Characteristics and pharmacological treatment options of delirium patients treated at Sanglah Central General Hospital

Ni Ketut Sri Diniari; Luh Nyoman Alit Aryani

doi:10.21744/ijhms.v5n1.1835

Authors

Ni Ketut Sri Diniari
sridiniari@ymail.com
Department of Psychiatry, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
Luh Nyoman Alit Aryani Departemen Psikiatri RSUP Sanglah/Fakultas Kedokteran, Universitas Udayana, Denpasar, Bali, Indonesia

Keywords:

characteristics, delirium, pharmacological, syndrome, treatment options

Abstract

Delirium is a syndrome characterized by disturbances of consciousness and cognition that occur acutely and fluctuate. Delirium can be caused by general medical conditions, drug users, sensory disturbances, polypharmacy, etc. The etiology of delirium is diverse and non-specific. The preference of pharmacological therapy in delirium is still a debate. Descriptive research with the retrospective cross-sectional method, using secondary data in medical records at the Sanglah Central General Hospital Denpasar for the period January 1, 2020, to December 31, 2020. Patients who were consulted were 166 people, with sex 57 people (34.3%) and 109 women (65.7%). The incidence of delirium in adults (20-59 years old) and elderly (age 60 years) is the highest with 51.2% and 45.1% respectively. One-third of 45 people (37.2%) had overlapping dementia. Most of the 142 people (85.5%) were experiencing significant life stress. The most common type of delirium was hyperactive delirium (74%). The underlying disease of delirium varies such as the cause of infection (24.1%), intracranial process (19%), malignancy 18.1%, cardiovascular (10.1%), endocrine disorders,(7.8%), kidney disorders (6%), and others in small percentages.

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References

Baller, E. B., Hogan, C. S., Fusunyan, M. A., Ivkovic, A., Luccarelli, J. W., Madva, E., ... & Smith, F. A. (2020). Neurocovid: Pharmacological recommendations for delirium associated with COVID-19. Psychosomatics, 61(6), 585-596. https://doi.org/10.1016/j.psym.2020.05.013

Bennett, C. (2019). Caring for patients with delirium. Nursing2020, 49(9), 17-20.

Burry, L., Hutton, B., Williamson, D. R., Mehta, S., Adhikari, N. K., Cheng, W., ... & Rose, L. (2019). Pharmacological interventions for the treatment of delirium in critically ill adults. Cochrane Database of Systematic Reviews, (9).

Cerveira, C. C. T., Pupo, C. C., Santos, S. D. S. D., & Santos, J. E. M. (2017). Delirium in the elderly: A systematic review of pharmacological and non-pharmacological treatments. Dementia & neuropsychologia, 11(3), 270-275.

Cummings, J. L., Coffey, C. E., Duffy, J. D., Lauterbach, E. C., Lovell, M., Malloy, P. F., ... & Salloway, S. (1998). The clinician-scientist in neuropsychiatry: a position statement from the Committee on Research of the American Neuropsychiatric Association. The Journal of neuropsychiatry and clinical neurosciences, 10(1), 1-9.

Davis, D. H., Kreisel, S. H., Terrera, G. M., Hall, A. J., Morandi, A., Boustani, M., ... & Brayne, C. (2013). The epidemiology of delirium: challenges and opportunities for population studies. The American Journal of Geriatric Psychiatry, 21(12), 1173-1189. https://doi.org/10.1016/j.jagp.2013.04.007

Engel, G. L., & Romano, J. (1959). Delirium, a syndrome of cerebral insufficiency. Journal of chronic diseases, 9(2-3), 260-277. https://doi.org/10.1016/0021-9681(59)90165-1

First, M. B. (2013). Diagnostic and statistical manual of mental disorders, and clinical utility. The Journal of nervous and mental disease, 201(9), 727-729.

Girard, T. D., Jackson, J. C., Pandharipande, P. P., Pun, B. T., Thompson, J. L., Shintani, A. K., ... & Ely, E. W. (2010). Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Critical care medicine, 38(7), 1513.

Inouye, S. K., Westendorp, R. G., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922. https://doi.org/10.1016/S0140-6736(13)60688-1

Juraj, K., & Kuhn, J. (2021). SOP: treatment of delirium. Neurological Research and Practice, 3(1).

Kourkouta, L., Iliadis, C., & Monios, A. (2015). Psychosocial issues in elderly. Progress in Health Sciences, 5(1), 232-237.

Lauretani, F., Bellelli, G., Pelà, G., Morganti, S., Tagliaferri, S., & Maggio, M. (2020). Treatment of delirium in older persons: what we should not do!. International journal of molecular sciences, 21(7), 2397.

Lee, J. (2020). Risk Factors for Nursing Home Delirium: A Systematic Review. Journal of Korean Gerontological Nursing, 22(1), 75-83.

Lucchetti, A., Barcelos-Ferreira, R., Blazer, D. G., & Moreira-Almeida, A. (2018). Spirituality in geriatric psychiatry. Current opinion in psychiatry, 31(4), 373-377.

Maldonado, J. R. (2008). Delirium in the acute care setting: characteristics, diagnosis and treatment. Critical care clinics, 24(4), 657-722. https://doi.org/10.1016/j.ccc.2008.05.008

Michaud, L., Büla, C., Berney, A., Camus, V., Voellinger, R., Stiefel, F., & Burnand, B. (2007). Delirium: guidelines for general hospitals. Journal of psychosomatic research, 62(3), 371-383. https://doi.org/10.1016/j.jpsychores.2006.10.004

Mueller, C., Thompsell, A., Harwood, D., Bagshaw, P., & Burns, A. (2017). Mental health in older people: a practice primer. Leeds: NHS England and NHS Improvement.

Mustika, I. W., & Sudiantara, K. (2019). Effects of health promotion with family approaches on blood pressure and headache toward elderly. International Journal of Health Sciences, 3(3), 8-16. https://doi.org/10.29332/ijhs.v3n3.344

Nogueira, V., Lagarto, L., Cerejeira, J., Renca, S., & Firmino, H. (2013). Improving quality of care: focus on liaison old age psychiatry. Mental health in family medicine, 10(3), 153.

Ospina, J. P., King IV, F., Madva, E., & Celano, C. M. (2018). Epidemiology, mechanisms, diagnosis, and treatment of delirium: a narrative review. Clinical Medicine and Therapeutics (CMT).

Pérez-Ros, P., & Martínez-Arnau, F. M. (2019). Delirium assessment in older people in emergency departments. A literature review. Diseases, 7(1), 14.

Reynish, E. L., Hapca, S. M., De Souza, N., Cvoro, V., Donnan, P. T., & Guthrie, B. (2017). Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions. BMC medicine, 15(1), 1-12.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Synopsis of psychiatry: behavioral sciences, clinical psychiatry. Wolters Kluwer.

Sastroasmoro, S., & Ismael, S. (2011). Dasar-dasar metodologi penelitian klinis. Jakarta: sagung seto, 55.

Schwartz, T. L., & Masand, P. S. (2002). The role of atypical antipsychotics in the treatment of delirium. Psychosomatics, 43(3), 171-174. https://doi.org/10.1176/appi.psy.43.3.171

Seitz, D. P., & Gill, S. S. (2009). Neuroleptic malignant syndrome complicating antipsychotic treatment of delirium or agitation in medical and surgical patients: case reports and a review of the literature. Psychosomatics, 50(1), 8-15. https://doi.org/10.1176/appi.psy.50.1.8

Serafim, R. B., Bozza, F. A., Soares, M., do Brasil, P. E. A., Tura, B. R., Ely, E. W., & Salluh, J. I. (2015). Pharmacologic prevention and treatment of delirium in intensive care patients: a systematic review. Journal of critical care, 30(4), 799-807. https://doi.org/10.1016/j.jcrc.2015.04.005

Sergeev, V. A., Glukhov, A. A., Sorokin, A. S., Zhuchkov, S. A., Gorokhov, A. V., & Troshkina, E. N. (2021). Clinical-functional and morphological parameters of purulonecrotic foci healing in diabetic foot syndrome using programmable sanitation technologies. International Journal of Health Sciences, 5(3), 260-275. https://doi.org/10.53730/ijhs.v5n3.1495

Thom, R. P., Levy-Carrick, N. C., Bui, M., & Silbersweig, D. (2019). Delirium. American Journal of Psychiatry, 176(10), 785-793.

Velásquez-Tirado, J. D., Trzepacz, P. T., & Franco, J. G. (2021). Etiologies of Delirium in Consecutive COVID-19 Inpatients and the Relationship Between Severity of Delirium and COVID-19 in a Prospective Study With Follow-Up. The Journal of Neuropsychiatry and Clinical Neurosciences.

Vilke, G. M., Payne-James, J., & Karch, S. B. (2012). Excited delirium syndrome (ExDS): redefining an old diagnosis. Journal of forensic and legal medicine, 19(1), 7-11. https://doi.org/10.1016/j.jflm.2011.10.006

Wan, M., & Chase, J. M. (2017). Delirium in older adults: Diagnosis, prevention, and treatment. British Columbia Medical Journal, 59(3).

Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P., & Van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. Jama, 304(4), 443-451.

Zipser, C. M., Deuel, J., Ernst, J., Schubert, M., Weller, M., von Känel, R., & Boettger, S. (2019). Predisposing and precipitating factors for delirium in neurology: a prospective cohort study of 1487 patients. Journal of neurology, 266(12), 3065-3075.