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Subsyndromal delirium in the intensive care setting: Phenomenological characteristics and discrimination of subsyndromal delirium versus no and full-syndromal delirium

Published online by Cambridge University Press:  06 March 2017

Soenke Boettger ,
David Garcia Nuñez ,
Rafael Meyer ,
André Richter ,
Maria Schubert  and
Josef Jenewein
Soenke Boettger*
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
David Garcia Nuñez
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland University Hospital Basel, University of Basel, Basel, Switzerland
Rafael Meyer
Affiliation:
Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
André Richter
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
Maria Schubert
Affiliation:
Inselspital, University Hospital Bern, Directorate of Nursing/MTT, Bern, Switzerland
Josef Jenewein
Affiliation:
Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
*
Address correspondence and reprint requests to Soenke Boettger, Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Ramistraase 100, 8091 Zurich, Switzerland. E-mail: soenke.boettger@usz.ch.
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Abstract

Objective:

Similar to delirium, its subsyndromal form has been recognized as the cause of diverse adverse outcomes. Nonetheless, the nature of this subsyndromal delirium remains vastly understudied. Therefore, in the following, we evaluate the phenomenological characteristics of this syndrome versus no and full-syndromal delirium.

Method:

In this prospective cohort study, we evaluated the Delirium Rating Scale–Revised, 1998 (DRS–R–98) versus the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM–IV–TR) diagnostic criteria and examined the diagnosis of delirium with respect to phenomenological distinctions in the intensive care setting.

Results:

Out of 289 patients, 36 with subsyndromal delirium versus 86 with full-syndromal and 167 without delirium were identified. Agreement with respect to the DSM–IV–TR diagnosis of delirium was perfect. The most common subtype in those with subsyndromal delirium was hypoactive, in contrast to mixed subtype in those with full-syndromal delirium versus no motor alterations in those without delirium. By presence and severity of delirium symptoms, subsyndromal delirium was intermediate. The ability of the DRS–R–98 items to discriminate between either form of delirium was substantial. Between subsyndromal and no delirium, the cognitive domain and sleep–wake cycle were more impaired and allowed a distinction with no delirium. Further, between full- and subsyndromal delirium, the prevalence and severity of individual DRS–R–98 items were greater. Although the differences between these two forms of delirium was substantial, the items were not very specific, indicating that the phenomenology of subsyndromal delirium is closer to full-syndromal delirium.

Significance of results:

Phenomenologically, subsyndromal delirium was found to be distinct from and intermediate between no delirium and full-syndromal delirium. Moreover, the greater proximity to full-syndromal delirium indicated that subsyndromal delirium represents an identifiable subform of full-syndromal delirium.

Keywords

DeliriumSubsyndromalFull-syndromalPhenomenologyIntensive care unit (ICU)Delirium Rating Scale–Revised1998 (DRS–R–98)Diagnostic and Statistical Manual of Mental Disorders4th ed.Text Revision (DSM–IV–TR)
Type
Original Articles
Information
Palliative & Supportive Care , Volume 16 , Special Issue 1: Special Instruments – Assessment and Measure Issues in Palliative Care , February 2018 , pp. 3 - 13
Copyright
Copyright © Cambridge University Press 2017 

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Footnotes

*

Shared first authorship.

References

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