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Phenomenology of delirium: Assessment of 100 adult cases using standardised measures

  • David J. Meagher (a1), Maria Moran (a1), Bangaru Raju (a1), Dympna Gibbons (a1), Sinead Donnelly (a2), Jean Saunders (a3) and Paula T. Trzepacz (a4)...
Abstract
Background

Delirium phenomenology is understudied.

Aims

To investigate the relationship between cognitive and non-cognitive delirium symptoms and test the primacy of inattention in delirium.

Method

People with delirium (n=100) were assessed using the Delirium Rating Scale-Revised-98(DRS-R98)and Cognitive Test for Delirium (CTD).

Results

Sleep-wake cycle abnormalities and inattention were most frequent, while disorientation was the least frequent cognitive deficit. Patients with psychosis had either perceptual disturbances or delusions but not both. Neither delusions nor hallucinations were associated with cognitive impairments. Inattention was associated with severity of other cognitive disturbances but not with non-cognitive items. CTD comprehension correlated most closely with non-cognitive features of delirium.

Conclusions

Delirium phenomenology is consistent with broad dysfunction of higher cortical centres, characterised in particular by inattention and sleep-wake cycle disturbance. Attention and comprehension together are the cognitive items that best account for the syndrome of delirium. Psychosis in delirium differs from that in functional psychoses.

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Copyright
Corresponding author
Dr David Meagher, Department of Adult Psychiatry, Midwestern Regional Hospital, Limerick, Ireland. Email: meaghermob@eircom.net
Footnotes
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Declaration of interest

P.T. is an employee off Eli Lilly D. M. has an unrestricted educational grant from Astra Zeneca Pharmaceuticals.

Footnotes
References
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Phenomenology of delirium: Assessment of 100 adult cases using standardised measures

  • David J. Meagher (a1), Maria Moran (a1), Bangaru Raju (a1), Dympna Gibbons (a1), Sinead Donnelly (a2), Jean Saunders (a3) and Paula T. Trzepacz (a4)...
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eLetters

Phenomenolgy of Delirium

Sarah M Maddicott, Locum Consultant Psychiatrist
07 September 2007

Letter to British Journal of Psychiatry26th April 2007

Phenomenology of Delirium

Meagher et al (2007) describe the phenomenology of delirium in 100 patients in an in-patient palliative care setting. Delirium is an under-researched area and we were interested in the findings gained from a largenumber of delirium cases using tools including the Delirium Rating Scale-Revised-’98 (DRS R98) and the Cognitive Test for Delirium.

We have conducted a small study into the phenomenology of delirium inpatients with liver disease. Consecutive, consenting admissions to a gastro-intestinal ward with primary intra-hepatic liver disease as diagnosed by the responsible physician, were screened for the presence of delirium using a combination of DSM-IV criteria and the DRS R98. Patients were seen by one of the researchers within 7 days of admission. In patients with delirium, the Motoric subtype was classified according tocriteria described by Liptzin and Levkoff (1992).

78 out of a possible 145 subjects were screened (39 refused, 28 were missed and the remainder were excluded because of a language barrier, inability to consent or being considered too unwell to approach). Eleven of these patients met DSM IV criteria for delirium ; 9 of these fulfilled the criteria for hypoactive delirium and 2 could not be classified. However, using the suggested cut-off scores on the DRS-R of 15.25 on the severity scale and 17.75 on the total score, only 4 out of 11 of our subjects scored above this cut off. In our subject group, the mean severity score was 12.41 (SD 3.7) and the mean total score was 16.23 (SD 4.9).

We therefore suggest that while the DRS-R is a useful tool to help describe and record symptoms of delirium it is less useful as a screening instrument for detecting hypoactive delirium. Research into the phenomenology of delirium can be difficult to carry out due to the variable presentations of delirium and its fluctuating course, the possibility of multiple aetiologies and the ethics of obtaining consent onpatients with impaired cognition. We hope that despite this, there will beon-going interest and further advances in developing research methods and trying to clarify the nature and causes of delirium.

References

Meagher D, Moran M, Raju B and Gibbons D. (2007) Phenomenology of delirium. British Journal of Psychiatry, 190, 135 – 141.

Liptzin B, Levkoff S.E. (1992) An empirical study of delirium subtypes. British Journal of Psychiatry, 161, 843 - 845

Declaration of interest ; None

Authors; Dr Sarah Maddicott, Locum Consultant Psychiatrist,Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK. EH10 5HF Tel; 0131 537 6631 Fax; 0131 537 6112

Dr Dinah Bennett, Career Medical Officer,Parkview Unit, Macquarie Hospital, North Ryde, NSW 2112, Australia

Dr Stephen Lawrie, Senior Clinical Research fellow,Edinburgh University Department of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF
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Conflict of interest: None Declared

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