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2450 Delirium and catatonia: Age matters
- Jo E. Wilson, Richard Carlson, Maria C. Duggan, Pratik Pandharipande, Timothy D. Girard, Li Wang, Jennifer L. Thompson, Rameela Chandrasekhar, Andrew Francis, Stephen E. Nicolson, Robert S. Dittus, Stephan Heckers, E. W. Ely
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, p. 39
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- Article
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OBJECTIVES/SPECIFIC AIMS: Background: Delirium is a well described form of acute brain organ dysfunction characterized by decreased or increased movement, changes in attention and concentration as well as perceptual disturbances (i.e., hallucinations) and delusions. Catatonia, a neuropsychiatric syndrome traditionally described in patients with severe psychiatric illness, can present as phenotypically similar to delirium and is characterized by increased, decreased and/or abnormal movements, staring, rigidity, and mutism. Delirium and catatonia can co-occur in the setting of medical illness, but no studies have explored this relationship by age. Our objective was to assess whether advancing age and the presence of catatonia are associated with delirium. METHODS/STUDY POPULATION: Methods: We prospectively enrolled critically ill patients at a single institution who were on a ventilator or in shock and evaluated them daily for delirium using the Confusion Assessment for the ICU and for catatonia using the Bush Francis Catatonia Rating Scale. Measures of association (OR) were assessed with a simple logistic regression model with catatonia as the independent variable and delirium as the dependent variable. Effect measure modification by age was assessed using a Likelihood ratio test. RESULTS/ANTICIPATED RESULTS: Results: We enrolled 136 medical and surgical critically ill patients with 452 matched (concomitant) delirium and catatonia assessments. Median age was 59 years (IQR: 52–68). In our cohort of 136 patients, 58 patients (43%) had delirium only, 4 (3%) had catatonia only, 42 (31%) had both delirium and catatonia, and 32 (24%) had neither. Age was significantly associated with prevalent delirium (i.e., increasing age associated with decreased risk for delirium) (p=0.04) after adjusting for catatonia severity. Catatonia was significantly associated with prevalent delirium (p<0.0001) after adjusting for age. Peak delirium risk was for patients aged 55 years with 3 or more catatonic signs, who had 53.4 times the odds of delirium (95% CI: 16.06, 176.75) than those with no catatonic signs. Patients 70 years and older with 3 or more catatonia features had half this risk. DISCUSSION/SIGNIFICANCE OF IMPACT: Conclusions: Catatonia is significantly associated with prevalent delirium even after controlling for age. These data support an inverted U-shape risk of delirium after adjusting for catatonia. This relationship and its clinical ramifications need to be examined in a larger sample, including patients with dementia. Additionally, we need to assess which acute brain syndrome (delirium or catatonia) develops first.
22 - Medication-Induced Psychosis
- from Part VI - Substance Abuse and Medications
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- By Junji Takeshita, University of Hawaii, Diane Thompson, Queen's Medical Center, Stephen E. Nicolson, Massachusetts General Hospital
- Edited by Daryl Fujii, University of Hawaii, Manoa, Iqbal Ahmed, University of Hawaii, Manoa
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- Book:
- The Spectrum of Psychotic Disorders
- Published online:
- 06 January 2010
- Print publication:
- 08 March 2007, pp 406-452
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Summary
Medication-induced psychosis is a common occurrence. Both in and out of the hospital, patients with multiple health problems are at an increased risk of developing both psychosis and delirium with the addition of prescription and over-the-counter medications. This chapter will define medication-induced psychosis, differentiate this disorder from delirium, and discuss the drug classes most often associated with psychosis. Unlike many forms of psychosis, medication-induced psychosis does not have specific long-term psychiatric symptoms, prodromes, positive versus negative symptoms, common brain neuropathology, or genetic factors. It is neither gender specific nor age specific. The sole risk of medication-induced psychosis lies in a patient's general risk of developing a medical problem that requires the use of drug therapy.
Many medications when taken at therapeutic doses are associated with the development of psychotic symptoms (Anonymous, 2002). There are few large studies to substantiate these relationships; instead we must rely on case studies. Because many of these same medicines can also cause delirium (Trzepacz & Meagher, 2005), it is necessary to differentiate “delirium” from “psychosis” as there is obvious overlap between the disorders. Differentiating between drug-induced psychosis and delirium can be difficult. This distinction appears to be at least historically ambiguous if not controversial. Some texts group delirium in with “secondary psychoses” whose characteristic features of “clouding of consciousness” and “fluctuating course” differentiate them from primary psychoses. Charlton and Kavanau argue that most psychiatric conditions, including primary mental illness as well as intoxications have a delirious component to the disease (Charlton & Kavanau, 2002).