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Diagnostic and treatment practices of delirium in a general hospital

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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.

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Acknowledgment

The study was funded by a research seed grant awarded by Sligo Regional Hospital (SRH) Research and Education Foundation.

Conflict of interest

The authors have reported no conflicts of interest.

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Authors and Affiliations

  1. Medical Education, Sligo Medical Academy, NUI Galway, Galway, Ireland

    Siobhan Rooney, Munir Qadir & Geraldine McCarthy

  2. Sligo Mental Health Services, Clarion Rd, Sligo, Ireland

    Siobhan Rooney, Munir Qadir, Dimitrios Adamis & Geraldine McCarthy

  3. Research and Academic Institute of Athens, Athens, Greece

    Dimitrios Adamis

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  1. Siobhan Rooney
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  2. Munir Qadir
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Correspondence to Dimitrios Adamis.

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Rooney, S., Qadir, M., Adamis, D. et al. Diagnostic and treatment practices of delirium in a general hospital. Aging Clin Exp Res 26, 625–633 (2014). https://doi.org/10.1007/s40520-014-0227-x

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