No abstract available.
Alcohol Withdrawal Delirium* ; Delirium*

No abstract available.
Delirium* ; Sweat* ; Sweating*

Background: Due to the increasing number of elderly patients being referred to anesthesia for surgical procedures, there is a growing interest with regard to the incidence of postoperative delirium and its contributing factors. Objectives: The primary objective of this study is to determine the incidence of postoperative delirium in the charity elderly patients at the Philippine General Hospital (PGH). Methods: The incidence of postoperative delirium was assessed in an analytic prospective study conducted at the PGH among elderly patients undergoing elective surgeries. Through interviews and chart reviews, the collected data focused on baseline intellectual status, age, gender, ASA classification, level of education, comorbidities, vices, previous surgeries, maintenance medications, preoperative diagnostics, duration of surgery, duration of anesthesia, type of anesthetic technique, and pain scores at the recovery room and 24 hours postoperatively. Responses to the Short Portable Mental Status Questionnaire (SPMSQ), the Preoperative and Postoperative assessment forms and the Confusion Assessment Method (CAM) instrument were analyzed. Results: It was observed that there was a 2.5% incidence of postoperative delirium in the study population and among the risk factors assessed, polypharmacy and presence of moderate to severe pain scores on the first day following surgery were significant contributors in its occurrence. Conclusion In this preliminary study, the incidence of postoperative delirium as well as the significant contributing factors were described. In succeeding investigations, it is recommended to extend the observation and follow-up periods.
Emergence Delirium ; Aged ; Incidence

No Abstract available.
Anesthetics* ; Delirium* ; Postoperative Nausea and Vomiting*

OBJECTIVES: This study developed and validated the Perceived Stigma of Delirium Scale(PSDS), which is designed to measure perceived stigma associated with delirium in patients suffering from that disorder. METHODS: Based on a literature review of scales assessing stigma, a preliminary scale comprising seven items was developed. After recovering from delirium, 128 patients completed the PSDS and the Distress Thermometer (DT). Factor analysis was used to examine construct validity, and internal consistency and test-retest reliability were examined to ensure reliability. Concurrent validity was assessed using the correlation between the total scores on the PSDS and the DT. RESULTS: Factor analysis yielded a single-factor structure from the seven candidate items. One item was excluded due to low factor loading. The internal consistency was computed and Cronbach's α was 0.85 for the total score. The overall test-retest reliability was 0.71, with items ranging from 0.58 to 0.83. The total score on the PSDS was significantly correlated with the DT score. CONCLUSIONS: The PSDS may be a reliable, valid instrument for evaluating perceived stigma in patients who have recovered from delirium. Further study of the perceived stigma by delirium patients is required to assess the implications of the PSDS for clinical practice and research.
Delirium* ; Humans ; Thermometers ; Weights and Measures

Delirium is a common and serious condition which is often under-detected and under-treated. This may be partly due to a lack of concensus regarding the definition of its subtypes. Subtypes of delirium may be explained according to different pathophysiologic mechanisms. Three subtypes (hyperactive, hypoactive, mixed) of delirium, based on arousal disturbance and psychomotor behavior have been identified. However, definitions may vary from author to author. Irrespective of the way delirium is diagnosed and the subtypes defined, the hypoactive subtype is more prevalent than the hyperactive. Despite this prevalence, a diagnosis of hypoactive delirium is often missed, and rather ismost frequently misdiagnosed as depression or dementia. The hypoactive delirium subtype may be less responsive to antipsychotic drug therapy than the hyperactive delirium subtype. Clinical subtypes of delirium may provide information concerning the etiology, the pathogenesis, and the prognosis of delirium, but also may have therapeutic consequences. There remains no consensus regarding the optimal classification system for delirium subtypes. More studies are needed to isolate two, three, or more delirium subtypes, in terms of predicting factors, outcome predictors, and therapeutic management.
Arousal ; Consensus ; Delirium ; Dementia ; Depression ; Prevalence ; Prognosis

No abstract available.
Anesthesia, General* ; Delirium* ; Intraoperative Awareness* ; Memory* ; Midazolam*

OBJECTIVES: To investigate clinical and symptomatic differences among motoric subtypes of delirium. METHODS: A total of 256 patients referred to psychiatric consultation services for delirium due to general medical condition were assessed retrospectively. Motoric subtypes were determined according to Lipowski's criteria for hyperactive, hypoactive and mixed subtypes. All patients were evaluated according to Delirium Rating Scale-Revised-98(DRS-98-R) by trained psychiatrists to obtain symptomatic profiles of delirium. RESULTS: Hyperactive subtype were 50.8%(n=130), mixed 46.1%(n=118) and hypoactive 3.1%(n=8). Hyperactive patients were younger than mixed subtype(69.62±13.976 vs. 73.97±11.569, p=0.022) and received antipsychotics to manage symptoms of delirium more frequently(83.8% vs. 57.6%, p<0.001). Hyperactive patients had higher DRS-R-98 scores on both noncognitive(7.14±3.543 for hyperactive, 5.62±3.279 for mixed subtype) and cognitive subscales(10.00±3.574 for hyperactive, 6.38±2.875 for hypoactive, 7.43±3.771 for mixed subtype, p<0.001). CONCLUSION: We demonstrated that clinical and symptomatic profiles were different across motoric subtypes in delirium. Diagnostic and therapeutic approach should be made differently according to motoric subtypes of delirium and special attention is needed not to underestimate or delay treatment in specific motoric subtype of delirium.
Antipsychotic Agents ; Delirium* ; Humans ; Psychiatry ; Retrospective Studies

Delirium is not uncommon and is a devastating clinical syndrome. Elderly patients are vulnerable to delirium, especially demented or/and medically-surgically ill patients. Old age, comorbid psychiatric, medical and/or neurological diseases, medications, changed pharmacodynamics, sensory impairment and psychosocial stresses contribute to the development of delirium. Delirium in elderly patients is somewhat different from delirium in younger patients, sometimes under detected and/or poorly managed. This review discusses the diagnosis, classification, etiology and treatment, and presents 3 clinical cases of delirium in elderly patients. This review also focuses on a practical approach in assessing and managing delirium in elderly patients. The management of delirium consists of identifying and correcting the underlying problems, including prescribing suitable medication.
Aged* ; Classification ; Delirium* ; Diagnosis ; Geriatric Psychiatry ; Humans

Injection-related necrosis is a common pattern in the arterial injuries. But the acute embolization that led to extremity necrosis is very rare. Here we described a case of 43-year male patient with arm necrosis due to intra-arterial drug injection. The patient has addicted drug for 24 years and has injected opium for 18 years with dose of 2 ml self-prepared opium solution, 3-4 times daily. On April 2000, after second injection of a day, the patient felt burn and pain in his left hand. Then watery purples and necrotic papules appeared on the skin of left arm. He was treated by antibiotics, analgesics, and vasodilators, but the condition was not improved. The patients had to be amputated his left arm after 3 days of admission.
Substance Withdrawal Syndrome ; Alcohol Withdrawal Delirium ; diagnosis