Download DELIRIUM – Mise à jour – Medline, Current Contents

DELIRIUM – Mise à jour – Medline, Current Contents.
Août 2006
Giltay, E. J., R. V. Huijskes, et al. (2006). "Psychotic symptoms in patients undergoing
coronary artery bypass grafting and heart valve operation." Eur J Cardiothorac Surg
30(1): 140-7.
OBJECTIVE: Delirium on internal medicine and surgical wards of the general
hospital is associated with several predisposing and precipitating factors as well
as adverse outcomes. Whether psychosis, the symptom of delirium that may be
recognized most promptly, is similarly associated with these factors and
outcomes is largely unknown. METHODS: Eight thousand one hundred and
thirty-nine consecutive patients undergoing coronary artery bypass grafting
and/or heart valve operation were screened for preoperative predisposing factors
and postoperative psychotic symptoms between January 1999 and July 2004.
Data on per- and postoperative precipitating factors were collected in 4942
patients enrolled between January 2001 and July 2004. Data were examined
using logistic regression to estimate odds ratios. RESULTS: The rate of severe
psychotic symptoms was 2.1% (n=168). Higher age, renal failure, dyspnoea,
heart failure, and left ventricle hypertrophy were independent preoperative
predisposing factors. Peroperative hypothermia (<33 degrees C), hypoxemia, low
hematocrit, renal failure, increased sodium, infection and stroke were
independent precipitating factors. Psychotic symptoms were independently
associated with a prolonged length of stay on the intensive care unit (odds ratio
7.8; 95% confidence interval 5.6-11), multi-organ failure or shock (3.2; 95% CI:
2.2-4.9), cardiopulmonary resuscitation (3.6; 95% CI: 2.1-6.2), and in-hospital
death after surgery (2.1; 95% CI: 1.1-4.1). CONCLUSIONS: Psychotic symptoms
are independently associated with several chronic and peroperative problems
(including mild hypothermia during surgery), closely resembling those for delirium
(with and without psychotic symptoms). Psychotic symptoms are also
independently associated with adverse outcomes. Prompt diagnostic and
therapeutic intervention aimed at the underlying problem may improve outcomes.
Good, P. D., J. D. Cavenagh, et al. (2006). "What are the essential medications in
pallative care? - a survey of Australian palliative care doctors." Aust Fam Physician
35(4): 261-4.
BACKGROUND: There is a disparity of availability and cost of drugs in the
community for palliative care patients through the Pharmaceutical Benefits
Scheme (PBS) compared to those available to inpatients in public hospitals.
METHODS: The Joint Therapeutics Committee of the Australian and New
Zealand Society of Palliative Medicine, Palliative Care Australia and the Clinical
Oncological Society of Australia surveyed palliative care practitioners in Australia
to compile a list of drugs they considered essential. RESULTS: Drugs nominated
generally had good levels of evidence for use in palliative care, although many
practitioners still used some without evidence of benefit. DISCUSSION: We are
now working with the Commonwealth Department of Health and Ageing to agree
on a list of drugs for specific palliative care indications. As a result, the first ever
section in the PBS for a specific patient population has been created. There is a
need for high quality studies in palliative care to determine the best drugs to add
to the list.
Leentjens, A. F. and A. Diefenbacher (2006). "A survey of delirium guidelines in
Europe." J Psychosom Res 61(1): 123-8.
OBJECTIVE: The aim of this study was to investigate the existence and content
of delirium guidelines of the national psychiatric associations in Europe.
METHOD: A survey was sent by email to national coordinators of the European
Association for Consultation-Liaison Psychiatry and Psychosomatics. RESULTS:
Responses were obtained for 12 of the 14 countries that were approached. Of
these 12 countries, only two national psychiatric associations reported having
national delirium guidelines. The Dutch Psychiatric Association was the only
national psychiatric association that had developed a comprehensive
multidisciplinary guideline on the diagnosis and treatment of delirium. The
German Association of Scientific Medical Societies has a comprehensive
guideline on the treatment of alcohol withdrawal delirium, in which the German
Society for Psychiatry, Psychotherapy, and Mental Disorders participated. In
addition, the delirium guideline of the British Geriatrics Society and the guideline
for alcohol withdrawal delirium of the German Neurological Society were
mentioned by respondents. CONCLUSIONS: Although the development of
evidence-based treatment guidelines is considered an important way to improve
clinical practice, the national psychiatric associations of only two countries have
such a guideline for the diagnosis and treatment of delirium. The advantages of
supranational collaboration in the development of guidelines are stressed.
Moncada, L. V., R. E. Andersen, et al. (2006). "The impact of cognitive impairment on
short-term outcomes of hip fracture patients." Arch Gerontol Geriatr 43(1): 45-52.
The purpose of this study is to examine the differences in outcomes related to
recovery after hip fracture among patients with and without cognitive impairment.
This is a prospective cohort study of consecutively hospitalized elderly patients
with acute hip fracture in a setting utilizing a multidisciplinary hip fracture service.
Of the 48 patients admitted with hip fracture, 18 patients were found to have
cognitive impairment postoperatively as determined by a Mini-Mental State
Examination (MMSE) score <or=24. Compared to patients without cognitive
impairment, cognitively impaired patients reported no difference in the number of
activities of daily living (ADL) performed independently or the number of
instrumental activities of daily living (IADL) performed independently in the month
prior to admission. There was no difference in hospital length of stay. The
impaired group had a mean rehabilitation length of stay that was 8 days longer
than that of the unimpaired group. Six weeks after surgery, the number of
independent activities did not differ between groups. This investigation suggests
that although patients with cognitive impairment require longer rehabilitation
courses after hip fracture surgery as compared to those who are cognitively
unimpaired, they achieve comparable short-term outcomes in the setting of a
dedicated hip fracture service.
Olfson, M., S. C. Marcus, et al. (2006). "Antidepressant drug therapy and suicide in
severely depressed children and adults: A case-control study." Arch Gen Psychiatry
63(8): 865-72.
CONTEXT: The Food and Drug Administration has issued a boxed warning
concerning increased suicidal ideation and behavior associated with
antidepressant drug treatment in children and adolescents. It is unknown whether
antidepressant agents increase the risk of suicide death in children or adults.
OBJECTIVE: To estimate the relative risk of suicide attempt and suicide death in
severely depressed children and adults treated with antidepressant drugs vs
those not treated with antidepressant drugs. DESIGN: Matched case-control
study. SETTING: Outpatient treatment settings in the United States.
PARTICIPANTS: Medicaid beneficiaries from all 50 states who received inpatient
treatment for depression, excluding patients treated for pregnancy, bipolar
disorder, schizophrenia or other psychoses, mental retardation, dementia, or
delirium. Controls were matched to cases for age, sex, race or ethnicity, state of
residence, substance use disorder, recent suicide attempt, number of days since
hospital discharge, and recent treatment with antipsychotic, anxiolytic/hypnotic,
mood stabilizer, and stimulant medications. MAIN OUTCOME MEASURES:
Suicide attempts and suicide deaths. RESULTS: In adults (aged 19-64 years),
antidepressant drug treatment was not significantly associated with suicide
attempts (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.86-1.39 [521
cases and 2394 controls]) or suicide deaths (OR, 0.90; 95% CI, 0.52-1.55 [86
cases and 396 controls]). However, in children and adolescents (aged 6-18
years), antidepressant drug treatment was significantly associated with suicide
attempts (OR, 1.52; 95% CI, 1.12-2.07 [263 cases and 1241 controls]) and
suicide deaths (OR, 15.62; 95% CI, 1.65-infinity [8 cases and 39 controls]).
CONCLUSIONS: In these high-risk patients, antidepressant drug treatment does
not seem to be related to suicide attempts and death in adults but might be
related in children and adolescents. These findings support careful clinical
monitoring during antidepressant drug treatment of severely depressed young
people.
Sandhaus, S., F. Harrell, et al. (2006). "Here's HELP to prevent delirium in the hospital."
Nursing 36(7): 60-2.