Abstract
Delirium develops through a multifactorial process and include multiple subtypes with different pathological factors. To refine the treatment and care for delirium, a more detailed examination of these subtypes is needed. Therefore, this study aimed to explore the factors affecting delirium in cases in which hallucinations are conspicuous. In total, 602 delirium cases referred to the psychiatry department at a general hospital between May 2015 and August 2020 were enrolled. The Delirium Rating Scale-revised-98 was used to assess perceptual disturbances and hallucinations in patients with delirium. Multiple regression analysis was applied to determine whether individual factors were associated with the hallucinations. A total of 156 patients with delirium (25.9%) experienced hallucinations, with visual hallucinations being the most common subtype. Alcohol drinking (p < 0.0005), benzodiazepine withdrawal (p = 0.004), and the use of angiotensin II receptor blockers (p = 0.007) or dopamine receptor agonists (p = 0.014) were found to be significantly associated with hallucinations in patients with delirium. The four factors detected in this study could all be reversible contributing factors derived from the use of or withdrawal from exogenous substances.
Highlights
Delirium develops through a multifactorial process and include multiple subtypes with different pathological factors
The results of this study revealed that 156 patients with delirium (25.9%) experienced hallucinations and 27 (4.5%) experienced illusions
BZD withdrawal, and the use of ARBs and dopamine receptor agonists were positively associated with hallucinations in patients with delirium, suggesting that these variables act as aggravating factors
Summary
Delirium develops through a multifactorial process and include multiple subtypes with different pathological factors. This study aimed to explore the factors affecting delirium in cases in which hallucinations are conspicuous. A total of 156 patients with delirium (25.9%) experienced hallucinations, with visual hallucinations being the most common subtype. The inter-rater reliability of a diagnosis of delirium is expected to increase because of the simple definition in the DSM-5, based on the diagnostic criteria, delirium includes multiple subtypes with different pathological factors. In this study, to help provide a clinical subdivision of delirium that could lead to more appropriate treatment and care in clinical practice, various factors affecting the development of hallucinations in patients with delirium, including demographic, clinical, and pharmacological aspects, were examined
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