Symptoms Of Delirium In Patients Research Articles

Evaluating the effects of the pharmacological and nonpharmacological interventions to manage delirium symptoms in palliative care patients: systematic review

There is a high prevalence of delirium in palliative care patients. This review aims to evaluate the effects of the pharmacological and nonpharmacological interventions used to manage delirium symptoms in this patient group. A recent study has suggested there is no role for antipsychotic medication in the management of delirium in palliative care patients, which is a move away from previous expert opinion. In addition, recent findings suggest there may be a role for the use of antipsychotics in combination with benzodiazepines in the management of agitated delirium. It is too early to abandon the use of antipsychotic medication entirely in the management of delirium, however there remains inadequate evidence to support the routine use of either pharmacological or nonpharmacological interventions for delirium treatment. Clinicians should determine the delirium subtype and severity, using this to inform the most appropriate pharmacological treatment if required. Further rigorously designed research is needed to seek clarity over whether the alleviation of symptoms is dose dependent, and to determine whether there is a severity threshold over which pharmacological interventions are most effective. Future research is required to evaluate nonpharmacological interventions in this population.

Implementasi Reorientasi Pasien Delirium Melalui Rekaman Suara Keluarga di Ruang ICU RSUD Prof. Dr. Margono Soekarjo: Case Study

Background. Delirium in critically ill patients who have decreased consciousness is a case that’s found in the ICU. Disorientation and anxiety are common characteristics shown in delirium patients. Collaboration between nurses and patients can be done by giving reorientation through voice recording of family members in delirium patients in the ICU.Methods. Implementation is carried out using experimental studies with a pre-post control group. Six patients were selected by simple random sampling technique which was divided into three groups. The criteria for patients in implementation included, patients aged > 18 years, entering the ICU within ? 24 hours, and positive delirium based on the score of the Confusion Assessment Method for the ICU (CAM-ICU) assessment.Results. There was a change in the family voice intervention group with an RASS rating scale. But in the three groups, patients were still diagnosed with delirium positive after being given an implementation based on the CAM-ICU rating scale.Conclusion. Giving reoriented message recordings using family voice can be used to reduce symptoms of delirium in patients undergoing treatment in the ICU.

Palliative care patients have worsening symptoms of delirium with risperidone, haloperidol

The Brown University Psychopharmacology UpdateVolume 28, Issue 4 p. 4-5 What's New in Research Palliative care patients have worsening symptoms of delirium with risperidone, haloperidol First published: 23 March 2017 https://doi.org/10.1002/pu.30222Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Antipsychotic drugs often are prescribed to relieve symptoms of delirium in patients receiving palliative care, but a randomized trial has found that patients receiving an antipsychotic over a 72-hour period actually saw a worsening of delirium symptoms relative to placebo. Volume28, Issue4April 2017Pages 4-5 RelatedInformation

Comparative Study of Delirium in Emergency and Consultation Liaison- A Tertiary Care Hospital Based Study in Northern India.

Delirium is an acute and often fluctuating disturbance in level of consciousness and thought process (cognition) that develops over a short period of time and is a significant change from previous level of functioning. Its prevalence increases with age, complexity of medical co- morbidities and number of medications prescribed. To compare the cause and severity of delirium in patients in emergency and consultation liaison psychiatry group. A cross-sectional, tertiary care hospital based study was conducted on the patients who presented with delirium from emergency department (50) and consultation-liaison psychiatry groups (50), over a period of one year. The diagnosis was made on the basis of DSM- 5 criteria. The Delirium Rating Scale (DRS-R-98) was applied to know the severity of delirium, cognitive and non-cognitive symptoms of delirium in patients. The results were subjected to appropriate statistical analysis. In emergency group, 42% patients had metabolic abnormalities, while in consultation-liaison, 38% patients had hyponatremia and hypokalemia and the difference was found to be statistically non-significant (p>0.05). In emergency group, 21(42%) patients were diagnosed as delirium due to other medical condition, followed by 13 (26%) and 8(16%) patients, who were diagnosed as delirium due to multiple aetiologies and substance intoxication each respectively. In only 33(66%) cases in consultation liaison group patients had delirium secondary to other medical conditions. As per DRS-R98 Scale, mean severity score was found to be statistically significant (p<0.05) in consultation liaison group as compared to emergency department group (p> 0.05). Delirium is multifactorial aetiological disease, with variable but preventable outcome. Approach should be aimed at finding the treatable causes to reduce morbidity and mortality.

Hematoma Locations Predicting Delirium Symptoms After Intracerebral Hemorrhage.

Delirium symptoms are associated with later worse functional outcomes and long-term cognitive impairments, but the neuroanatomical basis for delirium symptoms in patients with acute brain injury is currently uncertain. We tested the hypothesis that hematoma location is predictive of delirium symptoms in patients with intracerebral hemorrhage, a model disease where patients are typically not sedated or bacteremic. We prospectively identified 90 patients with intracerebral hemorrhage who underwent routine twice-daily screening for delirium symptoms with a validated examination. Voxel-based lesion-symptom mapping with acute computed tomography was used to identify hematoma locations associated with delirium symptoms (N=89). Acute delirium symptoms were predicted by hematoma of right-hemisphere subcortical white matter (superior longitudinal fasciculus) and parahippocampal gyrus. Hematoma including these locations had an odds ratio for delirium of 13 (95% CI 3.9-43.3, P<0.001). Disruption of large-scale brain networks that normally support attention and conscious awareness was thus associated with acute delirium symptoms. Higher odds ratio for delirium was increased due to hematoma location. The location of neurological injury could be of high prognostic value for predicting delirium symptoms.

Abstract W P226: Delirium After Intracerebral Hemorrhage Is Common and Independently Predicts Reduced Domain-Specific Quality Of Life

Background: Delirium sypmptoms are common after ischemic stroke and in the medical and surgical ICU, and predictive of increased length of stay and worse outcomes. There are few data in intracerebral hemorrhage (ICH). We tested the hypothesis that delirium symptoms were associated with increased length of stay, worse functional outcomes, and worse domain-specific quality of life (QOL) at follow-up. Methods: We prospectively identified 114 patients with ICH. Delirium symptoms were assessed by trained nursing staff twice daily with the Confusion Assessment Method for the ICU (CAM-ICU), a validated method. Arousal was measured with the Richmond Agitation Sedation Score. Functional outcomes were measured with the modified Rankin Scale at 1 and 3 months, with poor outcome defined at &lt;=3 (moderately severe disability or worse). QOL was assessed at 1, 3 and 12 months with Neuro-QOL, instruments developed by NIH for neurologic disease and validated for proxy report. Results: Of 114 patients, 31(27%) patients had delirium symptoms, 67 (59%) were never delirious, and the remainder (14%) had persistent coma. Only 2 (2%) were ever very agitated (both of whom were delirious), so most delirium symptoms were hypoactive. Any benzodiazepine (BZD) use, age, pneumonia, seizure, hematoma volume and NIH Stroke Scale were not associated with delirium symptoms in patients who could be assessed. Delirium symptoms were detected mean 5.9 days after ICH symptom onset and were associated with longer ICU length of stay (mean 3.5 days longer in ever delirious patients, 95%CI 1.5 - 8.3, P=0.004) after correction for age, admit NIH Stroke Scale (NIHSS) and any BZD exposure. Delirium symptoms were associated with increased odds of poor outcome at 28 days (OR 8.7, 95%CI 1.4 - 52.5, P=0.018) after correction for admission NIHSS and age. After correction for NIHSS, age, any BZD use and time of follow-up, delirium symptoms were associated with worse QOL in the domains of applied cognition - executive function (0.6 SD, 95%CI 0.2 - 1.1 SD, P=0.045) and fatigue (0.7 SD, 95%CI 0.17-1.3 SD, P=0.01). Conclusions: Delirium symptoms (encephalopathy) were not predictable on admission, common after ICH, and independently predictive of longer length of stay, worse functional outcomes and reduced QOL.

Successful treatment with quetiapine for delirium in terminally ill cancer patients

AbstractWe describe six patients with terminal cancer whose delirium improved after they started quetiapine (QTP). Haloperidol (HPD) had failed to improve their delirium, and they had suffered adverse effects, including over‐sedation, extrapyramidal signs and dysphagia. We prescribed QTP to improve their delirium. We evaluated the severity of the delirium using the Japanese version of the Memorial Delirium Assessment Scale (jMDAS) before QTP treatment and 3, 7 and 14 days after QTP administration. The basal the Japanese version of the Memorial Delirium Assessment Scale score ranged from 18 to 24. Effective doses of QTP in the present cases were 12.5–50 mg/day. Delirium improved in all patients, and no significant adverse effects were observed. Several factors appear to contribute to symptoms of delirium in patients with terminal cancer. These causative factors are usually complicated and delirium often is refractory to usual pharmacotherapy, involving typical neuroleptics like HPD. QTP, however, appeared to be useful for delirium treatment in patients with advanced cancer.