Sleep-wake Cycle Disturbances Research Articles

Links between sleep and body mass index in bipolar disorders: An exploratory study

Study objectivesObesity and excess bodyweight are highly prevalent in individuals with bipolar disorders (BD) and are associated with adverse consequences. Multiple factors may explain increased bodyweight in BD including side effects of psychotropic medications, and reduced physical activity. Research in the general population demonstrates that sleep disturbances may also contribute to metabolic burden. We present a cross-sectional study of the associations between body mass index (BMI) and sleep parameters in patients with BD as compared with healthy controls (HC). MethodsTwenty-six French outpatients with remitted BD and 29 HC with a similar BMI completed a 21-day study of sleep parameters using objective (actigraphy) and subjective (PSQI: Pittsburgh Sleep Quality Index) assessments. ResultsIn BD cases, but not in HC, higher BMI was significantly correlated with lower sleep efficiency (P=0.009) and with several other sleep parameters: shorter total sleep time (P=0.01), longer sleep onset latency (P=0.05), higher fragmentation index (P=0.008), higher inter-day variability (P=0.05) and higher PSQI total score (P=0.004). ConclusionsThe findings suggest a link between a high BMI and several sleep disturbances in BD, including lower sleep efficiency. Physiological mechanisms in BD cases may include an exaggeration of phenomena observed in non-clinical populations. However, larger scale studies are required to clarify the links between metabolic and sleep-wake cycle disturbances in BD.

Sleep-Wake Cycle in Young and Older Persons with a Lifetime History of Mood Disorders

Considering the marked changes in sleep and circadian rhythms across the lifespan, age may contribute to the heterogeneity in sleep-wake profiles linked to mood disorders. This study aimed to investigate the contributions of age and depression severity to sleep-wake disturbances. The Hamilton Depression Rating Scale (HDRS) was administered to assess current symptoms severity in 238 persons with a history of a mood disorder between 12 and 90 years of age (y.o.). Actigraphy was recorded over five to 22 days. Regression analyses and analyses of variance [age (12–19 y.o., 20–39 y.o., 40–59 y.o., and ≥60 y.o.) by depression severity (HDRS< and ≥8)] were conducted. The 12–19 y.o. and 20–39 y.o. groups had a delayed sleep schedule and acrophase compared to all other groups. The ≥60 y.o. group had a lower rhythmicity and amplitude (p≤.006) than the 12–19 y.o. group (p≤.046). Participants with a HDRS≥8 spent longer time in bed, had later sleep offset times and had lower circadian rhythmicity than those with a HDRS<8 (p≤.036). Younger age and higher HDRS score correlated with later sleep onset and offset times, longer time in bed, higher WASO, lower sleep efficiency and later acrophase (p≤.023). Age was a significant predictor of delayed sleep and activity schedules (p≤.001). The profile of sleep-wake cycle disturbances associated with mood disorders changes with age, with prominent sleep phase delay during youth and reduced circadian strength in older persons. Conversely, disruptions in sleep consolidation seem more stable across age.

Motoric subtypes of delirium in geriatric patients

Aim of the Study: To study the relationship of delirium motor subtypes with cognitive and non-cognitive symptoms of delirium in geriatric patients referred to consultation-liaison psychiatry services. Materials and Methods: Ninety eight (N = 98) consecutive patients (aged ≥60 years) with diagnosis of delirium as per DSM-IV TR were rated on Delirium Rating scale-Revised-98 version (DRS-R-98) and amended Delirium motor symptom scale (DMSS).Results: On amended DMSS, hyperactive subtype (N = 45; 45.9%) was the most common motoric subtype of delirium, followed by hypoactive subtype (N = 23; 23.5%), and mixed subtype (N = 21; 21.4%). On DRS-R-98, all patients fulfilled the criteria of 'acute (temporal) onset of symptoms', 'presence of an underlying physical disorder' and 'difficulty in attention'. In the total sample, >90% of the patients had disturbances in sleep-wake cycle, orientation and fluctuation of symptoms. The least common symptoms were delusions, visuospatial disturbances and motor retardation. When compared to hypoactive group, significantly higher proportion of patients with hyperactive subtype had delusions, perceptual disturbances, and motor agitation. Whereas, compared to hyperactive subtype, significantly higher proportion of patients with hypoactive subtype had thought process abnormality and motor retardation. When the hyperactive and mixed motoric subtype groups were compared, patients with mixed subtype group had significantly higher prevalence of thought process abnormality and motor retardation. Comparison of hypoactive and mixed subtype revealed significant differences in the frequency of perceptual disturbances, delusions and motor agitation and all these symptoms being found more commonly in patients with the mixed subtype. Severity of symptoms were found to be significantly different across the various motoric subtypes for some of the non-cognitive symptoms, but significant differences were not seen for the cognitive symptoms as assessed on DRS-R-98. Conclusion: In elderly patients, motor subtypes of delirium differ from each other on non-cognitive symptom profile in terms of frequency and severity.

The role of the circadian clock in animal models of mood disorders.

An association between circadian clock function and mood regulation is well established and has been proposed as a factor in the development of mood disorders. Patients with depression or mania suffer disturbed sleep-wake cycles and altered rhythms in daily activities. Environmentally disrupted circadian rhythms increase the risk of mood disorders in the general population. However, proof that a disturbance of circadian rhythms is causally involved in the development of psychiatric disorders remains elusive. Using clock gene mutants, manipulations of sleep-wake and light-dark cycles, and brain lesions affecting clock function, animal models have been developed to investigate whether circadian rhythm disruptions alter mood. In this review, selected animal models are examined to address the issue of causality between circadian rhythms and affective behavior.

Association between the consolidation of the rest-activity cycle and brain recovery in the acute phase of traumatic brain injury

Introduction Based on clinical observations, sleep–wake cycle disturbances, arise in the days following traumatic brain injury (TBI), and remain among the most persistent and debilitating symptoms. The aim of this study was to document the evolution of rest-activity cycle consolidation in the acute phase of moderate/severe TBI, and its association with injury severity and outcome, using actigraphy. Materials and methods Sixteen hospitalised patients (13 men; 27.1 ± 11.3 years) with moderate/severe TBI wore actigraphs for 10 days. Recordings began in the intensive care unit (ICU) when continuous sedation was discontinued and patients had reached medical stability. The ratio of daytime (7:00–21:59) activity to total 24-h activity was used to quantify the level of consolidation of a day-night rest-activity cycle, and a ratio ⩾80% was considered to reflect adequate consolidation. The Galveston Orientation and Amnesia Test and the Disability Rating Scale were used to assess posttraumatic amnesia (PTA) and functionality at discharge. An analysis of variance was used to characterize the evolution of the daytime activity ratio over the recording period. Pearson’s correlations were carried out to measure associations between actigraphy and injury severity and outcome. T-tests for independent samples were used to compare the rest-activity cycle of patients with and without PTA at discharge. Results Most patients showed a very low daytime activity ratio during the first 48-h of recording (mean ± SD = 70.8 ± 10.1%), with only 4 patients having a ratio ⩾80%. Although this consolidation threshold was reached in only 46.6% of all recording days, there was a significant linear trend of improvement over the 10 days of recording (p Conclusion TBI patients have severe rest-activity cycle disturbances during their hospital stay, but these disturbances globally improve over time. The absence of rest-activity cycle consolidation reflects severe fragmentation of sleep–wake patterns. A faster return to rest-activity cycle consolidation may predict enhanced brain recovery. Acknowledgements Research funded by the Canadian Institutes of Health Research (CIHR) and the Fonds de recherche du Quebec – Sante (FRQS).

A longitudinal study of delirium phenomenology indicates widespread neural dysfunction

Delirium affects all higher cortical functions supporting complex information processing consistent with widespread neural network impairment. We evaluated the relative prominence of delirium symptoms throughout episodes to assess whether impaired consciousness is selectively affecting certain brain functions at different timepoints. Twice-weekly assessments of 100 consecutive patients with DSM-IV delirium in a palliative care unit used the Delirium Rating Scale Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD). A mixed-effects model was employed to estimate changes in severity of individual symptoms over time. Mean age = 7 0.2 ± 10.5 years, 51% were male, and 27 had a comorbid dementia. A total of 323 assessments (range 2-9 per case) were conducted, but up to 6 are reported herein. Frequency and severity of individual DRS-R98 symptoms was very consistent over time even though the majority of patients (80%) experienced fluctuation in symptom severity over the course of hours or minutes. Over time, DRS-R98 items for attention (88-100%), sleep-wake cycle disturbance (90-100%), and any motor disturbance (87-100%), and CTD attention and vigilance were most frequently and consistently impaired. Mixed-effects regression modeling identified only very small magnitudes of change in individual symptoms over time, including the three core domains. Attention is disproportionately impaired during the entire episode of delirium, consistent with thalamic dysfunction underlying both an impaired state of consciousness and well-known EEG slowing. All individual symptoms and three core domains remain relatively stable despite small fluctuations in symptom severity for a given day, which supports a consistent state of impaired higher cortical functions throughout an episode of delirium.

EComment. Postoperative delirium in elderly cardiac surgery patients

I read with great interest the paper by Smulter et al. [1]. The authors aimed at determining the incidence of and risk factors for postoperative delirium (POD), in older patients undergoing cardiac surgery. They reported an incidence of POD of 54.9% and confirmed many of the previously suggested risk factors. In their study, POD was strongly associated with an increased volume load during surgery. I would like to add some comment on this important topic. POD is a common and serious complication in elderly cardiac surgery patients. It is defined as an acute and fluctuating disturbance in consciousness, characterized by disorientation, a disturbed sleep-wake cycle, memory impairment, perceptual disturbances, and altered psychomotor activity [2,3]. POD is an important cause of prolonged hospital stay (economic burden), nursing home placement, and increased morbidity and mortality after cardiovascular surgery. In addition, it is associated with late death, hospital readmission, and reduced cognitive and functional recovery. The reported incidence of POD ranges from 30 to 73% depending on the diagnostic method used to define POD, study design, and type of cardiovascular procedure [2-a5]. The exact pathophysiology of POD is unknown. There are several potential mechanisms including perioperative cerebral hypoperfusion, alterations in the levels of neurotransmitters, systemic inflammation and physiologic stresses. This pathophysiologic complexity contributes to high incidence of POD [3,4]. Elderly cardiac surgery patients are at a particularly high risk for POD owing to the use of cardiopulmonary bypass, the presence of macro- or microemboli resulting from aortic and cardiac manipulation, the complexity and duration of surgical procedure, cerebral reperfusion injury, and large volume and pressure shifts [3]. The likelihood of developing POD increases proportionally with the number of existing risk factors [4]. Identification of risk factors for developing POD allows surgeons to implement interventions aimed at reducing the incidence of POD in these high risk patients. There are many patient (predisposing) and surgery (precipitating) risk factors related to POD. These risk factors include advanced age, pre-existing dementia, depression, functional impairment, cognitive impairment, hearing and visual impairment, alcohol abuse, smoking, decreased left ventricular ejection fraction, pre-existing pulmonary disease, hypertension, atrial fibrillation, laboratory abnormalities, cerebrovascular disease, decreased albumin level, lower hematocrit, postoperative hypotension and increased blood transfusion [2-5]. The most critical steps in management of POD are prevention and early recognition. Both prevention and treatment should focus on the minimization and/or elimination of predisposing and precipitating factors. There is currently no accepted preventive treatment for POD. Due to the multifactorial nature of POD, approaches which include strategies from multiple disciplines are the most effective in its prevention [5]. To prevent POD in high-risk patients, it should be focused on environmental modifications, psychoactive medication reduction, early mobilization, and prevention of complications [3]. Ten targeted domains to reduce delirium include (1) oxygen delivery to the brain, (2) fluid and electrolyte balance, (3) appropriate pain management, (4) decreased use of psychoactive medications, (5) optimization of bowel and bladder function, (6) nutritional support, (7) early mobilization, (8) prevention of postoperative complications, (9) appropriate environmental stimuli, and (10) treatment of delirium symptoms [5]. I think that recognition of early clinical signs and risk factors could be helpful for prevention and treatment, resulting in better outcomes. Conflict of interest: none declared

Recent Advances in Sleep-Wake Cycle and Biological Rhythms in Bipolar Disorder

The cyclical nature of periodic switches in energy, motor activation and sleep-wake cycles in bipolar disorder suggests a strong underlying relationship with disturbances in chronobiology. Current research is refining our understanding of the various patterns of sleep-wake and biological rhythms alterations at early and later stages of this illness, as well as across its depressive/fatigue, manic/hypomanic and euthymic phases. This research focuses on early detection and subsequent monitoring to predict and better manage recurrent episodes. Sleep-wake cycle and biological rhythms disturbances are also well known to affect other key aspects of physical health (notably metabolic functions), cognitive performance and elevated risks for suicide. Increasing evidence now supports the integration of behavioural or pharmacological therapeutic strategies that target the sleep-wake and circadian systems in the ongoing treatment of various phases of bipolar disorder.

First Spanish Version of the Memorial Delirium Assessment Scale: Psychometric Properties, Responsiveness, and Factor Loadings

ContextThe Memorial Delirium Assessment Scale (MDAS) is a reliable and validated instrument with which to assess delirium. However, MDAS responsiveness has only been investigated in an indirect way. Also, neurobehavioral and global cognitive factors seem to be the MDAS main factor loads. ObjectivesThe primary objective of this study was to evaluate MDAS responsiveness and analyze individual factors on this scale. The secondary objective was to confirm concurrent validity and reliability of the Spanish version of the MDAS. MethodsThe translation-back translation method was used to obtain the Spanish version of the MDAS. Delirium diagnosis was determined by the clinical Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria and with the Confusion Assessment Method. Responsiveness and factor loadings were determined with the Delirium Rating Scale-Revised-98, the Mini-Mental State Examination (MMSE), and the MDAS at baseline (0 hours) and at 72 hours. ResultsVariation in the scores of the Delirium Rating Scale-Revised-98 shows a correlation of r = 0.93, with variation in MDAS scores at P < 0.001. Variation in MMSE scores shows a correlation of r = −0.84, with variation in MDAS scores at P = 0.015. Factor I, neurobehavioral (reduced awareness, reduced attention, perceptual disturbance, delusions, altered psychomotor activity, and sleep-wake cycle disturbance), correlated moderately with the MMSE at −0.56. Factor II, global cognitive (disorientation, short-term memory impairment, impaired digit span, and disorganized thinking), correlated strongly with the MMSE at −0.81. Factor II was significantly more reliable than Factor I, rho = 0.7, P = 0.01. ConclusionThe high responsiveness confirms the value of the MDAS for ongoing delirium assessment. Two differentiated factor loadings point to a potential future need for MDAS subscales.

Prospective Evaluation of the Nature, Course, and Impact of Acute Sleep Abnormality After Traumatic Brain Injury

ObjectiveTo prospectively characterize the prevalence, course, and impact of acute sleep abnormality among traumatic brain injury (TBI) neurorehabilitation admissions. DesignProspective observational study. SettingFreestanding rehabilitation hospital. ParticipantsPrimarily severe TBI (median emergency department Glasgow Coma Scale [GCS] score=7; N=205) patients who were mostly men (71%) and white (68%) were evaluated during acute neurorehabilitation. InterventionsNone. Main Outcome MeasureDelirium Rating Scale-Revised-98 (DelRS-R98) was administered weekly throughout rehabilitation hospitalization. DelRS-R98 item 1 was used to classify severity of sleep-wake cycle disturbance (SWCD) as none, mild, moderate, or severe. SWCD ratings were analyzed both serially and at 1 month postinjury. ResultsFor the entire sample, 66% (mild to severe) had SWCD at 1 month postinjury. The course of the SWCD using a subset (n=152) revealed that 84% had SWCD on rehabilitation admission, with 63% having moderate to severe ratings (median, 24d postinjury). By the third serial exam (median, 35d postinjury), 59% remained with SWCD, and 28% had moderate to severe ratings. Using general linear modeling and adjusting for age, emergency department GCS score, and days postinjury, presence of moderate to severe SWCD at 1 month postinjury made significant contributions in predicting duration of posttraumatic amnesia (P<.01) and rehabilitation hospital length of stay (P<.01). ConclusionsResults suggest that sleep abnormalities after TBI are prevalent and decrease over time. However, a high percent remained with SWCD throughout the course of rehabilitation intervention. Given the brevity of inpatient neurorehabilitation, future studies may explore targeting SWCD to improve early outcomes, such as cognitive functioning and economic impact, after TBI.

EEG-vigilance regulation during the resting state in obsessive–compulsive disorder

ObjectiveObsessive compulsive disorder (OCD) has been associated with disturbed sleep-wake cycles and cortical hypermetabolism. However, it still remains unclear whether OCD is associated with a dysregulation of vigilance (i.e. “brain arousal”). VIGALL (Vigilance Algorithm Leipzig) is an EEG-based tool to assess vigilance dynamics. Aim of this study is to test the hypothesis that during resting state less declines to lower vigilance stages are found in unmedicated patients with OCD (n=30) compared to healthy controls (HCs, n=30). MethodsFifteen minutes of resting EEG were recorded; preceding sleep duration, nicotine/caffeine consumption and severity of OCD and depressive symptoms were assessed. ResultsSignificant differences of EEG-vigilance were found for the factor “group” (OCD vs. HC), factor “time” and interaction “group×time” in a repeated measures ANOVA with increased EEG-vigilance in OCD patients. OCD patients showed significantly fewer transitions between EEG-vigilance stages. ConclusionsIn line with findings of disturbed sleep regulation, OCD is associated with altered EEG-vigilance regulation with a failure of declining toward low vigilance stages during rest. SignificanceThese results encourage the use of EEG-vigilance regulation for determining subgroups for e.g. studying treatment response and suggest awareness for possible vigilance effects in neuroimaging studies of OCD.

Symptom profile of delirium in children and adolescent—does it differ from adults and elderly?

ObjectiveThe objective was to evaluate the phenomenology, etiology and outcome of delirium in children and adolescents (8–18 years of age) seen in a consultation–liaison psychiatric service in India. Additionally, an attempt was made to compare the phenomenology with adult and elderly patients with delirium. MethodThirty children and adolescents (age 8–18 years) diagnosed with delirium by the consultation–liaison psychiatry team were rated on the Delirium Rating Scale-Revised-98 (DRS-R-98) and compared with DRS-R-98 data on 120 adults and 109 elderly patients. ResultsThe commonly observed symptoms in children and adolescents with delirium were disturbance in attention, orientation, sleep–wake cycle disturbances, fluctuation of symptoms, disturbance of short-term memory and motor agitation. The least commonly seen symptoms included delusions and motor retardation. Compared to adults, children and adolescents had lower frequency of long-term memory and visuospatial disturbances. Compared to the elderly, children and adolescents had higher frequency of lability of affect. For severity of symptoms, compared to adults, the children and adolescents had lower severity of sleep–wake disturbances, abnormality of thought, motor agitation, orientation, attention, short-term memory, long-term memory and visuospatial abilities. When compared to elderly patients, children and adolescents had higher severity of lability of affect and lower severity of language disturbances, short-term memory and visuospatial abilities. ConclusionsIn general, phenomenology, of delirium in children and adolescents (age 8–18 years) is similar to that seen in adults and elderly patients.

Effect of Melatonin on Seizure Frequency in Intractable Epilepsy

Melatonin is effective for treating sleep-wake cycle disturbances and has been reported occasionally to decrease epileptic seizure frequency, with no long-term side effects. In this pilot study, the investigators examined the effect of melatonin on seizures, sleep quality, and behavior in 10 patients aged 9 to 32 years with intractable epilepsy. Patients were randomized to receive melatonin (10 mg daily at bedtime) followed by placebo or placebo followed by melatonin for 3 weeks each, with a 1-week washout period in between. Seizure frequency was monitored by daily diaries and actigraphy recordings; behavioral and sleep parameters were rated by caregivers. Diurnal seizures decreased significantly with melatonin compared with placebo (P = .034, Wilcoxon test). Maximal number of seizures, seizure duration, sleep efficiency or latency, and behavioral parameters remained unchanged. No major side effects or seizure aggravation were documented. It is concluded that melatonin could be effective and safe for decreasing daytime seizure frequency in patients with intractable epilepsy.

Delirium in elderly people: a study of a psychiatric liaison service in north India

Very few studies from India have studied the phenomenology of delirium. The aim of the present study was to study the phenomenology as measured using the Delirium Rating Scale-Revised-98 (DRS-R98), the associated etiologies and the outcome of delirium among the elderly participants seen by the consultation-liaison psychiatric service in India. In addition, an attempt was made to study the factor structure of symptoms using principal components analysis. The case notes of 109 elderly patients referred to psychiatry liaison services were reviewed. The mean age of the sample was 73.35 years (SD: 7.44; range 65-95 years) and two-thirds of the sample had hospital emergent delirium. The mean DRS-R98 severity score was 18.77 and the DRS-R98 total score was 24.81. In 15 patients the DRS-R98 scores were in the subsyndromal range. Among the various symptoms present, most patients had sleep-wake cycle disturbance, disturbance in orientation, attention and short-term memory impairments, fluctuation of symptoms, temporal onset of symptoms and a physical disorder. Principal components analysis identified three factors which explained 43.5% of variance of symptomatology and it yielded a three-factor structure. Endocrine/metabolic disturbances were the commonest associated etiological category with delirium. The mean hospital stay after being referred to psychiatry referral services was 8.89 days, after which delirium improved in 58.7% of cases. The mortality rate during the inpatient stay was 16.5%. Results suggest that the symptoms of delirium as assessed by DRS-R98 separate out into a three-factor structure. Delirium is commonly associated with metabolic endocrine disturbances and about one-sixth of the patients die during the short inpatient stay.

Symptoms of delirium: an exploratory factor analytic study among referred patients

Objective Factor analytic studies of delirium symptoms among patients referred through consultation–liaison psychiatric services are rare. We examined the factor structure of delirium symptoms in referred patients and determined whether combining items from several delirium rating scales influenced the factor structure of delirium symptoms. Method Eighty-six patients with delirium ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) referred though the consultation–liaison services were assessed with structured rating scales. Nineteen symptom items extracted from the Delirium Rating Scale—Revised-98 (DRS-R-98), the Memorial Delirium Assessment Scale and the Confusional State Evaluation Scale were subjected to an exploratory (principal component) factor analysis. A second such analysis was conducted on 15 items of the DRS-R-98 for comparison. Results Compared with prior studies, patients were younger and the majority had hyperactive delirium. Principal components analysis identified two factors: (1) a “cognitive” factor comprising of disturbances in language, thought processes, orientation, attention, short- and long-term memory, visuospatial ability, consciousness (awareness) and perseveration accounted for 28.9% of the variance and (2) a “behavioral” factor consisting of sleep–wake cycle disturbances, delusions, perceptual disturbances, motor agitation, affect–lability, distractibility, irritability and temporal onset accounted for 18.9% of the variance. An identical factor structure was obtained with the DRS-R-98 items. Conclusions Similar to previous factor analytic studies, the present study supported the existence of two principal dimensions of delirium, cognitive and behavioral. Additionally, it extended the results of earlier investigations to a wider group of patients with delirium, suggesting that these dimensions might provide important clues to the neurobiology of delirium.

Phase Advance of the Light-Dark Cycle Perturbs Diurnal Rhythms of Brain-derived Neurotrophic Factor and Neurotrophin-3 Protein Levels, Which Reduces Synaptophysin-positive Presynaptic Terminals in the Cortex of Juvenile Rats

In adult rat brains, brain-derived neurotrophic factor (BDNF) rhythmically oscillates according to the light-dark cycle and exhibits unique functions in particular brain regions. However, little is known of this subject in juvenile rats. Here, we examined diurnal variation in BDNF and neurotrophin-3 (NT-3) levels in 14-day-old rats. BDNF levels were high in the dark phase and low in the light phase in a majority of brain regions. In contrast, NT-3 levels demonstrated an inverse phase relationship that was limited to the cerebral neocortex, including the visual cortex, and was most prominent on postnatal day 14. An 8-h phase advance of the light-dark cycle and sleep deprivation induced an increase in BDNF levels and a decrease in NT-3 levels in the neocortex, and the former treatment reduced synaptophysin expression and the numbers of synaptophysin-positive presynaptic terminals in cortical layer IV and caused abnormal BDNF and NT-3 rhythms 1 week after treatment. A similar reduction of synaptophysin expression was observed in the cortices of Bdnf gene-deficient mice and Ca(2+)-dependent activator protein for secretion 2 gene-deficient mice with abnormal free-running rhythm and autistic-like phenotypes. In the latter mice, no diurnal variation in BDNF levels was observed. These results indicate that regular rhythms of BDNF and NT-3 are essential for correct cortical network formation in juvenile rodents.

Phenomenological and Neuropsychological Profile Across Motor Variants of Delirium in a Palliative-Care Unit

Studies using composite measurement of cognition suggest that cognitive performance is similar across motor variants of delirium. The authors assessed neuropsychological and symptom profiles in 100 consecutive cases of DSM-IV delirium allocated to motor subtypes in a palliative-care unit: Hypoactive (N=33), Hyperactive (N=18), Mixed (N=26), and No-Alteration motor groups (N=23). The Mixed group had more severe delirium, with highest scores for DRS–R-98 sleep–wake cycle disturbance, hallucinations, delusions, and language abnormalities. Neither the total Cognitive Test for Delirium nor its five neuropsychological domains differed across Hyperactive, Mixed, and Hypoactive motor groups. Most patients (70%) with no motor alteration had DRS–R-98 scores in the mild or subsyndromal range even though they met DSM-IV criteria. Motor variants in delirium have similar cognitive profiles, but mixed cases differ in expression of several noncognitive features.

Phenomenological and Neuropsychological Profile Across Motor Variants of Delirium in a Palliative-Care Unit

Studies using composite measurement of cognition suggest that cognitive performance is similar across motor variants of delirium. The authors assessed neuropsychological and symptom profiles in 100 consecutive cases of DSM-IV delirium allocated to motor subtypes in a palliative-care unit: Hypoactive (N=33), Hyperactive (N=18), Mixed (N=26), and No-Alteration motor groups (N=23). The Mixed group had more severe delirium, with highest scores for DRS-R-98 sleep-wake cycle disturbance, hallucinations, delusions, and language abnormalities. Neither the total Cognitive Test for Delirium nor its five neuropsychological domains differed across Hyperactive, Mixed, and Hypoactive motor groups. Most patients (70%) with no motor alteration had DRS-R-98 scores in the mild or subsyndromal range even though they met DSM-IV criteria. Motor variants in delirium have similar cognitive profiles, but mixed cases differ in expression of several noncognitive features.

Neuropsychiatric and cognitive profile of patients with DSM-IV delirium referred to an old age psychiatry consultation-liaison service

The phenomenology of delirium is understudied, including how the symptom profile varies across populations. The aim of this study was to explore phenomenology occurring in patients with delirium referred to an old age psychiatry consultation-liaison setting and compare with delirium occurring in palliative care patients. Consecutive cases of DSM-IV delirium were assessed with the Delirium Rating scale Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD). Eighty patients (mean age 79.3 ± 7.7 years; mean DRS-R98 total score 21.7 ± 4.9 and total CTD score 10.2 ± 6.3) were included. Forty patients (50%) with comorbid dementia were older, had a longer duration of symptoms at referral, and more severe delirium due to greater cognitive impairments. Inattention (100%) was the most prominent cognitive disturbance, while sleep-wake cycle disturbance (98%), altered motor activity (97%), and thought process abnormality (96%) were the most frequent DRS-R98 non-cognitive features. Inattention was associated with severity of other cognitive disturbances on both the DRS-R98 and CTD, but not with DRS-R98 non-cognitive items. The phenomenological profile was similar to palliative care but with more severe delirium due to greater cognitive and non-cognitive disturbance. Delirium is a complex neuropsychiatric syndrome with generalized cognitive impairment and disproportionate inattention. Sleep-wake cycle and motor-activity disturbances are also common. Comorbid dementia results in a similar phenomenological pattern but with greater cognitive impairment and later referral.

A factor analytic study of the Delirium Rating Scale-Revised-98 in untreated patients with delirium

Objective Existing factor analytic studies of symptoms of delirium are mostly based on small numbers of patients from specialized settings. This study thus sought to examine the factor structure of symptoms of delirium in a reasonably large sample of untreated patients referred to liaison psychiatric services of a multi-specialty hospital in north India, employing the more commonly used Delirium Rating Scale-Revised Version-1998 (DRS-R-98). Method Patients ( n=151) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for delirium were assessed with the DRS-R-98 prior to starting treatment with psychotropics. A principal component analysis was carried out to determine the factor structure of the symptoms based on these ratings. Results Unlike previous efforts, patients of this study were relatively younger (mean age 47 years), with mainly hyperactive delirium, and did not have comorbid dementia. Three factors which together explained 47.32 % of variance of symptoms were identified. A “global cognitive” factor including disturbances of orientation, attention, short- and long-term memory, and visuospatial ability accounted for 18.33% of the variance. A “sleep and motor symptoms” factor consisting of sleep–wake cycle disturbances; delusions; and perceptual disturbances including hallucinations, motor-agitation, inverse of motor-retardation, and affect-lability accounted for 16% of the variance. A “thought and language” factor comprising abnormalities in language and thought process, temporal onset, and fluctuation of symptoms explained 13% of the variance. Conclusions Thus, the current factor analysis not only confirmed the presence of three principal symptom dimensions of delirium (found in several previous studies) but also extended these findings to a broader group of patients usually referred to liaison psychiatric services.