articles. Out of these articles, 151 had the terms “delirium,” “delirious,” “delirium tremens” in the title and these were included for the review. Additionally, 14 articles were included for the review, although these did not have these terms in the title, but delirium was one of the major outcome parameters in these studies. Majority of the papers were original articles (
n
= 81), and these were followed by, case reports (
n
= 58), review articles (
n
= 10), letter to the editor (not as case reports but as a communication;
n
= 13), editorials (
n
= 2) and one clinical practice guideline. Most of the original papers have either focused on epidemiology (incidence, prevalence, outcome, etc.), symptom profile, with occasional studies focusing on effectiveness of various pharmacological interventions. There is a dearth of research in the field of delirium from India. There is a lack of studies on biomarkers, evaluation of nonpharmacological interventions, and evaluation of prevention strategies. It is the need of the hour to carry out more studies to further our understanding of delirium in the Indian context.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjana Kathiravan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devakshi Dua
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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FitzGerald JM. Delirium clinical motor subtypes: a narrative review of the literature and insights from neurobiology. Aging Ment Health 2018; 22:431-443. [PMID: 28394177 DOI: 10.1080/13607863.2017.1310802] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Clinical motor subtypes have been long recognised in delirium and, despite a growing body of research, a lack of clarity exists regarding the importance of these motor subtypes. The aims of this review are to (1) examine how the concept of motor subtypes has evolved, (2) explore their relationship to the clinical context, (3) discuss the relationship between the phenomenology of delirium and motor activity, (4) discuss the application of neurobiology to the theory of delirium motor subtypes, and (5) identify methodological issues and provide solutions for further studies. METHODS The following databases were searched: PubMed, PsychInfo, EBSCO, Medline, BioMed central and Science Direct. Inclusion criteria specified peer-reviewed research assessing delirium motor subtypes published between 1990 and 2016. RESULTS Sixty-one studies met the inclusion criteria. The majority of studies (n = 50) were found to use validated psychometric tools, while the remainder (n = 11) used clinical criteria. The majority of studies (n = 45) were conducted in the medical setting, while the remainder were in the ICU/post-operative setting (n = 17). CONCLUSION Although host sensitivities (e.g. frailty) and exogenous factors (e.g. medication exposure) may determine the type of motor disturbance, it remains unclear to what extent motor subtypes are influenced by other features of delirium. The use of more specialised tools (e.g. delirium motor subtyping scale), may enable researchers to develop an approach to delirium that has a greater nosological consistency. Future studies investigating delirium motor subtypes may benefit from enhanced theoretical considerations of the dysfunctional neural substrate of the delirious state.
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Otani VHO, Otani TZDS, Freirias A, Calfat ELDB, Aoki PS, Cordeiro Q, Kanaan RAA, Cross S, Liersch-Sumskis S, Uchida RR. Misidentification of mental health symptoms in presence of organic diseases and delirium during psychiatric liaison consulting. Int J Psychiatry Clin Pract 2017; 21:215-220. [PMID: 28326870 DOI: 10.1080/13651501.2017.1301483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify predictors of misidentification of organic mental disorders and delirium in patients undergoing psychiatric liaison consultation. METHODS Data were collected at Santa Casa de São Paulo between July of 2009 and March of 2013. We included in our analysis all inpatients for whom the requesting service judged that a psychiatric consultation was required for a possible mental health condition. Outcomes of interest were the instances of misidentification where a condition was initially deemed to be of a psychiatric nature, whereas the final diagnosis by the liaison psychiatric team was of an organic disease or delirium. Our predictors were the clinical specialty of the requesting service, requester and patient characteristics. A series of generalised linear models were used to evaluate misidentification risks. RESULTS A total of 947 subjects met our inclusion criteria, 14.6% having a final liaison diagnosis of organic mental disorder and 8.1% of delirium. Older patients were significantly associated with increased risk of misidentification for both organic conditions (OR 3.01 - 95% CI 2.01, 4.5) and delirium (OR 3.92 - 2.4, 6.39). CONCLUSIONS Educational interventions in general hospitals focused on preventing psychiatric misdiagnosis should target in-hospital services where patients tend to be older.
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Affiliation(s)
| | | | - Andrea Freirias
- a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil
| | | | | | - Quirino Cordeiro
- a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil
| | - Richard A A Kanaan
- b Chair of Psychiatry, Austin Health , University of Melbourne , Melbourne , Australia
| | - Sean Cross
- c Maudsley Simulation, South London & Maudsley Foundation NHS Trust , Lambeth Hospital , London , UK
| | - Susan Liersch-Sumskis
- d School of Nursing, Faculty of Science, Medicine and Health University of Wollongong , Wollongong , Australia
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Natasha Kate
- Department of Psychiatry, KEM Hospital, Mumbai, Maharashtra, India E-mail:
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Affiliation(s)
- K S Shaji
- Department of Psychiatry, Government Medical College, Thrissur, Kerala, India E-mail:
| | - K S Jyothi
- Department of Psychiatry, Government Medical College, Thrissur, Kerala, India E-mail:
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