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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.