Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Part I Basic skills
- Part II Common psychiatric problems across the general hospital
- 7 Functional somatic syndromes
- 8 Alcohol problems in the general hospital
- 9 Drug misuse in medical patients
- 10 Sexual problems in medical patients
- 11 Suicide and deliberate self-harm
- 12 Delirium
- 13 Childhood experiences
- Part III Working with specific units
- Part IV Treatment
- Part V Different treatment settings
- Index
- References
12 - Delirium
from Part II - Common psychiatric problems across the general hospital
Published online by Cambridge University Press: 10 December 2009
Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Part I Basic skills
- Part II Common psychiatric problems across the general hospital
- 7 Functional somatic syndromes
- 8 Alcohol problems in the general hospital
- 9 Drug misuse in medical patients
- 10 Sexual problems in medical patients
- 11 Suicide and deliberate self-harm
- 12 Delirium
- 13 Childhood experiences
- Part III Working with specific units
- Part IV Treatment
- Part V Different treatment settings
- Index
- References
Summary
A short history of the concept of delirium
The term ‘delirium’ comes from the Latin expression de lira, literally ‘out of the furrow’, and was introduced by Celso (first century AD) to define an acute pathological state with alterations of consciousness, behavioural anomalies and fever. From the beginning, the relationship of delirium to intoxication and other conditions has been widely recognized (Fele et al. 1999; Lipowski 1980). Delirium was, in fact, one of the first psychiatric syndromes to be described.
In the nineteenth century, French psychiatrists introduced the concept of mental confusion as an acute psychotic state, independent of the cause (Chaslin 1892, 1895). Bonhoeffer noted that psychopathological phenomenology is not specific of organic aetiology (Bleuler 1967). Bonhoeffer, in 1909, defined delirium as a stereotypic manifestation of an acute cerebral disturbance, whilst Régis, in the same period, referred to toxic or infective causes.
Engel and Romano (1958), described typical electroencephalogram (EEG) pathological slow waves and considered the finding as distinctive of ‘cerebral insufficiency’, or ‘acute brain failure’; latterly, Lipowski contributed greatly to research on delirium and its diagnostic definition in the Diagnostic and Statistical Manual (DSM; 1980, 1990).
Epidemiology and risk factors
Delirium is frequent among medical and surgical patients and is one of the most common psychiatric complications, affecting 10–30% of patients in the general hospital (GH) (Cohen-Cole et al. 1998; Rigatelli & Ferrari 1999; Wise et al. 2002). It is one of the main diagnostic groups referred for psychiatric consultation (Huyse et al. 2000), although the prevalence varies widely due to differences in patient populations.
Keywords
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- Handbook of Liaison Psychiatry , pp. 270 - 289Publisher: Cambridge University PressPrint publication year: 2007
References
American Psychiatric Association. (1999). Practice Guideline for the Treatment of Patients with Delirium. Washington DC: APA.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, IV edition, Text Revision. Washington DC: American Psychiatric Association, pp. 135–47.
(1967). Trattato di Psichiatria, X edizione. Milano: Feltrinelli.
, , , et al. (2000). The cause of delirium in patients with hip fracture. Archives of Internal Medicine, 160, 1856–60.Google Scholar
, and (2002a). An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics, 43, 175–82.Google Scholar
, and (2002b). The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics, 43, 183–94.Google Scholar
(1991). Utility of EEG in delirium: past views and current practice. International Psychogeriatrics, 3, 211–29.Google Scholar
and (2003). Multidisciplinary team interventions for delirium in patients with chronic cognitive impairment (Cochrane Review). In The Cochrane Library, Issue 1. Oxford: Update Software.
and (2001). Immunology of delirium: new opportunities for treatment and research. British Journal of Psychiatry, 179, 288–9.Google Scholar
and (2002). ABC of psychological medicine. Delirium. British Medical Journal, 325, 644–7.Google Scholar
(1895). La Confusion Mental Primitive. Stupidité, Démence, Aiguë, Stupeur Primitive. Paris: Asselin et Houzeau.
, , , et al. (1998). Mental Disorders in General Medical Practice. Adding Value to Healthcare Through Consultation-liaison Psychiatry. Taskforce on Healthcare Value Enhancement. Academy of Psychosomatic Medicine.
, , , et al. (1994). Systematic intervention for elderly inpatients with delirium: a randomised trial. Canadian Medical Association Journal, 151, 965–70.Google Scholar
, and (1996). Effectiveness of interventions to prevent delirium in hospitalized patients: a systematic review. Canadian Medical Association Journal, 155, 1263–8.Google Scholar
(1987). The phenomenology of acute organic psychosis. British Journal of Psychiatry, 151, 324–32.Google Scholar
, , , et al. (1998). Journal of General Internal Medicine, 13, 204–12.
and (1958). Delirium, a syndrome of cerebral insufficiency. Journal of Chronic Disease, 9, 260–77.Google Scholar
and (1995). Misdiagnosing delirium as depression in medically ill elderly patients. Archives of Internal Medicine, 155, 2459–64.Google Scholar
Fele, P., Fornaro, P., Mungo, S., et al. (1999). Delirium. In Trattato Italiano di Psichiatria, 2nd edn., ed. and . Milano: Masson, pp. 1171–85.
, and (1989). Management of delirium in terminally ill AIDS patients. International Journal of Psychiatry in Medicine, 19, 165–72.Google Scholar
, and (1975). Mini-Mental State Examination: a practical method for grading the cognitive state of patients for clinicians. Journal of Psychosomatic Research, 11, 189–98.Google Scholar
(1997). Outcomes of delirium: can systems of care make a difference. American Geriatric Society, 45, 247–8.Google Scholar
, and (1990). A prospective study of delirium in hospitalised elderly. Journal of the American Medical Association, 263, 1097–101.Google Scholar
, , , et al. (2001). The cost of delirium in the surgical patient. Psychosomatics, 42, 68–73.Google Scholar
, , , et al. (2000). European C-L service and their user populations. The ECLW collaborative study. Psychosomatics, 41, 330–8.Google Scholar
(1994). The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalised elderly medical patients. American Journal of Medicine, 97, 278–88.Google Scholar
(2000). Prevention of delirium in hospitalised older patients: risk factors and targeted intervention strategies. Annals of Medicine, 32, 257–63.Google Scholar
and (1996). Precipitating factors for delirium in hospitalised elderly persons: predictive model and interrelationships with baseline vulnerability. Journal of American Medical Association, 275, 852–7.Google Scholar
, , , et al. (1990). Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113, 941–8.Google Scholar
, , , et al. (1998). Does delirium contribute to poor hospital outcomes? A three-site epidemiologic study. Journal of General Internal Medicine, 13, 234–42.Google Scholar
, , , et al. (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340, 669–76.Google Scholar
(1998). Integrated medicine and psychiatry treatment programs. Medicine and Psychiatry, 1, 10–16.Google Scholar
, , , et al. (1995). Delirium in critical care unit patients admitted through an emergency room. General Hospital Psychiatry, 17, 371–9.Google Scholar
, and (1989). Delirium among elderly persons admitted to a psychiatric hospital: clinical course during the acute stage and one-year follow-up. Acta Psychiatrica Scandinavica, 79, 579–85.Google Scholar
(2002). Consultation-liaison psychiatry: contributions to medical practice. American Journal of Psychiatry, 159, 1964–72.Google Scholar
, , , et al. (1974). Personality and psychological factors in postcardiotomy delirium. Archives of General Psychiatry, 31, 249–53.Google Scholar
(1995). High-dose intravenous haloperidol for agitated delirium following lung transplantation. Psychosomatics, 36, 66–8.Google Scholar
, , , et al. (2002). Intractable delirium associated with ziconotide successfully treated with electroconvulsive therapy. Psychosomatics, 43, 63–6.Google Scholar
(1980). Delirium. Acute Brain Failure in Man. Springfield: Charles C. Thomas Publisher.
(1990). Delirium; Acute Confusional States. New York: Oxford University Press.
and (1992). An empirical study of delirium subtypes. British Journal of Psychiatry, 161, 843–5.Google Scholar
(2001). Psichiatria di consultazione: i temi scottanti della clinica. Noos, 7, 281–304 (in Italian).
, , , et al. (1994). A clinical prediction rule for delirium after elective noncardiac surgery. Journal of the American Medical Association, 271, 134–9.Google Scholar
, , , et al. (2000). Delirium is independently associated with poor functional recovery after hip fracture. Journal of the American Geriatrics Society, 48, 618–24.Google Scholar
and (1996). Delirium after cardiac surgery: a critical review. Journal of Psychosomatic Research, 41, 13–30.Google Scholar
, , , et al. (2002). Delirium predicts 12-month mortality. Archives of Internal Medicine, 162, 457–63.Google Scholar
, , , et al. (1996). The use of environmental strategies and psychotropic medication in the management of delirium. British Journal of Psychiatry, 168, 512–15.Google Scholar
, , , et al. (1987). Decreased extrapyramidal symptoms with intravenous haloperidol. Journal of Clinical Psychiatry, 48, 278–80.Google Scholar
, , , et al. (2001). Delirium in the hospitalized elderly: nursing assessment and management. The Nursing Clinics of North America, 33, 417–39.Google Scholar
(1990). Mental status change in the elderly: recognizing and treating delirium. Journal of Professional Nursing, 6, 356–65.Google Scholar
Philpott, R. (1989). Recurrent acute confusional states. In The Clinical Neurology of Old Age, ed. . New York: John Wiley & Sons, pp. 453–66.
and (1982). Delirium and dementia: diagnostic criteria and fatality rates. British Journal of Psychiatry, 140, 149–53.Google Scholar
, , , et al. (2000). Delirium episode as a sign of undetected dementia among community dwelling elderly subjects: a 2 year follow-up study. Journal of Neurology, Neurosurgery and Psychiatry, 69, 519–21.Google Scholar
and (1999). Differences and analogies in consultation-liaison activity to primary care and general hospital physicians: one or two services? XV World Congress of Psychosomatic Medicine (proceedings). Athens.
Rigatelli, M., Ferrari, S., Bertoncelli, B., et al. (2003). Tre tipi particolari di urgenze in psichiatria di consultazione. In Psichiatria e Medicina. Dialogo e Confini, ed. , and . Roma: CIC Edizioni Internazionali, pp. 48–53 (in Italian).
, , , et al. (2001). Prevalence, detection and treatment of anxiety, depression and delirium in the adult critical care unit. Psychosomatics, 42, 391–6.Google Scholar
, , , et al. (2001). Hyperactivity in the hypothalamic-pituitary-adrenal axis in demented patients with delirium. International Clinical Psychopharmacology, 16, 39–47.Google Scholar
(2002). Probable Lewy body dementia presenting as ‘delirium’. Psychosomatics, 43, 84–5.Google Scholar
, , , et al. (1997). The natural history of delirium in older hospitalised patients: a syndrome of heterogeneity. Age and Ageing, 26, 169–75.Google Scholar
, , , et al. (2002). Risk factors for postoperative delirium in vascular surgery. General Hospital Psychiatry, 24, 28–34.Google Scholar
and (2002). The role of atypical antipsychotics in the treatment of delirium. Psychosomatics, 43, 171–4.Google Scholar
, , , et al. (1998). Torsades de pointes associated with intravenous haloperidol in critically ill patients. American Journal of Cardiology, 81, 238–40.Google Scholar
, and (1997). Treatment of delirium with risperidone. International Journal of Geriatric Psychopharmacology, 1, 24–6.Google Scholar
. and (2004). Association between risperidone treatment and cerebrovascular adverse events: examining the evidence and postulating hypotheses for an underlying mechanism. Journal of the American Medical Directors Association, 5 (2), 129–32.Google Scholar
and (1989). Postcardiotomy delirium: conclusions after 25 years?American Journal of Psychiatry, 146, 452–8.Google Scholar
(1983). Continuous infusion of physostigmine in anticholinergic delirium: a case report. Journal of Clinical Psychiatry, 44, 463–4.Google Scholar
, and (1994). AMP Task Force on psychosocial interventions in the general hospital inpatient setting: a review of cost-offset studies. Psychosomatics, 25, 253–62.Google Scholar
(1994). Medical psychiatry units and the roles of the inpatient psychiatric service in the general hospital. General Hospital Psychiatry, 16, 20–31.Google Scholar
(1999). The delirium rating scale. Its use in consultation-liaison research. Psychosomatics, 40, 193–204.Google Scholar
(2000). Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Seminars in Clinical Neuropsychiatry, 5, 132–48.Google Scholar
, and (1985). Delirium and other organic mental disorders in a general hospital. General Hospital Psychiatry, 7, 101–6.Google Scholar
and (1958). Psychosis after eye surgery – establishment of a specific doctor-patient relationship in prevention and treatment of black patch delirium. New England Journal of Medicine, 258, 1284–9.Google Scholar
, and (1998). Donepezil improves symptoms of delirium in dementia: implications for future research. Journal of Geriatric Psychiatry and Neurology, 11, 159–61.Google Scholar
Wise, M. G., Hilty, D. M., Cerda, G. M., et al. (2002). Delirium (confusional states). In The American Psychiatric Publishing Textbook of Consultation-liaison Psychiatry. Psychiatry in the Medically Ill, 2nd edn., ed. and . Washington DC: American Psychiatric Publishing Inc, pp. 257–72.
and (1935). Nature of delirium and allied states. Archives of Neurology and Psychiatry, 33, 1175–215.Google Scholar
(2002). Risperidone (Risperdal): increased rate of cerebrovascular events in dementia trials. Canadian Medical Association Journal, 167 (11).Google Scholar
(2004). Olanzapine (Zyprexa): increased incidence of cerebrovascular events in dementia trials. Canadian Medical Association Journal, 170 (9).Google Scholar
World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: WHO.
(2001). Delirium: still searching for risk factors and effective preventive measures. Journal of the American Geriatrics Society, 49, 1729–32.Google Scholar
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