The correlation between delirium subtypes and treatment efficacy and biochemical parameters: A preliminary study

The correlation between delirium subtypes and treatment efficacy and biochemical parameters: A preliminary study

Aim: Delirium is one of the most important emergency cases in geriatric patient population with high morbidity and mortality rates.In clinical practice, three delirium types are defined as hyperactive, hypoactive and mixed according to the psychomotor activity andthe level of wakefulness. In the present study, the purpose was to examine the treatment response of the subtypes of delirium andits relation with possible biochemical parameters.Material and Methods: Thirty patients, who were diagnosed with delirium and who were hospitalized for treatment were included inthe present study. Following the classification of the patients according to the subtypes of delirium, they were evaluated before thetreatment and on the 7th day of the treatment. In both interviews, the Delirium Rating Scale (DRS), Richmond Agitation and SedationScale (RASS), and Memorial Delirium Rating Scale (MDRS) were applied to the patients. In addition, the biochemical parameters thatwere required for the patients in relevant clinics were recorded.Results: Delirium patients consisted of a total of 30 patients. The patients of all three subtypes of delirium responded to the treatmentscores at significant levels in terms of scale scores. However, when the Hyperactive, Hypoactive and Mixed subtypes were evaluatedin terms of the difference of change on the 1st and 7th days of the treatment separately, it was determined that the difference ofchange values were significantly higher in the hyperactive type in terms of RASS, DRS and MDRS (p=0.004; p=0.002; p=0.001,respectively).Conclusions: As a result, the findings of the present study showed that patients who are diagnosed with delirium might show differenttreatment responses according to motor subtypes. Further studies are required to be conducted with bigger sampling groups.

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  • 1. American psychiatric association. diagnostic and statistical manual of mental disorders: dsm-5. Arlington, VA: American Psychiatric Association, 2013;291-327.
  • 2. Ely EW, Margolin R, Francis J, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2001;29:1370-9.
  • 3. Witlox J, Eurelings LS, de Jonghe JF, et al. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 2010;304:443-51.
  • 4. Morandi A, Davis D, Fick DM, et al. Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients. J Am Med Dir Assoc 2014;15:349- 54.
  • 5. Kyziridis TC. Post-operative delirium after hip fracture treatment: a review of the current literature. GMS Psycho- Social-Med 2006;3:1-12.
  • 6. Mouzopoulos G, Vasiliadis G, Lasanianos N, et al. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. J Orthopaed Traumatol 2009;10:127-33.
  • 7. Munster BC, Korse CM, Rooij SE, et al. Markers of cerebral damage during delirium in elderly patients with hip fracture. BMC Neurol 2009;9:21
  • 8. Slor CJ, Adamis D, Jansen RW, et al. Delirium motor subtypes in elderly hip fracture patients: risk factors, outcomes and longitudinal stability. J Psychosom Res 2013;74:444-9.
  • 9. Grover S, Sharma A, Aggarwal M, et al. Comparison of symptoms of delirium across various motoric subtypes. Psychiatry Clin Neurosci 2014;68:283-91.
  • 10. Meagher DJ, Leonard M, Donnelly S, et al. A longitudinal study of motor subtypes in delirium: frequency and stability during episodes. J Psychosom Res 2012;72:236-41.
  • 11. Heidrich, DE. Delirium: An Under-Recognized Problem. Clin J Oncol Nurs 2007;11:805-7.
  • 12. Morandi A, Di Santo SG, Cherubini A, et al. Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients: Results of a Multicenter Study. Am J Geriatr Psychiatry 2017;25:1064-71.
  • 13. Kiely DK, Jones RN, Bergmann MA, et al. Association between psychomotor activity delirium subtypes and mortality among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci 2007;62:174-9.
  • 14. Inouye SK, Viscoli CM, Horwitz RI, et al. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med 1993;119:474- 81.
  • 15. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet 2014;383:911-22.
  • 16. Meagher D. Motor subtypes of delirium: past, present and future.Int Rev Psychiatry 2009;21:59-73.
  • 17. Aydemir Ö, Noyan A, Gülseren Ş, et al. Development, reliability and validity of the delirium rating scale. 3P Derg 1998;6:21-7.
  • 18. Sessler CN, Gosnell MS, Grap MJ, et al. The richmond agitation–sedation scale validity and reliability in adult ıntensive care unit patients. Am J Respir Crit Care Med 2002;166:1338-44.
  • 19. Breitbart W, Rosenfeld B, Roth A, et al. The memorial delirium assesment scale. J Pain Symptom Manage 1997;13:128-37.
  • 20. Krewulak KD, Stelfox HT, Leigh JP, et al. Incidence and prevalence of delirium subtypes in an adult icu: a systematic review and meta-analysis. Crit Care Med 2018;46:2029-35.
  • 21. Michaud CJ, Bullard HM, Harris SA, et al. Impact of quetiapine treatment on duration of hypoactive delirium in critically ill adults: a retrospective analysis. Pharmacotherapy 2015;35:731-9.
  • 22. FitzGerald JM. Delirium clinical motor subtypes: a narrative review of the literature and insights from neurobiology. Aging Ment Health 2018;22:431-43.
  • 23. Neufeld KJ, Yue J, Robinson TN, et al. Antipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta-analysis. J Am Geriatr Soc 2016;64:705-14.
  • 24. Boettger S, Friedlander M, Breitbart W, et al. Aripiprazole and haloperidol in the treatment of delirium. Aust N Z J Psychiatry 2011;45:477-82
  • 25. Breitbart W, Tremblay A, Gibson C. An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics 2002;43:175-82.
  • 26. Hui D, Dev R, Bruera E. Neuroleptics in the management of delirium in patients with advanced cancer. Curr Opin Support Palliat Care 2016;10:316-23.
  • 27. Hui D, De La Cruz M, Bruera E. Palliative care for delirium in patients in the last weeks of life: the final frontier. J Palliat Care 2014;30:259-64.
  • 28. Boettger S, Knöpfel S, Schubert M, et al. Pipamperone and delirium: a preliminary evaluation of its effectiveness in the management of delirium and its subtypes. Swiss Med Wkly 2017;24;147:w14471.
  • 29. Aldemir M, Özen S, Kara IH, et al. Predisposing factors for delirium in the surgical intensive care unit. Crit Care 2001;5:265-70.
  • 30. Marcantonio ER, Goldman L, Mangione CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 1994;271:134-9.
  • 31. Balan S, Leibovitz A, Zila SO, et al. The relation between the clinical subtypes of delirium and the urinary level of 6-SMT. J Neuropsychiatry Clin Neurosci 2003;15:363-6. 1288
Annals of Medical Research-Cover
  • Yayın Aralığı: 12
  • Yayıncı: İnönü Üniversitesi Tıp Fakültesi
Sayıdaki Diğer Makaleler

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Changes in serum BDNF levels after treatment of panic disorder patients

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Multidetector computed tomography and magnetic resonance imaging findings in pulmonary hydatid cysts

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Vocal cord paralysis after total thyroidectomy with ecchymosis secondary to thyroid biopsy

Mehmet SARAC, Serdar GURSUL, Serhat DOGAN

A rare complication of penile prosthesis: Migration to the posterior gluteal groove

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The predictors of occupational disability in obsessivecompulsive disorder in a large clinical sample

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Diagnostic performance of prostate imaging reporting and data system v2.1: Single center experience

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Is serum irisin level lower in neonates born to mothers with gestational diabetes?

Murat YURDAKOK, Şule YİĞİT, Davut BOZKAYA, Hasan Tolga ÇELİK

Liver transplantation in Wilson’s disease: Long-term experience of single center

Tufan EGELİ, Mesut AKARSU, Anıl AYSAL, Mücahit ÖZBİLGİN, Tarkan UNEK, Cihan AĞALAR, İbrahim ASTARCIOĞLU, Özgül SAĞOL, Ziya AYHAN

Bacterial colonization in uninfected pilonidal cyst and its role in developing recurrence in postoperative period: Prospective study

Mehmet Akif ÜSTÜNER, Enver İLHAN, Özlem Yüksel ERGİN, Mehmet Tahsin TEKELİ, Uğur GÖKÇELLİ, Hilmi GÜNGÖR, Emine Deniz BAYRAM, Ozcan ALPDOGAN, Orhan ÜREYEN