Psychiatry Newsletter - Demystifying Delirium
Date: April 15, 2013
Roughly 40 percent of inpatients at major medical centers will be delirious at some point in their stay,” Karin Neufeld told a recent gathering of fellow Johns Hopkins psychiatry faculty. “If they’re on ventilators in the ICU, that can jump to 85 percent.”
Delirium is a hospital bane, an unwelcome visitor calling reliably on the very ill or frail. And it can harm. In adults, the syndrome is tied to higher mortality and longer time in the hospital (see box, left). Yet common and damaging as it can sometimes be, “delirium remains under-recognized and understudied,” Neufeld says.
So she and colleagues are among a band of nationwide movers and shakers bent on correcting that.
Neufeld, who directs general hospital psychiatry, visits bedsides of three medical or psychiatric patients a day, on average, to assess suspected delirium and consult on therapy. That puts her well in position to see where the clinical gaps lie. It’s not uncommon in hospitals, for example, for staff to overlook “quiet” or hypoactive delirium or mistake it for depression, she says, or to find agitated delirium simply called psychosis.
Neufeld’s most recent work sheds light on the condition’s nature and its impact. In a new study, researchers followed about 100 fairly robust patients over age 70 undergoing hip surgery, assessing them before it, just afterward and at hospital discharge. Two results stood out. One was in the recovery room, where staff typically don’t look for delirium, since—the thinking goes—general anesthesia makes everyone unfocused and disoriented. But the study showed that nearly half of patients had frank, DSM-matching delirium. It faded quickly in some, but lasted three days in an equal number later moved to hospital beds.
The other result confirms others’ findings: Delirium increases the burden of frailty in older people. “Our elders who were delirious in recovery,” she says, “were nine times as likely to go to rehab or a nursing home.”
What’s the culprit in all this? Is it length of surgery? Anesthesia? Surgical sedatives? “Our work suggests the depth of sedation plays a part, but that needs more study,” says Neufeld. “We have a lot to learn.”
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