Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-15T09:19:23.789Z Has data issue: false hasContentIssue false
  • English
  • Français

A nationwide study on delirium in psychiatric patients from 1995 to 2011

Published online by Cambridge University Press:  13 December 2013

Anne Sofie Lundberg ,
Niels Okkels ,
Lea Nørgreen Gustafsson ,
Janne Tidselbak Larsen ,
Lisbeth Uhrskov Sørensen  and
Povl Munk-Jørgensen
Anne Sofie Lundberg*
Affiliation:
Department of Organic Psychiatric Disorders and Emergency Ward (Dep. M), Aarhus University Hospital, Risskov, Denmark
Niels Okkels
Affiliation:
Department of Organic Psychiatric Disorders and Emergency Ward (Dep. M), Aarhus University Hospital, Risskov, Denmark
Lea Nørgreen Gustafsson
Affiliation:
Department of Organic Psychiatric Disorders and Emergency Ward (Dep. M), Aarhus University Hospital, Risskov, Denmark
Janne Tidselbak Larsen
Affiliation:
Department of Organic Psychiatric Disorders and Emergency Ward (Dep. M), Aarhus University Hospital, Risskov, Denmark
Lisbeth Uhrskov Sørensen
Affiliation:
Department of Organic Psychiatric Disorders and Emergency Ward (Dep. M), Aarhus University Hospital, Risskov, Denmark
Povl Munk-Jørgensen
Affiliation:
Department of Organic Psychiatric Disorders and Emergency Ward (Dep. M), Aarhus University Hospital, Risskov, Denmark
*
Anne Sofie Lundberg, Department of Organic Psychiatric Disorders and Emergency Ward (Dep. M), Aarhus University Hospital, Risskov, Denmark. Tel: +45 21 72 30 22; E-mail: annesofie@lundbergs.dk
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Delirium shares symptoms with some mental illnesses. This may lead to misdiagnosis of delirium in psychiatric patients and a risk of inadequate management. Moreover, literature on delirium in psychiatric patients is sparse. The aim was to analyse possible changes in the diagnostic incidence of delirium in psychiatric patients from 1995 to 2011, and to investigate the patients with regard to sex, age, and type of patient.

Methods

All first time ever diagnoses of delirium among psychiatric patients were identified in the nationwide Danish Psychiatric Central Research Register (DPCRR) from 1995 to 2011. The delirium diagnoses include (1) delirium unspecified, (2) delirium with dementia, and (3) drug-related delirium, all in accordance with International Classification of Diseases-10. The incidence rates were age standardised.

Results

A total of 15 680 persons diagnosed with delirium for the first time were identified in the DPCRR between 1995 and 2011. The total incidence rate of delirium has decreased, reaching 8.4/1000 person-years in 2011. In 2011, 2.6% of the demented patients were diagnosed with delirium with dementia. Diagnosis of delirium is significantly more common in men, and the three groups of delirium showed a characteristic age distribution.

Conclusion

Our incidences were markedly lower when compared with previous studies. This suggests a possible underdiagnosis of delirium in psychiatric hospitals and should be investigated further, as delirium is a serious state and identifying the syndrome is important for sufficient treatment.

Keywords

deliriumdementiapsychiatric diagnosisregistries
Type
Original Articles
Information
Acta Neuropsychiatrica , Volume 26 , Issue 4 , August 2014 , pp. 234 - 239
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Cole, MG. Delirium in elderly patients. Am J Geriatr Psychiatry 2004;12:7–21.Google Scholar
2. Huang, LW, Inouye, SK, Jones, RN et al. Identifying indicators of important diagnostic features of delirium. J Am Geriatr Soc 2012;60:1044–1050.Google Scholar
3. Inouye, SK. Delirium in older persons. N Engl J Med 2006;354:1157–1165.Google Scholar
4. Witlox, J, Eurelings, LS, De Jonghe, JF, Kalisvaart, KJ, Eikelenboom, P, van Gool, WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. J Am Med Assoc 2010;304:443–451.Google Scholar
5. Inouye, SK. Delirium in older persons. N Engl J Med 2006;354:1157–1165.CrossRefGoogle ScholarPubMed
6. Massimo, G, Roberto, M. Seasonal variation in the occurrence of delirium in patients admitted to medical units of a general hospital in Italy. Acta Neuropsychiatr 2013;25:179–183.Google Scholar
7. Gonzalez, M, Martinez, G, Calderon, J et al. Impact of delirium on short-term mortality in elderly inpatients: a prospective cohort study. Psychosomatics 2009;50:234–238.Google Scholar
8. Zaubler, TS, Murphy, K, Rizzuto, L et al. Quality improvement and cost savings with multicomponent delirium interventions: replication of the hospital elder life program in a community hospital. Psychosomatics 2013;54:219–226.Google Scholar
9. Tsai, MC, Weng, HH, Chou, SY, Tsai, CS, Hung, TH, Su, JA. One-year mortality of elderly inpatients with delirium, dementia, or depression seen by a consultation-liaison service. Psychosomatics 2012;53:433–438.Google Scholar
10. Inouye, SK, Foreman, MD, Mion, LC, Katz, KH, Cooney, LM Jr. Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med 2001;161:2467–2473.Google Scholar
11. Martins, S, Fernandes, L. Delirium in elderly people: a review. Front Neurol 2012;3:101.Google Scholar
12. Gahr, M, Hügl, S, Freudenmann, R. Protracted delirium with Sheehan's syndrome. Acta Neuropsychiatr 2012;24:183–185.Google Scholar
13. Nicholas, LM, Lindsey, BA. Delirium presenting with symptoms of depression. Psychosomatics 1995;36:471–479.Google Scholar
14. Downing, LJ, Caprio, TV, Lyness, JM. Geriatric psychiatry review: differential diagnosis and treatment of the 3 D's – delirium, dementia, and depression. Curr Psychiatry Rep 2013;15:365.Google Scholar
15. Mittal, V, Muralee, S, Williamson, D et al. Review: delirium in the elderly: a comprehensive review. Am J Alzheimers Dis Other Demen 2011;26:97–109.Google Scholar
16. Martins, S, Fernandes, L. Delirium in elderly people: a review. Front Neurol 2012;3:101.Google Scholar
17. Fong, TG, Tulebaev, SR, Inouye, SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol 2009;5:210–220.Google Scholar
18. Patten, SB, Williams, JV, Haynes, L, Mccruden, J, Arboleda-Florez, J. The incidence of delirium in psychiatric inpatient units. Can J Psychiatry 1997;42:858–863.Google Scholar
19. Ritchie, J, Steiner, W, Abrahamowicz, M. Incidence of and risk factors for delirium among psychiatric inpatients. Psychiatr Serv 1996;47:727–730.Google Scholar
20. Sandberg, O, Gustafson, Y, Brannstrom, B, Bucht, G. Prevalence of dementia, delirium and psychiatric symptoms in various care settings for the elderly. Scand J Soc Med 1998;26:56–62.Google Scholar
21. Munk-Jorgensen, P, Mortensen, PB. The Danish psychiatric central register. Dan Med Bull 1997;44:82–84.Google Scholar
22. World Health Organization. The ICD-10 classification of mental and behavioural disorder. Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization, 1992.Google Scholar
23. Bray F. http://www.iarc.fr.ez.statsbiblioteket.dk:2048/en/publications/pdfs-online/epi/sp155/ci5v8-chap8.pdf. Cancer Incidence in Five Continents. Vol III. 2002.Google Scholar
24. Munk-Jorgensen, P, Andersen, BB. Diagnoses and dropout among patients of Danish psychiatrists in private practice. Psychiatr Serv 2009;60:1680–1682.Google Scholar
25. Huang, SC, Tsai, SJ, Chan, CH, Hwang, JP, Sim, CB. Characteristics and outcome of delirium in psychiatric inpatients. Psychiatry Clin Neurosci 1998;52:47–50.Google Scholar
26. Ryan, DJ, O'Regan, NA, Caoimh, RO et al. Delirium in an adult acute hospital population: predictors, prevalence and detection. BMJ Open 2013;3:e001772.Google Scholar
27. Siddiqi, N, House, AO, Holmes, JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing 2006;35:350–364.Google Scholar
28. Burns, A, Gallagley, A, Byrne, J. Delirium. J Neurol Neurosurg Psychiatry 2004;75:362–367.Google Scholar
29. Clegg, A, Young, JB. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing 2011;40:23–29.Google Scholar
30. Young, J, Inouye, SK. Delirium in older people. BMJ 2007;334:842–846.Google Scholar
31. Young, J, Murthy, L, Maggie, W, Akunne, A, O'Mahony, R. Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ 2010;341:c3704.Google Scholar
32. Saxena, S, Lawley, D. Delirium in the elderly: a clinical review. Postgrad Med J 2009;85:405–413.Google Scholar
33. Rigney, TS. Delirium in the hospitalized elder and recommendations for practice. Geriatr Nurs 2006;27:151–157.Google Scholar
34. Pisani, MA, Mcnicoll, L, Inouye, SK. Cognitive impairment in the intensive care unit. Clin Chest Med 2003;24:727–737.Google Scholar
35. Han, JH, Zimmerman, EE, Cutler, N et al. Delirium in older emergency department patients: recognition, risk factors, and psychomotor subtypes. Acad Emerg Med 2009;16:193–200.Google Scholar
36. Fiels, RR, Wall, MH. Delirium: past, present, and future. Semin Cardiothorac Vasc Anesth 2013;17:170–179.Google Scholar
37. Fick, D, Foreman, M. Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals. J Gerontol Nurs 2000;26:30–40.Google Scholar
38. Fick, DM, Agostini, JV, Inouye, SK. Delirium superimposed on dementia: a systematic review. J Am Geriatr Soc 2002;50:1723–1732.Google Scholar
39. Hasegawa, N, Hashimoto, M, Yuuki, S et al. Prevalence of delirium among outpatients with dementia. Int Psychogeriatr 2013;22:1–7.Google Scholar
40. Maclullich, AM, Beaglehole, A, Hall, RJ, Meagher, DJ. Delirium and long-term cognitive impairment. Int Rev Psychiatry 2009;21:30–42.CrossRefGoogle ScholarPubMed
41. Fong, TG, Jones, RN, Shi, P et al. Delirium accelerates cognitive decline in Alzheimer disease. Neurology 2009;72:1570–1575.Google Scholar
42. Saddichha, S, Manjunatha, N, Prasad Sinha, BN, Khess, C. Delayed-onset delirium tremens – a diagnostic and management challenge. Acta Neuropsychiatr 2008;20:152–156.CrossRefGoogle ScholarPubMed
43. Byrne, N, Regan, C, Howard, L. Administrative registers in psychiatric research: a systematic review of validity studies. Acta Psychiatr Scand 2005;112:409–414.Google Scholar
44. Anderson, KK. Health service registry data in psychiatric epidemiology: challenges for definition and interpretation: an editorial comment to: Okkels et al.'s ‘changes in the diagnosed incidence of early onset schizophrenia over four decades’ (1). Acta Psychiatr Scand 2013;127:9–10.Google Scholar
45. Munk-Jorgensen, P, Ostergaard, SD. Register-based studies of mental disorders. Scand J Public Health 2011;39:170–174.Google Scholar