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Sample records for alcohol withdrawal delirium

  1. Genital self mutilation in alcohol withdrawal state complicated with delirium

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    Sri Hari Charan

    2011-01-01

    Full Text Available Genital self mutilation is a rare and a severe form of self-injurious behavior usually described in psychotic disorders, with delusions and hallucinations. It has been ascribed to sexual conflicts, Body image distortions, Internalized aggression, and suicidal intent. This phenomenon has been described in schizophrenia, affective psychosis, alcohol intoxication, and personality disorders. The present case genital self mutilation in a case of alcohol withdrawal state complicated by delirium is reported.

  2. Use of propofol infusion in alcohol withdrawal-induced refractory delirium tremens

    DEFF Research Database (Denmark)

    Lorentzen, Kristian; Lauritsen, Anne Øberg; Bendtsen, Asger Ole

    2014-01-01

    INTRODUCTION: Delirium tremens is a potentially fatal complication of alcohol withdrawal. In severe delirium, very large dosages of benzodiazepines can be required and in refractory cases, sedation with propofol can be used. Treatment of refractory delirium tremens with propofol is mainly describ...

  3. Zolpidem withdrawal delirium

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    Surendra K Mattoo

    2011-01-01

    Full Text Available The Z-category hypnotics are promoted for their relative safety. However, this view is challenged by the emerging clinical evidence in the form of zolpidem related intoxication delirium and seizures, and dependence and complicated withdrawal. We report the case of a zolpidem-naive alcohol-dependent inpatient that, while undergoing alcohol de-addiction, was prescribed zolpidem for insomnia and developed delirium during taper-off. He was successfully detoxified for alcohol, treated for delirium and put on disulfiram prophylaxis. The case highlights the need for being cautious while using zolpidem for insomnia in alcohol dependent subjects.

  4. Dexmedetomidine as an adjuvant in the treatment of alcohol withdrawal delirium: a case report.

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    Rovasalo, Aki; Tohmo, Harri; Aantaa, Riku; Kettunen, Eija; Palojoki, Riitta

    2006-01-01

    In this case report, even a moderate dose of dexmedetomidine, a very selective alpha(2)-adrenergic agent, resulted in a rapid response to alcohol withdrawal delirium after the standard treatment. Psychiatrists should be aware of this relatively new drug that provides advantages over clonidine, heavy sedation and secondary restraints. Dexmedetomidine should be further evaluated in the treatment of specific forms of aggressive behavior and complicated withdrawal states.

  5. Safety and efficacy of flumazenil for reversal of iatrogenic benzodiazepine-associated delirium toxicity during treatment of alcohol withdrawal, a retrospective review at one center.

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    Moore, Philip W; Donovan, J Ward; Burkhart, Keith K; Waskin, Jeffrey A; Hieger, Michelle A; Adkins, Audrey R; Wert, Yijin; Haggerty, David A; Rasimas, J J

    2014-06-01

    Both alcohol withdrawal syndrome (AWS) and benzodiazepines can cause delirium. Benzodiazepine-associated delirium can complicate AWS and prolong hospitalization. Benzodiazepine delirium can be diagnosed with flumazenil, a GABA-A receptor antagonist. By reversing the effects of benzodiazepines, flumazenil is theorized to exacerbate symptoms of AWS and precludes its use. For patients being treated for alcohol withdrawal, flumazenil can diagnose and treat benzodiazepine delirium without precipitating serious or life-threatening adverse events. Hospital admission records were retrospectively reviewed for patients with the diagnosis of AWS who received both benzodiazepines and flumazenil from December 2006 to June 2012 at a university-affiliated inpatient toxicology center. The day of last alcohol consumption was estimated from available blood alcohol content or subjective history. Corresponding benzodiazepine, flumazenil, and adjunctive sedative pharmacy records were reviewed, as were demographic, clinical course, and outcome data. Eighty-five patients were identified (average age 50.3 years). Alcohol concentrations were detectable for 42 patients with average 261 mg/dL (10-530 mg/dL). Eighty patients were treated with adjunctive agents for alcohol withdrawal including antipsychotics (n = 57), opioids (n = 27), clonidine (n = 35), and phenobarbital (n = 23). Average time of flumazenil administration was 4.7 days (1-11 days) after abstinence, and average dose was 0.5 mg (0.2-1 mg). At the time of flumazenil administration, delirium was described as hypoactive (n = 21), hyperactive (n = 15), mixed (n = 41), or not specified (n = 8). Response was not documented in 11 cases. Sixty-two (72.9 %) patients had significant objective improvement after receiving flumazenil. Fifty-six patients required more than one dose (average 5.6 doses). There were no major adverse events and minor adverse effects included transiently increased anxiety

  6. Delirium

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    ... may increase the risk of stroke and death. Benzodiazepines (a type of sedative—see Table: Drugs Used ... due to withdrawal from a sedative or alcohol. Benzodiazepines are not used to treat delirium caused by ...

  7. Use of propofol infusion in alcohol withdrawal-induced refractory delirium tremens

    DEFF Research Database (Denmark)

    Lorentzen, Kristian; Lauritsen, Anne Øberg; Bendtsen, Asger Ole

    2014-01-01

    in case reports. We aimed to evaluate the treatment of delirium tremens with propofol infusion for 48 h. MATERIAL AND METHODS: This study was a single-centre retrospective cohort analysis of 15 patient journals covering the period from May 2012 to September 2013. RESULTS: Five women and ten men were...... and mechanically ventilated in the intensive care unit. The mean propofol infusion rate was 4.22 mg/kg/h. Thirteen patients received supplemental infusion of opioids, whereas seven required concomitant vasopressor infusion. Once propofol infusion was discontinued after 48 h, 12 patients had a long awakening...

  8. Alcohol Withdrawal Mimicking Organophosphate Poisoning

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    Nezihat Rana Disel

    2014-02-01

    Full Text Available Organophosphates, which can cause occupational poisoning due to inappropriate personal protective measures, are widely used insecticides in agricultural regions of southern Turkey. Therefore, the classical clinical findings of this cholinergic poisoning are myosis, excessive secretions, bradicardia and fasciculations are easy to be recognized by local medical stuff. Diseases and conditions related to alcoholism such as mental and social impairments, coma, toxicity, withdrawal, and delirium are frequent causes of emergency visits of chronic alcoholic patients. Here we present a case diagnosed and treated as organophosphate poisoning although it was an alcohol withdrawal in the beginning and became delirium tremens, due to similar symptoms.

  9. The alcohol withdrawal syndrome.

    LENUS (Irish Health Repository)

    McKeon, A

    2008-08-01

    The alcohol withdrawal syndrome (AWS) is a common management problem in hospital practice for neurologists, psychiatrists and general physicians alike. Although some patients have mild symptoms and may even be managed in the outpatient setting, others have more severe symptoms or a history of adverse outcomes that requires close inpatient supervision and benzodiazepine therapy. Many patients with AWS have multiple management issues (withdrawal symptoms, delirium tremens, the Wernicke-Korsakoff syndrome, seizures, depression, polysubstance abuse, electrolyte disturbances and liver disease), which requires a coordinated, multidisciplinary approach. Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients.

  10. Opium Withdrawal Delirium: Two Case Reports

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    Sharma, Ravi C.; Kumar, Ramesh; Sharma, Dinesh Dutt; Kanwar, Pankaj

    2017-01-01

    Two patients with opium dependence developed delirium during abstinence. The delirium resolved completely within 48–58 hours of appropriate treatment. Caution needs to be exercised during opioid detoxification in timely detecting and treating potentially life-threatening condition like delirium. PMID:28138205

  11. Multiple-etiology delirium and catatonia in an alcoholic with tubercular meningoencephalitis

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    Suneet Kumar Upadhyaya

    2011-01-01

    Full Text Available Delirium is a clinical entity with a variety of possible etiological conditions. Clinicians must be vigilant for the possibility of additional etiological factors. Secondly, catatonic patients should be carefully looked for general medical conditions. This case report depicts a chronic alcoholic who presented with withdrawal delirium, later on developed catatonia and then was diagnosed to have tubercular meningoencephalitis, a rare clinical sequence.

  12. Inpatient management of acute alcohol withdrawal syndrome.

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    Perry, Elizabeth C

    2014-05-01

    Alcohol withdrawal is a common condition encountered in the hospital setting after abrupt discontinuation of alcohol in an alcohol-dependent individual. Patients may present with mild symptoms of tremulousness and agitation or more severe symptoms including withdrawal seizures and delirium tremens. Management revolves around early identification of at-risk individuals and symptom assessment using a validated tool such as the revised Clinical Institute Withdrawal Assessment for Alcohol score. Benzodiazepines remain the mainstay of treatment and can be administered using a front-loading, fixed-dose, or symptom-triggered approach. Long-acting benzodiazepines such as chlordiazepoxide or diazepam are commonly used and may provide a smoother withdrawal than shorter-acting benzodiazepines, but there are no data to support superiority of one benzodiazepine over another. Elderly patients or those with significant liver disease may have increased accumulation and decreased clearance of the long-acting benzodiazepines, and lorazepam or oxazepam may be preferred in these patients. Patients with symptoms refractory to high doses of benzodiazepines may require addition of a rescue medication such as phenobarbital, propofol or dexmedetomidine. Anticonvulsants (carbamazepine, valproate, gabapentin) may have a role in the management of mild to moderate withdrawal. Other medications such as β-antagonists or neuroleptics may offer additional benefit in select patients but should not be used a monotherapy.

  13. Outpatient management of alcohol withdrawal syndrome.

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    Muncie, Herbert L; Yasinian, Yasmin; Oge', Linda

    2013-11-01

    Approximately 2% to 9% of patients seen in a family physician's office have alcohol dependence. These patients are at risk of developing alcohol withdrawal syndrome if they abruptly abstain from alcohol use. Alcohol withdrawal syndrome begins six to 24 hours after the last intake of alcohol, and the signs and symptoms include tremors, agitation, nausea, sweating, vomiting, hallucinations, insomnia, tachycardia, hypertension, delirium, and seizures. Treatment aims to minimize symptoms, prevent complications, and facilitate continued abstinence from alcohol. Patients with mild or moderate alcohol withdrawal syndrome can be treated as outpatients, which minimizes expense and allows for less interruption of work and family life. Patients with severe symptoms or who are at high risk of complications should receive inpatient treatment. In addition to supportive therapy, benzodiazepines, either in a fixed-dose or symptom-triggered schedule, are recommended. Medication should be given at the onset of symptoms and continued until symptoms subside. Other medications, including carbamazepine, oxcarbazepine, valproic acid, and gabapentin, have less abuse potential but do not prevent seizures. Typically, physicians should see these patients daily until symptoms subside. Although effective treatment is an initial step in recovery, long-term success depends on facilitating the patient's entry into ongoing treatment.

  14. Acute coronary ischemia during alcohol withdrawal: a case report

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    Sriram Ganeshalingam

    2011-08-01

    Full Text Available Abstract Introduction The potential of alcohol withdrawal to cause acute coronary events is an area that needs the urgent attention of clinicians and researchers. Case presentation We report the case of a 52-year-old heavy-alcohol-using Sri Lankan man who developed electocardiogram changes suggestive of an acute coronary event during alcohol withdrawal. Despite the patient being asymptomatic, subsequent echocardiogram showed evidence of ischemic myocardial dysfunction. We review the literature on precipitation of myocardial ischemia during alcohol withdrawal and propose possible mechanisms. Conclusions Alcohol withdrawal is a commonly observed phenomenon in hospitals. However, the number of cases reported in the literature of acute coronary events occurring during withdrawal is few. Many cases of acute ischemia or sudden cardiac deaths may be attributed to other well known complications of delirium tremens. This is an area needing the urgent attention of clinicians and epidemiologists.

  15. Identification and management of alcohol withdrawal syndrome.

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    Mirijello, Antonio; D'Angelo, Cristina; Ferrulli, Anna; Vassallo, Gabriele; Antonelli, Mariangela; Caputo, Fabio; Leggio, Lorenzo; Gasbarrini, Antonio; Addolorato, Giovanni

    2015-03-01

    Symptoms of alcohol withdrawal syndrome (AWS) may develop within 6-24 h after the abrupt discontinuation or decrease of alcohol consumption. Symptoms can vary from autonomic hyperactivity and agitation to delirium tremens. The gold-standard treatment for AWS is with benzodiazepines (BZDs). Among the BZDs, different agents (i.e., long-acting or short-acting) and different regimens (front-loading, fixed-dose or symptom-triggered) may be chosen on the basis of patient characteristics. Severe withdrawal could require ICU admission and the use of barbiturates or propofol. Other drugs, such as α2-agonists (clonidine and dexmetedomidine) and β-blockers can be used as adjunctive treatments to control neuroautonomic hyperactivity. Furthermore, neuroleptic agents can help control hallucinations. Finally, other medications for the treatment for AWS have been investigated with promising results. These include carbamazepine, valproate, sodium oxybate, baclofen, gabapentin and topiramate. The usefulness of these agents are discussed.

  16. Clinical management of alcohol withdrawal: A systematic review

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    Shivanand Kattimani

    2013-01-01

    Full Text Available Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed.

  17. [Non-withdrawal-related delirium : Evidence on prevention and therapy].

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    Haussmann, R; Bauer, M; Donix, M

    2016-05-01

    Delirium is a severe and common yet under-diagnosed disorder in the clinical routine. Multiple factors may contribute to the development of delirium, which is associated with increased mortality and high healthcare costs. Treatment of delirium is often provided with delay and limited to pharmacological interventions. This article summarizes the key symptoms for delirium as well as risk factors and highlights the pharmacological and non-pharmacological options for treatment and prevention.

  18. [Ambulant treatment of alcohol withdrawal].

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    Nüstedt, Volker

    2016-07-01

    Most of the patients addicted to alcohol are socially well integrated. The offer of a low threshold ambulant withdrawal therapy opens an opportunity to build a sustainable therapeutic relationship. The so started empathic addiction therapy will be well accepted and will lead to a satisfying outcome. Using Clomethiazole or Oxazepam in a daily reduced dose and with daily personal contacts, the ambulant withdrawal in patients without seizures or delir in medical history is a secure and successful therapeutic option.

  19. A 'symptom-triggered' approach to alcohol withdrawal management.

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    Murdoch, Jay; Marsden, Janet

    In acute hospital settings, alcohol withdrawal often causes significant management problems and complicates a wide variety of concurrent conditions, placing a huge burden on the NHS. A significant number of critical incidents around patients who were undergoing detoxification in a general hospital setting led to the need for a project to implement and evaluate an evidence-based approach to the management of alcohol detoxification-a project that included a pre-intervention case note audit, the implementation of an evidence-based symptom-triggered detoxification protocol, and a post-intervention case note audit. This change in practice resulted in an average reduction of almost 60% in length of hospital stay and a 66% reduction in the amount of chlordiazepoxide used in detoxification, as well as highlighting that 10% of the sample group did not display any signs of withdrawal and did not require any medication. Even with these reductions, no patient post-intervention developed any severe signs of withdrawal phenomena, such as seizures or delirium tremens. The savings to the trust (The Pennine Acute Hospital Trust) are obvious,but the development of a consistent, quality service will lead to fewer long-term negative effects for patients that can be caused by detoxification. This work is a project evaluation of a locally implemented strategy, which, it was hypothesised,would improve care by providing an individualised treatment plan for the management of alcohol withdrawal symptoms.

  20. Sleep quality during alcohol withdrawal with bright light therapy.

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    Schmitz, M; Frey, R; Pichler, P; Röpke, H; Anderer, P; Saletu, B; Rudas, S

    1997-08-01

    1. Alcohol withdrawal is a complex syndrome that ranges from anxiety, insomnia to delirium tremens. Common treatment is the application of sedative medication. Exposure to bright light in the daytime should advance the normal sleep/wake cycle and moreover it should improve the availability of man's adaptive behavior during alcohol withdrawal. 2. This pilot study describes bright light therapy (BL) during alcohol withdrawal in ten alcohol dependent patients (DSM-III-R: 291.80) without any sedative medication. BL (3000 Lux) was administered on day 3 of abstinence between 7.00-9.00 a.m. and 5.00-9.00 p.m. Total-sleep-polysomnography (recordings between 10.30 p.m.-6.00 a.m.) and self-rating scale were performed to compare intraindividual changes during three nights. After one adaptation night (immediately after alcohol withdrawal), one baseline night and one "BL-night" and one "post-BL night" were analysed. 3. At baseline, total sleep time and sleep efficiency were severely deteriorated, but tended to improve in the following nights after BL. Sleep onset latency showed a significant decline after BL. Stages 3 and 4 were reduced at baseline. Latencies to slow wave sleep were significantly shortened after BL. REM increased in the nights after BL. Subjective sleep quality improved after BL. Although the present results, bright light having a possible stabilizing effect on sleep maintenance and sleep architecture during acute alcohol withdrawal, the authors could only derive hypotheses for further ongoing controlled investigations using placebo light, to receive final verification.

  1. Takotsubo cardiomyopathy triggered by alcohol withdrawal.

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    Alexandre, Joakim; Benouda, Leila; Champ-Rigot, Laure; Labombarda, Fabien

    2011-07-01

    Takotsubo cardiomyopathy is a reversible cardiomyopathy frequently precipitated by a sudden emotional or physical stress. The exact physiopathology is still debated and may involve catecholamine-induced myocardial stunning. Alcohol withdrawal is associated with an hyperadrenergic state and may be a period at risk of cardiac events. We report a 56-year-old man with Takotsubo cardiomyopathy triggered by alcohol withdrawal.

  2. Treatment of alcohol withdrawal with gabapentin.

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    Bozikas, Vasilis; Petrikis, Petros; Gamvrula, Katerina; Savvidou, Ioanna; Karavatos, Athanasios

    2002-01-01

    Gabapentin is an anticonvulsant agent, also effective in the treatment of mood disorders and anxiety disorders. Three cases of alcohol withdrawal treated with gabapentin are presented. All patients received gabapentin 400 mg tid for 3 days, 400 mg bid for 1 day, and finally 400 mg for 1 day. Withdrawal symptoms subsided and no adverse effects were observed. The possible effectiveness of gabapentin in the treatment of alcohol withdrawal warrants further investigation by systematic and well-designed studies.

  3. Delirium

    Science.gov (United States)

    ... problems with Attention and awareness Thinking and memory Emotion Muscle control Sleeping and waking Causes of delirium include medications, poisoning, serious illnesses or infections, and severe pain. It can also be part of some mental ...

  4. Treatment of alcohol withdrawal syndrome with gabapentin.

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    Bonnet, U; Banger, M; Leweke, F M; Maschke, M; Kowalski, T; Gastpar, M

    1999-05-01

    Four in-patients with moderate alcohol-withdrawal syndromes benefited from treatment with gabapentin administered in an add-on fashion to clomethiazole. In comparison with the amount of clomethiazole required as estimated using a specially developed score during previous detoxifications of these patients at our hospital, gabapentin (400 mg q.i.d.) clearly reduced the amount of clomethiazole needed now Gabapentin, an anticonvulsant with favorable pharmacokinetic properties and tolerability, and with no known risk of dependence, may therefore be a useful new drug in the treatment of alcohol withdrawal. We believe that the potential value of gabapentin in alcohol withdrawal deserves further controlled studies.

  5. Sindrome confusional agudo por abstinencia aguda de nicotina Delirium due to acute nicotine withdrawal

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    Manuel Klein

    2002-08-01

    Full Text Available El síndrome confusional agudo (SCA o delirium en pacientes hospitalizados es un problema frecuente y grave. Se caracteriza por síntomas de comienzo agudo y curso fluctuante con inatención, pensamiento desorganizado, y con distintos niveles de alteración de la conciencia.En la bibliografía consultada, el SCA como manifestación de un síndrome de abstinencia aguda nicotínica fue descripto en solo ocho casos. Presentamos el caso de un tabaquista grave que, internado por una reagudización de su enfermedad pulmonar obstructiva crónica (EPOC, presentó un cuadro de SCA al tercer día de abstinencia tabacal, cediendo los síntomas tras la administración de un parche de nicotina. Lo descripto sugiere que en pacientes internados que presentan SCA y agitación, con fuertes antecedentes de tabaquismo, un simple ensayo con un parche de nicotina puede ofrecer en pocas horas una notable respuesta terapéutica y a su vez un test confirmatorio. El reconocimiento del SCA como forma de presentación de la abstinencia nicotínica permitirá identificar casos habitualmente complejos en los que se podrá implementar una sencilla y eficaz alternativa terapéutica.Delirium or acute confusional state among hospitalized patients is a frequent and serious problem. It is characterized by acute onset symptoms, fluctuating course, impaired attention, unorganized thinking, and altered level of conciousness. Delirium, as a manifestation of acute nicotine withdrawal syndrome has been reported in the reviewed literature only in eight cases. We report the case of a heavy smoker admitted because of a reagudization of his chronic obstructive pulmonary disease. At the third day of nicotine abstinence, he developed delirium with a rapid improvement of his symptoms after treatment with a transdermal nicotine patch. This description suggests that in hospitalized heavy smokers who develop delirium with agitation, a simple trial with a nicotine patch can offer a dramatic

  6. A psychometric validation of the Short Alcohol Withdrawal Scale (SAWS)

    DEFF Research Database (Denmark)

    Elholm, Bjarne; Larsen, Klaus; Hornnes, Nete;

    2011-01-01

    The study aimed to evaluate psychometrically a Danish translation of the Short Alcohol Withdrawal Scale (SAWS) in an outpatient setting in patients with Alcohol Dependence (AD) and Alcohol Withdrawal Symptoms/Syndrome (AWS).......The study aimed to evaluate psychometrically a Danish translation of the Short Alcohol Withdrawal Scale (SAWS) in an outpatient setting in patients with Alcohol Dependence (AD) and Alcohol Withdrawal Symptoms/Syndrome (AWS)....

  7. Repetitive Myocardial Infarctions Secondary to Delirium Tremens

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    David Schwartzberg

    2014-01-01

    Full Text Available Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal.

  8. Electrical amygdala kindling in alcohol-withdrawal kindled rats.

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    Ulrichsen, J; Woldbye, D P; Madsen, T M; Clemmesen, L; Haugbøl, S; Olsen, C H; Laursen, H; Bolwig, T G; Hemmingsen, R

    1998-01-01

    Repeated alcohol withdrawal has been shown to kindle seizure activity. The purpose of the present investigation was to study electrical amygdala kindling in rats previously exposed to alcohol-withdrawal kindling. In three independent experiments, male Wistar rats were subjected to multiple episodes each consisting of 2 days of severe alcohol intoxication and 5 days of alcohol withdrawal. In the first experiment, the alcohol-withdrawal kindled animals were divided into two groups depending on whether spontaneous alcohol-withdrawal seizures were observed in episodes 10-13. In the second and third experiments, the alcohol-withdrawal kindled animals were compared to a group in which alcohol-withdrawal kindling was prevented by diazepam treatment during the withdrawal reactions in order to discriminate between the effect of withdrawal and intoxication. Electrical kindling was initiated 28-35 days after the last alcohol dose by exposing the animals to daily electrical stimulations of the right amygdala. The results showed that amygdala kindling was facilitated in alcohol-withdrawal kindled animals which showed spontaneous withdrawal seizure activity, compared with animals exposed to multiple episodes of alcohol withdrawal which did not develop withdrawal seizures or with animals exposed to a single episode of alcohol intoxication. When compared to the control group, the alcohol-withdrawal kindled group with seizures also kindled at a faster rate, but the difference did not reach statistical significance and therefore the results must be regarded as preliminary at present.

  9. A case of γ-butyrolactone associated with severe withdrawal delirium and acute renal failure.

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    Bhattacharya, Indrani S; Watson, Fiona; Bruce, Malcolm

    2011-01-01

    γ-Butyrolactone (GBL) is a popular drug of abuse which is easily available over the internet. Following a UK classification change to a class C drug in January 2010, internet supply has become difficult. Some of the effects have resulted in sourcing GBL from industrial solvents. We report a case of a 24-year-old man who was admitted for detoxification from GBL. He reported having sourced the GBL by diluting the contents of nail varnish remover pads with water. During his admission he developed a severe withdrawal delirium and acute renal failure. He required admission to the intensive care unit. Physicians and psychiatrists should be aware of toxic sources of GBL leading to renal failure and consider GBL in those presenting with agitation, psychosis or coma.

  10. Update on the Neurobiology of Alcohol Withdrawal Seizures

    OpenAIRE

    2005-01-01

    Abrupt cessation of alcohol intake after prolonged heavy drinking may trigger alcohol withdrawal seizures. Generalized tonic–clonic seizures are the most characteristic and severe type of seizure that occur in this setting. Generalized seizures also occur in rodent models of alcohol withdrawal. In these models, the withdrawal seizures are triggered by neuronal networks in the brainstem, including the inferior colliculus; similar brainstem mechanisms may contribute to alcohol withdrawal seizur...

  11. Catatonia in mixed alcohol and benzodiazepine withdrawal

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    Aniruddha Basu

    2014-01-01

    Full Text Available Catatonia is mostly caused by different neuropsychiatric conditions. We report a case of a 30 year old man suffering from both alcohol and benzodiazepine dependence who exhibited catatonic features soon after stopping the intake of substances. This case will help clinicians to recognize catatonic features within the varied symptomatology of substance withdrawal and thereby helping in its early diagnosis and management.

  12. 27 CFR 19.997 - Withdrawal of fuel alcohol.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Withdrawal of fuel alcohol. 19.997 Section 19.997 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU... and Transfers § 19.997 Withdrawal of fuel alcohol. For each shipment or other removal of fuel...

  13. Rapid Death Due to Alcohol Withdrawal Syndrome: Case Report and Review of Literature

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    Rahul Mohanrao Band

    2015-03-01

    Full Text Available Background: Alcohol withdrawal syndrome (AWS is one of the most serious complications associated with chronic alcoholism. Sudden deaths are not uncommon in AWS. In severe stages of AWS, delirium tremens (DT occurs, which is characterized with agitation, global confusion, disorientation, visual and auditory hallucinations in addition to autonomic hyperactivity. Case report: A 30-year old man, chronic and heavy alcohol drinker for 10 years, abstained from alcohol for 3 days. Consequently, he started having palpitations, sweating and tremors. A day later, he was found having hallucinations and delirium. The patient was immediately transferred to the hospital. On admission, he was stuporous and had difficulty in breathing. He developed generalized seizures later on. He was successfully intubated, but there was bleeding through it. The patient’s condition deteriorated very rapidly and he died within two hours. After death, his body was transferred to forensic department. In autopsy, gastrointestinal tract was found to be intact. Massive pulmonary hemorrhage was present on cut section. Liver was found to be with yellowish discoloration and early cirrhotic changes. In heart, left ventricular hypertrophy with narrowed lumen was present and coronary arteries were patent. Discussion: Alcoholism is associated with liver dysfunction and especially in final phases with cirrhosis. Hence and due to resultant coagulopathy, patients are vulnerable to internal bleedings. Hypertrophic cardiomyopathy also occurs in chronic alcoholics. Therefore, we can speculate that our patient developed pulmonary hemorrhage as a result of combined effect of coagulopathy secondary to cirrhosis, alveolar damage (seizure and artificial ventilation and congestive heart failure. Conclusion: For a patient with delirium, convulsions, respiratory distress and coagulopathy, diagnosis of DT should be kept in mind.

  14. Use of propofol as adjuvant therapy in refractory delirium tremens

    Directory of Open Access Journals (Sweden)

    Rajiv Mahajan

    2010-01-01

    Full Text Available Delirium tremens is recognized as a potentially fatal and debilitating complication of alcohol withdrawal. Use of sedatives, particularly benzodiazepines, is the cornerstone of therapy for delirium tremens. But sometimes, very heavy doses of benzodiazepines are required to control delirious symptoms. We are reporting one such case of delirium tremens, which required very heavy doses of benzodiazepines and was ultimately controlled by using infusion of propofol. Thus propofol should always be considered as an option to treat patients with resistant delirium tremens.

  15. Withdrawal-induced delirium associated with a benzodiazepine switch: a case report

    Directory of Open Access Journals (Sweden)

    Bosshart Herbert

    2011-05-01

    Full Text Available Abstract Introduction Introduced in the early 1960s, diazepam remains among the most frequently prescribed benzodiazepine-type sedatives and hypnotics. Patients with chronic use of short-acting benzodiazepines are frequently switched to diazepam because the accumulating, long-acting metabolite, N-desmethyl-diazepam, prevents benzodiazepine-associated withdrawal symptoms, which can occur during trough plasma levels of short-acting benzodiazepines. Although mild to moderate withdrawal symptoms are frequently observed during benzodiazepine switching to diazepam, severe medical complications associated with this treatment approach have thus far not been reported. Case presentation A 64-year-old female Caucasian with major depression, alcohol dependence and benzodiazepine dependence was successfully treated for depression and, after lorazepam-assisted alcohol detoxification, was switched from lorazepam to diazepam to facilitate benzodiazepine discontinuation. Subsequent to the benzodiazepine switch, our patient unexpectedly developed an acute delirious state, which quickly remitted after re-administration of lorazepam. A newly diagnosed early form of mixed dementia, combining both vascular and Alzheimer-type lesions, was found as a likely contributing factor for the observed vulnerability to benzodiazepine-induced withdrawal symptoms. Conclusion Chronic use of benzodiazepines is common in the elderly and a switch to diazepam often precedes benzodiazepine discontinuation trials. However, contrary to common clinical practice, benzodiazepine switching to diazepam may require cross-titration with slow tapering of the first benzodiazepine to allow for the build-up of N-desmethyl-diazepam, in order to safely prevent severe withdrawal symptoms. Alternatively, long-term treatment with low doses of benzodiazepines may be considered, especially in elderly patients with chronic use of benzodiazepines and proven vulnerability to benzodiazepine

  16. Add on dexmedetomidine in the treatment of severe alcohol withdrawal in a patient of emergency laparotomy

    Directory of Open Access Journals (Sweden)

    Roshan Madan Shende

    2015-09-01

    Full Text Available According to American statistics 90% of people drink alcohol at some time in life. The estimated prevalence of alcohol abuse among hospitalized in patients is 20 % and 10- 33 % in patients admitted to the ICU. Approximately 18% of these patients will develop alcohol withdrawal syndrome (AWS whose symptoms can include physical and psychological manifestations that range from mild to life threatening. Although AWS has been reported in literature in post-operative periods and in intensive care unit, there is less information on treatment and preparing of a patient with AWS, coming for emergency surgical procedure. The surgical stress and deranged liver functions possess an additional challenge to the anesthesiologist. Here we are reporting the successful management of a case of delirium tremens by using Dexmedetomidine in pre, intra and post-operative period in a patient with hollow viscous perforation for emergency laparotomy. [Int J Res Med Sci 2015; 3(9.000: 2446-2449

  17. Alcohol withdrawal syndrome--an auto-immune disease? A neuroimmunologic model for pathogenesis of alcohol withdrawal symptoms.

    Science.gov (United States)

    Schubert, S

    1990-08-01

    A neuroimmunologic model of alcohol withdrawal symptoms is developed according to which these may be considered as an idiopathic auto-immune disease. During the alcohol abuse period of non-addicts, homeostasis may alter pathologically by gradual adaptation of the organism: auto-sensitisation develops and finally leads to the breakdown of auto-immune tolerance of the structural modifications set by alcohol withdrawal. The immunosystem regards the existing assimilation of alcohol as self, the withdrawal of alcohol as non-self. Alcohol withdrawal may be considered as an acknowledged physical stressor, and physical stressors as potential triggers of auto-immune diseases. Some so-called alcohol-induced diseases may originate in the pathogenic effects of preceding auto-immune responses to repeated alcohol withdrawals. Neuroimmunologic preconditions of potential auto-immune diseases exactly fit the alcohol withdrawal situation. Neuroimmunologic diseases themselves show close analogies respectively to alcohol withdrawal symptoms as well as to some alcohol-induced diseases. The myelin basis protein is assumed to be a potential auto-allergen. Finally withdrawal symptoms being the expression of physical dependence on alcohol, the model may highlight the very nature of physical dependence.

  18. Alterations of BDNF and GDNF serum levels in alcohol-addicted patients during alcohol withdrawal

    Directory of Open Access Journals (Sweden)

    Mehmet Bülent Sönmez

    Full Text Available Background and Objectives: Brain-derived neurotrophic factor (BDNF and glial cell line-derived neurotrophic factor (GDNF are neurotrophic neuropeptides that play important roles in the synaptic plasticity, neuronal growth, survival and function. A possible neuroprotective role of neurotrophic factors against alcohol-induced cell damage has been suggested, and dysregulations in neurotrophic factors may be involved in the vulnerability to addiction. The aim of this study was to investigate the alterations of BDNF and GDNF serum levels in alcohol-addicted patients during alcohol withdrawal compared to healthy controls. Methods: BDNF and GDNF serum levels of 34 male inpatients diagnosed with alcohol addiction according to DSM-IV-TR were investigated during alcohol withdrawal (day 1, 7 and 14 in comparison to 32 healthy controls using an enzyme-linked immunosorbent assay (ELISA. Severity of alcohol withdrawal was measured by Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar, and intensity of alcohol craving was measured by Penn Alcohol Craving Scale (PACS during alcohol withdrawal (day 1, 7 and 14. Results: BDNF serum levels increased significantly during alcohol withdrawal (p = 0.020. They were negatively correlated to the severity of alcohol withdrawal, and the correlation was close to being statistically significant (p = 0.058. BDNF and GDNF serum levels did not differ significantly between the patient and control groups. GDNF serum levels did not change significantly during alcohol withdrawal. Conclusions: Our results may provide support for the previously hypothesized role of BDNF in the neuroadaptation during alcohol withdrawal.

  19. A case of mistaken identity: alcohol withdrawal, schizophrenia, or central pontine myelinolysis?

    Directory of Open Access Journals (Sweden)

    Schneider P

    2012-02-01

    Full Text Available Paul Schneider1, Vicki A Nejtek2,3, Cheryl Hurd2,31Green Oaks Behavioral Health Care Services, Dallas, 2University of North Texas Health Science Center, Fort Worth, 3John Peter Smith Health Network, Fort Worth, Texas, USAAbstract: Demyelination is a hallmark of central pontine myelinolysis (CPM. Neuropsychiatric manifestations of this condition include weakness, quadriplegia, pseudobulbar palsy, mood changes, psychosis, and cognitive disturbances. These psychiatric symptoms are also associated with schizophrenia and alcohol withdrawal. Thus, it is clinically relevant to differentiate between CPM, schizophrenia, and alcohol withdrawal as the treatment and prognostic outcomes for each diagnosis are distinct. We present a series of events that led to a misdiagnosis of a patient admitted to the medical emergency center presenting with confusion, psychomotor agitation, and delirium who was first diagnosed with schizophrenia and alcohol withdrawal by emergency medical physicians and later discovered by the psychiatric consult team to have CPM. With a thorough psychiatric evaluation, a review of the laboratory results first showing mild hyponatremia (127 mmol/L, subsequent hypernatremia (154 mmol/L, and magnetic resonance brain imaging, psychiatrists concluded that CPM was the primary diagnosis underlying the observed neuropsychopathology. This patient has mild impairments in mood, cognition, and motor skills that remain 12 months after her emergency-center admission. This case report reminds emergency clinicians that abnormal sodium metabolism can have long-term and devastating psychopathological and neurological consequences. Differentiating between CPM, schizophrenia, and alcohol withdrawal using neuroimaging techniques and preventing the risks for CPM using slow sodium correction are paramount.Keywords: MRI, alcohol, schizophrenia, central pontine myelinolysis, hyponatremia

  20. Inpatient management of alcohol withdrawal: a practical approach

    OpenAIRE

    2008-01-01

    Alcohol intake contributes directly or indirectly to 15 to 20% of medical problems in primary care or an inpatient setting. It is estimated that approximately 500,000 episodes of withdrawal will be severe enough to require pharmacologic intervention. The total cost to the United States economy from alcohol abuse was estimated to be $185 billion for 1998. This review attempts to put forth a practical and evidence based approach towards the inpatient management of alcohol withdrawal. Various ag...

  1. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals

    NARCIS (Netherlands)

    J. Harris (Julia); A.-S. Ramelet (Anne-Sylvie); M. van Dijk (Monique); P. Pokorna (Pavla); J.M. Wielenga (Joke); L.N. Tume (Lyvonne); D. Tibboel (Dick); E. Ista (Erwin)

    2016-01-01

    textabstractBackground: This position statement provides clinical recommendations for the assessment of pain, level of sedation, iatrogenic withdrawal syndrome and delirium in critically ill infants and children. Admission to a neonatal or paediatric intensive care unit (NICU, PICU) exposes a child

  2. Phenobarbital compared to benzodiazepines in alcohol withdrawal treatment

    DEFF Research Database (Denmark)

    Askgaard, Gro; Hallas, Jesper; Fink-Jensen, Anders

    2016-01-01

    BACKGROUND: Long-acting benzodiazepines such as chlordiazepoxide are recommended as first-line treatment for alcohol withdrawal. These drugs are known for their abuse liability and might increase alcohol consumption among problem drinkers. Phenobarbital could be an alternative treatment option......, possibly with the drawback of a more pronounced acute toxicity. We evaluated if phenobarbital compared to chlordiazepoxide decreased the risk of subsequent use of benzodiazepines, alcohol recidivism and mortality. METHODS: The study was a register-based cohort study of patients admitted for alcohol...... withdrawal 1998-2013 and treated with either phenobarbital or chlordiazepoxide. Patients were followed for one year. We calculated hazard ratios (HR) for benzodiazepine use, alcohol recidivism and mortality associated with alcohol withdrawal treatment, while adjusting for confounders. RESULTS: A total...

  3. Phenobarbital versus diazepam for delirium tremens--a retrospective study

    DEFF Research Database (Denmark)

    Hjermø, Ida; Anderson, John Erik; Fink-Jensen, Anders;

    2010-01-01

    Delirium tremens (DT) is a severe and potentially fatal condition that may occur during withdrawal from chronic alcohol intoxication. The purpose of the present study was to compare the effects and the rates of complications of phenobarbital and diazepam treatment in DT.......Delirium tremens (DT) is a severe and potentially fatal condition that may occur during withdrawal from chronic alcohol intoxication. The purpose of the present study was to compare the effects and the rates of complications of phenobarbital and diazepam treatment in DT....

  4. Comparison of Alcohol Withdrawal Outcomes in Patients Treated with Benzodiazepines Alone versus Adjunctive Phenobarbital: a Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Lauren Z. Gashlin

    2015-03-01

    Full Text Available Background: For treatment of severe alcohol withdrawal syndrome, high dose benzodiazepines (BZDs may cause delirium and over-sedation. Phenobarbital (PBT is a long-acting barbiturate effective for the treatment of alcohol withdrawal. Given the potential benefits of PBT, we sought to investigate the effectiveness of PBT as adjunctive treatment for alcohol withdrawal. Methods: This was a retrospective cohort study on patients with a diagnosis of alcohol withdrawal who had a CIWA-Ar score > 10 treated with either BZDs alone (BZD alone group or BZDs with adjunctive PBT (PBT-adjunct group. The patients received at least one dose of PBT in addition to BZDs (variable doses in the PBT-adjunct group, and three doses of 20 mg diazepam equivalents within 6 hours in the BZD alone group. The primary endpoint was the proportion of patients with a CIWA-Ar score < 10 at 24 hours after initial treatment. Duration of withdrawal and cumulative dose of BZDs were also assessed. Results: Seven subjects in the adjunctive phenobarbital and 21 in the benzodiazepine group were included in the final analysis. Two patients (28.6% in the PBT-adjunct group and 5 patients (23.8% in the BZD only group achieved the primary endpoint, though the difference between the two groups was not statistically significant (P = 0.588. The median (IQR duration of withdrawal symptoms was 44 (12-62 hours in the PBT-adjunct group compared to 53 (37-87 hours in the BZD only group, with no significant difference between the groups (P = 0.249. The median (IQR cumulative BZD dose requirement (diazepam equivalent in the PBT-adjunct group was significantly lower than BZD alone group (25 (20-226 vs. 326 (160-550 mg, P = 0.02. Conclusion: PBT appears to be a safe and effective alternative to BZDs for the treatment of alcohol withdrawal in non-critically ill patients and may be BZD sparing.

  5. [Psychopharmalogical treatment of delirium in the elderly].

    Science.gov (United States)

    Drach, Lutz M

    2014-04-01

    Delirium is frequent in hospitalized elderly. Treatment of the medical problems causing delirium is paramount. Mostly antipsychotics are used for treatment of psychological and behavioral symptoms in delirium. Increased mortality of elderly and demented patients receiving antipsychotics suggests caution in prescribing antipsychotics for delirium. Standard treatment is low-dose haloperidol. If more sedation is needed, melperone or pipamperone can be used. In delirious Parkinsonian patients or if dementia with Lewy-bodies is suspected quetiapine is better tolerated. Other sedating antipsychotics like prothipendyl, promethazine or levomepromazin are considered inappropriate medication in the elderly due to their anticholinergic and orthostatic side effects. Cholinesterase inhibitors are not effective in delirium, except physostigmine for treatment of anticholinergic intoxication confined to intensive care. Benzodiazepines are effective in alcohol- und benzodiazepine-withdrawal, but may induce delirium (paradox reaction). Clomethiazole is contraindicated in frequent pulmonal conditions in the elderly like COPD. Chloral hydrate is considered inappropriate medication in the elderly due to QTc-prolongation. On intensive care units clonidine and recently dexmedetomidine are useful. At the moment there are no data indicating melatonin being effective for treatment of delirium.

  6. Sodium valproate in the treatment of the alcohol withdrawal syndrome.

    Science.gov (United States)

    Lambie, D G; Johnson, R H; Vijayasenan, M E; Whiteside, E A

    1980-09-01

    The value of sodium valproate in the management of patients during withdrawal from alcohol dependence has been assessed. Alcoholic inpatients were randomly allocated to two groups - one treated with sodium valproate and the other acting as a control. All patients received multivitamins and fluid and electrolyte replacement, and some received chlormethiazole or other tranquillisers. Treatment with sodium valproate (1200 mg daily) was continued for one week. The occurrence of seizures and other withdrawal symptoms (tremulousness, nausea, sweating, disorientation) were noted daily. Forty-nine episodes of withdrawal have been included in the trial - 22 in the sodium valproate group and 27 in the control group. Five patients, all in the control group, had seizures. Other withdrawal symptoms disappeared more quickly in the sodium valproate group even though fewer patients were receiving chlormethiazole.

  7. Evolution of Metabolic Abnormalities in Alcoholic Patients during Withdrawal

    Directory of Open Access Journals (Sweden)

    X. Vandemergel

    2015-01-01

    Full Text Available Chronic alcohol intoxication is accompanied by metabolic abnormalities. Evolution during the early withdrawal period has been poorly investigated. The aim of this study was to determine the evolution of metabolic parameters during alcohol withdrawal. Patients and Methods. Thirty-three patients admitted in our department for alcohol withdrawal were prospectively included. Results. Baseline hypophosphatemia was found in 24% of cases. FEPO4 was reduced from 14.2 ± 9% at baseline to 7.3 ± 4.2% at day 3 (Pnl, respectively. No correlation was found between the sodium and CPK levels (P=0.75 nor between the CPK level and the amount of alcohol ingested (rs = 0.084, P=0.097. Baseline urate level was elevated and returned to normal after three days. Baseline magnesium concentration was normal and stable over time. Conclusion. Chronic alcohol intoxication was accompanied by phosphaturia, rapidly reversible after alcohol withdrawal and inversely correlated with albuminemia, slight hyponatremia, low levels of 25 hydroxy vitamin D, elevated CPK level in about 30% of women, and hyperuricemia with rapid normalization.

  8. Withdrawal-induced delirium associated with a benzodiazepine switch: a case report

    OpenAIRE

    2011-01-01

    Abstract Introduction Introduced in the early 1960s, diazepam remains among the most frequently prescribed benzodiazepine-type sedatives and hypnotics. Patients with chronic use of short-acting benzodiazepines are frequently switched to diazepam because the accumulating, long-acting metabolite, N-desmethyl-diazepam, prevents benzodiazepine-associated withdrawal symptoms, which can occur during trough plasma levels of short-acting benzodiazepines. Although mild to moderate withdrawal symptoms ...

  9. Central Pontine Myelinolysis Induced by Alcohol Withdrawal: A Case Report

    Science.gov (United States)

    2017-01-01

    Central pontine myelinolysis (CPM) is a demyelinating disorder characterized by the loss of myelin in the center of the basis pons, and is mainly caused by the rapid correction of hyponatremia. We report the case of a young woman who presented with gait disturbance and alcohol withdrawal, and who was eventually diagnosed with CPM. Generally, the cause and pathogenesis of CPM in chronic alcoholics remain unclear. In this cases, the CPM may be unrelated to hyponatremia or its correction. However, it is possible that the osmotic pressure changes due to refeeding syndrome after alcohol withdrawal was the likely cause in this case. This case illustrates the need for avoiding hasty, and possibly incomplete diagnoses, and performing more intensive test procedures to ensure a correct diagnosis.

  10. Complicated alcohol withdrawal presenting as self mutilation.

    Science.gov (United States)

    Patra, Bichitra Nanda; Sharma, Akhilesh; Mehra, Aseem; Singh, Shubhmohan

    2014-01-01

    Self-mutilation has been defined as deliberate self injury to body tissue without the intent to die. There has been an association between substance abuse and self mutilation. Alcoholic hallucinosis is usually in auditory modality and regarded as harmless. But patients can indulge in self harm behavior when the hallucinosis is commanding type. We are presenting a case in which the patient inflicted multiple stab injury to his own abdomen in response to alcoholic hallucinosis. This has clinical implication to enquire about substance abuse in patients presenting to emergency setting.

  11. Progressive alcohol-induced sperm alterations leading to spermatogenic arrest, which was reversed after alcohol withdrawal.

    Science.gov (United States)

    Sermondade, Nathalie; Elloumi, Hanène; Berthaut, Isabelle; Mathieu, Emmanuelle; Delarouzière, Vanina; Ravel, Célia; Mandelbaum, Jacqueline

    2010-03-01

    This is a report of a 6-year follow-up of a male patient's semen parameters during heavy chronic alcohol intoxication and after withdrawal. A slowly progressive negative impact of alcohol could be observed: isolated moderate teratozoospermia was firstly noted followed by oligoasthenoteratospermia. Then a severe worsening resulted in cryptozoospermia and ultimately in azoospermia. At this moment, the histological analysis of a testicular biopsy revealed a maturation arrest of the germinal cells at the pachytene stage with no mature sperm cells. Alcohol withdrawal was then obtained, allowing a very fast and drastic improvement of semen characteristics; strictly normal semen parameters were observed after no more than 3 months. Taking into consideration these data, patients should be questioned about their alcohol intake before assisted reproductive technology and should be informed about this adverse effect. Moreover, this case report emphasizes how quickly benefits can be obtained after withdrawal, even in the case of heavy chronic alcohol intake.

  12. Identification and management of in-hospital drug-induced delirium in older patients.

    Science.gov (United States)

    Catic, Angela G

    2011-09-01

    Delirium, an acute confusional state with changes in attention and cognition, is a common cause of morbidity and mortality among hospitalized elders. Medications are responsible for up to 39% of delirium cases in the elderly. The incidence of drug-induced delirium is particularly high in this population due to the altered pharmacokinetics and pharmacodynamics of aging, high prevalence of polypharmacy and occurrence of co-morbid disease. Although certain medications are more often associated with the development of delirium, including opioids, benzodiazepines, anticholinergics and antidepressants, any medication can cause delirium in the elderly. Evaluation of delirium should include a thorough medication history, which should determine if any new medications have been initiated, if medications have been discontinued, and the details of any recent dosage adjustments. It is important to understand the utility of medications in preventing and treating delirium in the elderly. Acetylcholinesterase inhibitors have not been found to reduce the incidence of delirium or length of hospitalization. Study results regarding the utility of antipsychotic medications in preventing delirium have been mixed. Haloperidol prophylaxis did not reduce the occurrence of delirium, but it did reduce the severity and duration. Olanzapine and risperidone were associated with a reduced incidence of delirium compared with placebo. Pharmacological therapy to treat delirium should be implemented only if patients pose a safety risk to themselves or others. Typical and atypical antipsychotics are effective in treating the symptoms of delirium, but it is important to note that they are not approved by the US FDA for this indication. Short-acting benzodiazepines are second-line therapy and are typically reserved for patients with sedative/alcohol withdrawal, Parkinson's disease or neuroleptic malignant syndrome. Study results regarding the utility of acetylcholinesterase inhibitors have been mixed.

  13. Excited delirium: Consideration of selected medical and psychiatric issues

    Directory of Open Access Journals (Sweden)

    Edith Samuel

    2009-01-01

    Full Text Available Edith Samuel1, Robert B Williams1, Richard B Ferrell21Department of Psychology, Atlantic Baptist University, Moncton, New Brunswick Canada; 2Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire, USAAbstract: Excited delirium, sometimes referred to as agitated or excited delirium, is the label assigned to the state of acute behavioral disinhibition manifested in a cluster of behaviors that may include bizarreness, aggressiveness, agitation, ranting, hyperactivity, paranoia, panic, violence, public disturbance, surprising physical strength, profuse sweating due to hyperthermia, respiratory arrest, and death. Excited delirium is reported to result from substance intoxication, psychiatric illness, alcohol withdrawal, head trauma, or a combination of these. This communication reviews the history of the origins of excited delirium, selected research related to its causes, symptoms, management, and the links noted between it and selected medical and psychiatric conditions. Excited delirium involves behavioral and physical symptoms that are also observed in medical and psychiatric conditions such as rhabdomyolysis, neuroleptic malignant syndrome, and catatonia. A useful contribution of this communication is that it links the state of excited delirium to conditions for which there are known and effective medical and psychiatric interventions.Keywords: excited delirium, excited states, cocaine misuse, restraint or in custody deaths

  14. [Delirium: Concepts, Etiology, and Clinical Management].

    Science.gov (United States)

    Hübscher, A; Isenmann, S

    2016-04-01

    Delirium is a common condition: up to 35 percent of non-ICU- and 80 percent of ICU-patients experience delirium - particularly the elderly suffering from cerebral dysfunction accompanied by acute infection, surgery, or change of medication. Medical staff should be alert for decrease (within hours) of concentration, memory, orientation, and consciousness - especially when agitation appears and symptoms are fluctuating. Vegetative lapses and seizures may complicate the course, in particular in delirium in withdrawal (of alcohol or drugs). Treatment comprises neuroleptic and sedative medication (be careful with benzodiazepines because of their delirogenic potential) as well as alpha-2-agonists for vegetative derangements and anti-epileptics in case of seizures. As usual: start with low doses, and keep the medical treatment as short as possible. Additionally, take care in the · search and solution of delir-causes,. · termination of unnecessary medication (in particular, anticholinergic agents),. · comfort, intimacy and orientation,. · cognitive training and mobilization.. Avoiding a delirium is the best medicine. For that reason, identification of patients at risk, early detection of signs of delirium and prevention are most important. Beside factors 2 to 4, personalized treatment has been proved to be very helpful.

  15. Benzodiazepines should still be first-line treatment for alcohol withdrawal

    DEFF Research Database (Denmark)

    Askgaard, Gro; Pottegård, Anton; Fink-Jensen, Anders

    2017-01-01

    In this review, we summarize the evidence for benzodiazepines and barbiturates as alcohol withdrawal treatment and outline a treatment guideline. A number of randomized controlled trials (RCTs) indicate that benzodiazepine treatment decreases alcohol withdrawal seizures and is safe....... For barbiturates, only a few RCTs have been undertaken, and barbiturates were not found to be superior to benzodiazepines. Consequently, we suggest that benzodiazepines should still be first-line treatment for alcohol withdrawal....

  16. Study on Alcoholic Withdrawal Score, with Questionnaire Based Session Conducted on Acute and Chronic Alcoholic Liver Disease Patients

    Directory of Open Access Journals (Sweden)

    Bandi Navyatha

    2016-07-01

    Full Text Available Alcohol liver disease is damage to the Liver and its function due to alcohol abuse. It occurs after years of heavy drinking and by through which cirrhosis can occur and which leads to the final phase of Alcoholic liver disease. It not only occurs in heavy drinkers but also there is a chance of getting liver disease go up the longer of been drinking and more alcohol consumption. A study was observational, prospective and descriptive; and was carried out one hundred and nine patients [n=109] who were with suffering from an Alcoholic liver disease, to determine the alcohol withdrawal score and there symptoms involved after they were kept on alcohol withdrawal therapy. An observational, prospective and randomized study was conducted in the hospital from March 2014-March 2016. Questionnaire based session with 10 scaled questions were framed according to CIWA (assessment and management of alcohol withdrawal and the score was noted with their symptoms occurrence after the alcohol cessation plan. CIWA score with moderate severity were found to be highest. 7 patients out of 33 patients in severe category of CIWA score were admitted in the hospital with alcohol withdrawal syndrome and psychological disturbances. Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA helps clinicians assess and treat potential alcohol withdrawal.

  17. Anticonvulsants for the treatment of alcohol withdrawal syndrome and alcohol use disorders.

    Science.gov (United States)

    Hammond, Christopher J; Niciu, Mark J; Drew, Shannon; Arias, Albert J

    2015-04-01

    Alcoholic patients suffer from harmful allostatic neuroplastic changes in the brain causing an acute withdrawal syndrome upon cessation of drinking followed by a protracted abstinence syndrome and an increased risk of relapse to heavy drinking. Benzodiazepines have long been the treatment of choice for detoxifying patients and managing alcohol withdrawal syndrome (AWS). Non-benzodiazepine anticonvulsants (NBACs) are increasingly being used both for alcohol withdrawal management and for ongoing outpatient treatment of alcohol dependence, with the goal of either abstinence or harm reduction. This expert narrative review summarizes the scientific basis and clinical evidence supporting the use of NBACs in treating AWS and for reducing harmful drinking patterns. There is less evidence in support of NBAC therapy for AWS, with few placebo-controlled trials. Carbamazepine and gabapentin appear to be the most promising adjunctive treatments for AWS, and they may be useful as monotherapy in select cases, especially in outpatient settings and for the treatment of mild-to-moderate low-risk patients with the AWS. The body of evidence supporting the use of the NBACs for reducing harmful drinking in the outpatient setting is stronger. Topiramate appears to have a robust effect on reducing harmful drinking in alcoholics. Gabapentin is a potentially efficacious treatment for reducing the risk of relapse to harmful drinking patterns in outpatient management of alcoholism. Gabapentin's ease of use, rapid titration, good tolerability, and efficacy in both the withdrawal and chronic phases of treatment make it particularly appealing. In summary, several NBACs appear to be beneficial in treating AWS and alcohol use disorders.

  18. Attenuation of alcohol withdrawal syndrome and blood cortisol level with forced exercise in comparison with diazepam.

    OpenAIRE

    2015-01-01

    Relieving withdrawal and post-abstinence syndrome of alcoholism is one of the major strategies in the treatment of alcohol addicted patients. Diazepam, chlordiazepoxide, and topiramate are the approved medications that were used for this object. To assess the role of non-pharmacologic therapy in the management of alcohol withdrawal syndrome, we analyzed effects of forced exercise by treadmill on alcohol dependent mice as an animal model. A total of 60 adult male mice were divided into 5 group...

  19. Alcohol Withdrawal and Brain Injuries: Beyond Classical Mechanisms

    Directory of Open Access Journals (Sweden)

    Marianna E. Jung

    2010-07-01

    Full Text Available Unmanaged sudden withdrawal from the excessive consumption of alcohol (ethanol adversely alters neuronal integrity in vulnerable brain regions such as the cerebellum, hippocampus, or cortex. In addition to well known hyperexcitatory neurotransmissions, ethanol withdrawal (EW provokes the intense generation of reactive oxygen species (ROS and the activation of stress-responding protein kinases, which are the focus of this review article. EW also inflicts mitochondrial membranes/membrane potential, perturbs redox balance, and suppresses mitochondrial enzymes, all of which impair a fundamental function of mitochondria. Moreover, EW acts as an age-provoking stressor. The vulnerable age to EW stress is not necessarily the oldest age and varies depending upon the target molecule of EW. A major female sex steroid, 17β-estradiol (E2, interferes with the EW-induced alteration of oxidative signaling pathways and thereby protects neurons, mitochondria, and behaviors. The current review attempts to provide integrated information at the levels of oxidative signaling mechanisms by which EW provokes brain injuries and E2 protects against it. Unmanaged sudden withdrawal from the excessive consumption of alcohol (ethanol adversely alters neuronal integrity in vulnerable brain regions such as the cerebellum, hippocampus, or cortex. In addition to well known hyperexcitatory neurotransmissions, ethanol withdrawal (EW provokes the intense generation of reactive oxygen species (ROS and the activation of stress-responding protein kinases, which are the focus of this review article. EW also inflicts mitochondrial membranes/membrane potential, perturbs redox balance, and suppresses mitochondrial enzymes, all of which impair a fundamental function of mitochondria. Moreover, EW acts as an age-provoking stressor. The vulnerable age to EW stress is not necessarily the oldest age and varies depending upon the target molecule of EW. A major female sex steroid, 17

  20. Study on related factors of delirium tremens caused by alcohol%酒精所致震颤谵妄相关因素研究

    Institute of Scientific and Technical Information of China (English)

    王桂英; 李宁宁; 郭卜豪

    2014-01-01

    目的:研究使用酒精所致的精神和行为障碍患者出现震颤谵妄( delirium tremens,DT)的相关因素。方法:对118例首次住院的男性使用酒精所致精神和行为障碍患者,按照是否出现DT分为两组,对酒依赖年限、饮酒量和实验室检查(肝功、肾功、心肌酶、血细胞和电解质等)相关指标进行比较。结果:出现DT的51例患者,日饮酒量大,谷草转氨酶、谷氨酸转氨酶及肌酸激酶显著升高;而血红蛋白、红细胞、血小板及钾则显著降低,与非DT组相比,差异均有统计学意义(P<0.05或P<0.01)。结论:使用酒精所致的精神和行为障碍患者,日饮酒量大小,血液相关指标(转氨酶、心肌酶、血细胞及钾等)对DT具有一定意义。%Objective:To research related factors of delirium tremens for patients with mental and behavioral disorders caused by alcohol. Methods:118 male inpatients with mental and behavioral disorders caused by alcohol were divided into two groups ( deliri-um tremens and non delirium tremens) in terms of delirium tremens occurrence. The alcohol dependence years, alcohol consumption and laboratory examination ( hepatic function, renal function, myocardial enzyme, blood cells, and the electrolyte, etc. ) were com-pared. Results:Compared with non delirium tremens group, delirium tremens group (51 cases) showed higher daily alcohol consump-tion, AST, GGT, and CK, but lower Levels in HGB, HRB, PLT, and K, and the differences were statistically significant (P<0. 05 or P<0. 01). Conclusions:The blood related indexes and daily alcohol consumption of the inpatient with mental and behavioral disorders caused by alcohol to some degree can predict delirium tremens.

  1. Tobacco smoking interferes with GABAA receptor neuroadaptations during prolonged alcohol withdrawal.

    Science.gov (United States)

    Cosgrove, Kelly P; McKay, Reese; Esterlis, Irina; Kloczynski, Tracy; Perkins, Evgenia; Bois, Frederic; Pittman, Brian; Lancaster, Jack; Glahn, David C; O'Malley, Stephanie; Carson, Richard E; Krystal, John H

    2014-12-16

    Understanding the effects of tobacco smoking on neuroadaptations in GABAA receptor levels over alcohol withdrawal will provide critical insights for the treatment of comorbid alcohol and nicotine dependence. We conducted parallel studies in human subjects and nonhuman primates to investigate the differential effects of tobacco smoking and nicotine on changes in GABAA receptor availability during acute and prolonged alcohol withdrawal. We report that alcohol withdrawal with or without concurrent tobacco smoking/nicotine consumption resulted in significant and robust elevations in GABAA receptor levels over the first week of withdrawal. Over prolonged withdrawal, GABAA receptors returned to control levels in alcohol-dependent nonsmokers, but alcohol-dependent smokers had significant and sustained elevations in GABAA receptors that were associated with craving for alcohol and cigarettes. In nonhuman primates, GABAA receptor levels normalized by 1 mo of abstinence in both groups--that is, those that consumed alcohol alone or the combination of alcohol and nicotine. These data suggest that constituents in tobacco smoke other than nicotine block the recovery of GABAA receptor systems during sustained alcohol abstinence, contributing to alcohol relapse and the perpetuation of smoking.

  2. S100B and homocysteine in the acute alcohol withdrawal syndrome.

    Science.gov (United States)

    Wedekind, Dirk; Neumann, Karolin; Falkai, Peter; Malchow, Berend; Engel, Kirsten Rita; Jamrozinski, Katja; Havemann-Reinecke, Ursula

    2011-03-01

    Elevations of serum homocysteine levels are a consistent finding in alcohol addiction. Serum S100B levels are altered in different neuropsychiatric disorders but not well investigated in alcohol withdrawal syndromes. Because of the close connection of S100B to ACTH and glutamate secretion that both are involved in neurodegeneration and symptoms of alcoholism the relationship of S100B and homocysteine to acute withdrawal variables has been examined. A total of 22 male and 9 female inpatients (mean age 46.9 ± 9.7 years) with an ICD-10 diagnosis of alcohol addiction without relevant affective comorbidity were examined on admission and after 24, 48, and 120 h during withdrawal. S100B and homocysteine levels in serum were collected, and severity of withdrawal symptoms (AWS-scale), applied withdrawal medication, initial serum ethanol levels and duration of addiction were recorded. Serum S100B and homocysteine levels declined significantly (P < .05) over time. Both levels declined with withdrawal syndrome severity. Females showed a trend to a more intense decline in serum S100B levels compared to males at day 5 (P = .06). Homocysteine levels displayed a negative relationship to applied amount of clomethiazole (P < .05) and correlated with age of onset of addiction. No withdrawal seizures were recorded during the trial. As it is known for homocysteine, S100B revealed to decline rapidly over withdrawal treatment in alcoholism. This effect is more pronounced in female patients. S100B could be of relevance in the neurobiology of alcohol withdrawal syndromes. It may be indirectly related to the level of stress level or glutamatergic activity during alcohol withdrawal.

  3. Central pontine and extrapontine myelinolysis that developed during alcohol withdrawal, without hyponatremia, in a chronic alcoholic.

    Science.gov (United States)

    An, Jae Young; Park, Sung Kyung; Han, Si Ryung; Song, In Uk

    2010-01-01

    Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are osmotic demyelination syndrome. A 45-year-old man with a history of alcoholism visited the ER with dysarthria and dysphagia for 2 days. These symptoms occurred 3 days after he had stopped drinking alcohol. The neurological symptoms progressed to anarthria, pseudobulbar palsy and gait disturbance. During admission, the electrolyte studies were within the normal range. Diffusion-weighted images revealed high signal intensities in the pons, thalamus and basal ganglia. Apparent diffusion coefficient image showed low signal intensities in the pontine lesion, but isosignal intensities in the extrapontine lesion. The symptoms gradually improved after 1 month with only conservative treatment. The 1 month-follow-up MRI showed significant reduction of the previous extrapontine lesions. These findings suggest that cytotoxic edema is central to the pathogenesis of CPM, but vasogenic edema plays an important role in the pathogenesis of EPM occurring during alcohol withdrawal.

  4. Sodium oxybate: a review of its use in alcohol withdrawal syndrome and in the maintenance of abstinence in alcohol dependence.

    Science.gov (United States)

    Keating, Gillian M

    2014-01-01

    A liquid formulation of sodium oxybate (Alcover(®)), the sodium salt of γ-hydroxybutyric acid (GHB), is approved in Italy and Austria for use in alcohol withdrawal syndrome and for the maintenance of abstinence in alcohol dependence. This article reviews the efficacy and tolerability of sodium oxybate in alcohol withdrawal syndrome and in the maintenance of abstinence in alcohol dependence, as well as summarizing its pharmacological properties. Results of randomized controlled trials indicate that sodium oxybate was at least as effective as diazepam and clomethiazole in patients with alcohol withdrawal syndrome, rapidly alleviating symptoms, and was at least as effective as naltrexone or disulfiram in the maintenance of abstinence in alcohol-dependent patients. Sodium oxybate was generally well tolerated. The risk of sodium oxybate abuse is generally low when it is administered to alcohol-dependent patients at its approved dosage, under the supervision of a designated family member and with continuous strict medical surveillance. However, certain patient groups, such as patients with alcohol dependence and borderline personality disorder or who are in remission from heroin or cocaine addiction, may not be suitable candidates for sodium oxybate therapy because of an increased risk of abuse. In conclusion, sodium oxybate is a useful option for the treatment of alcohol withdrawal syndrome and for the maintenance of abstinence in alcohol dependence.

  5. Alcohol Withdrawal Syndrome: Symptom-Triggered versus Fixed-Schedule Treatment in an Outpatient Setting

    DEFF Research Database (Denmark)

    Elholm, B.; Larsen, Klaus; Hornnes, N.;

    2011-01-01

    , time to relapse and patient satisfaction were measured. Patients assessed their symptoms using the Short Alcohol Withdrawal Scale (SAWS). Patient satisfaction was monitored by the Diabetes Treatment Satisfaction Questionnaire. We used the Well-Being Index and the European addiction severity index......Aims: To investigate whether, in the treatment with chlordiazepoxide for outpatient alcohol withdrawal, there are advantages of symptom-triggered self-medication over a fixed-schedule regimen. Methods: A randomized controlled trial in outpatient clinics for people suffering from alcohol dependence...... (AD) and alcohol-related problems; 165 adult patients in an outpatient setting in a specialized alcohol treatment unit were randomized 1:1 to either a symptom-triggered self-medication or tapered dose, using chlordiazepoxide. Alcohol withdrawal symptoms, amount of medication, duration of symptoms...

  6. A randomized, open-label, controlled trial of gabapentin and phenobarbital in the treatment of alcohol withdrawal.

    Science.gov (United States)

    Mariani, John J; Rosenthal, Richard N; Tross, Susan; Singh, Prameet; Anand, Om P

    2006-01-01

    Gabapentin was compared with phenobarbital for the treatment of alcohol withdrawal in a randomized, open-label, controlled trial in 27 inpatients. There were no significant differences in the proportion of treatment completers between treatment groups or the proportion of patients in each group requiring rescue medication for breakthrough signs and symptoms of alcohol withdrawal. There were no significant treatment differences in withdrawal symptoms or psychological distress, nor were there serious adverse events. These findings suggest that gabapentin may be as effective as phenobarbital in the treatment of alcohol withdrawal. Given gabapentin's favorable pharmacokinetic profile, further study of its effectiveness in treating alcohol withdrawal is warranted.

  7. Delirium (PDQ)

    Science.gov (United States)

    ... depression and dementia. Physical exams and other laboratory tests are used to diagnose the causes of delirium. Possible signs of delirium include sudden personality changes, problems thinking, and unusual anxiety or depression. When the following symptoms occur suddenly, ...

  8. The importance of depression and alcohol use in coronary artery bypass graft surgery patients:risk factors for delirium and poorer quality of life

    Institute of Scientific and Technical Information of China (English)

    Joanne M Humphreys; Linley A Denson; Robert A Baker; Phillip J Tully

    2016-01-01

    ObjectiveToinvestigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life (QOL) after co-ronary artery bypass (CABG) surgery.MethodsA total of 180 CABG patients (mean age of 63.5 ± 10.1 years, 82.2% males) completed baseline and postoperative self-report questionnaires to assess distress and QOL. Incident delirium was diagnosed postoperatively with a structured clinical interview and patients were monitored every day post-operatively for confusion and disturbance in consciousness.Results Delirium developed in 63 persons (35% of sample). After adjustment for covariates, delirium was significantly associated with depression [odds ratio (OR): 1.08; 95% confidence interval (CI): 1.03–1.13,P = 0.003], anxiety (OR: 1.07; 95% CI: 1.02–1.13,P= 0.01) and stress (OR: 1.05; 95% CI: 1.00–1.09,P= 0.03). Preoperative depression scores were associated with poorer QOL including bodily pain (β =-0.39,P = 0.013), vitality (β=-0.32,P = 0.020), social functioning (β=-0.51,P£0.001), emotional role function (β=-0.44,P = 0.003) and general health (β=-0.33,P = 0.038). Among the covariates, harmful levels of alcohol use was consistently associated with poorer QOL.Conclusions Depression and harmful levels of alcohol use were consistently associated with poorer QOL whereas depression, anxiety and stress were associated with delirium risk. These findings point to further research examining depression and harmful levels of alcohol use in coronary heart disease populations undergoing coronary revascularization.

  9. Resistance to alcohol withdrawal-induced behaviour in Fyn transgenic mice and its reversal by ifenprodil.

    Science.gov (United States)

    Stork, Oliver; Kojima, Nobuhiko; Stork, Simone; Kume, Nobuko; Obata, Kunihiko

    2002-09-30

    Recent studies suggest that the protein tyrosine kinase Fyn constitutes a determinant of fear and anxiety as well as alcohol sensitivity in mice. We investigated these functions and their relatedness in mice with transgenic over-expression of native or mutated, constitutively active Fyn. Fear- and anxiety-related behaviour of these animals were normal under varying levels of stress, but under withdrawal from alcohol both types of transgenic mice failed to show any increase of anxiety-like behaviour or reduction of exploratory activity as seen in their wild-type littermates. This apparent lack of alcohol withdrawal-induced behavioural effects was associated with increased Fyn activity and tyrosine phosphorylation of several proteins including the NMDA receptor subunit NR2B in the different mutant lines. NR2B phosphorylation itself remained unaffected by the chronic alcohol ingestion and subsequent withdrawal, but challenge with an NR2B antagonist, ifenprodil, restored a normal behavioural response in alcohol-withdrawn fyn mutants. Moreover, both types of transgenic mice showed a reduction of voluntary alcohol consumption compared to their wild-type littermates. Together, these results suggest that Fyn can modulate alcohol consumption and prevent behavioural changes during alcohol withdrawal, possibly via phosphorylation of NR2B.

  10. Attenuation of alcohol withdrawal syndrome and blood cortisol level with forced exercise in comparison with diazepam.

    Directory of Open Access Journals (Sweden)

    Majid Motaghinejad

    2015-05-01

    Full Text Available Relieving withdrawal and post-abstinence syndrome of alcoholism is one of the major strategies in the treatment of alcohol addicted patients. Diazepam, chlordiazepoxide, and topiramate are the approved medications that were used for this object. To assess the role of non-pharmacologic therapy in the management of alcohol withdrawal syndrome, we analyzed effects of forced exercise by treadmill on alcohol dependent mice as an animal model. A total of 60 adult male mice were divided into 5 groups, from which 4 groups became dependent to alcohol (2 g/kg/day for 15 days. From day 16, treatment groups were treated by diazepam (0.5mg/kg, forced exercise, and diazepam (0.5 mg/kg concurrent with forced exercise for two weeks; And the positive control group received same dose of alcohol (2 g/kg/day for two weeks. The negative control group received normal saline for four weeks. Finally, on day 31, all animals were observed for withdrawal signs, and Alcohol Total Withdrawal Score (ATWS was determined. Blood cortisol levels were measured in non-fasting situations as well. Present findings showed that ATWS significantly decrease in all treatment groups in comparison with positive control group (P<0.05 for groups received diazepam and treated by forced exercise and P<0.001 for group under treatment diazepam + forced exercise. Moreover, blood cortisol level significantly decreased in all treatment groups (P<0.001. This study suggested that forced exercise and physical activity can be useful as adjunct therapy in alcoholism and can ameliorate side effects and stress situation of withdrawal syndrome periods.

  11. Attenuation of alcohol withdrawal syndrome and blood cortisol level with forced exercise in comparison with diazepam.

    Science.gov (United States)

    Motaghinejad, Majid; Bangash, Mohammad Yasan; Motaghinejad, Ozra

    2015-01-01

    Relieving withdrawal and post-abstinence syndrome of alcoholism is one of the major strategies in the treatment of alcohol addicted patients. Diazepam, chlordiazepoxide, and topiramate are the approved medications that were used for this object. To assess the role of non-pharmacologic therapy in the management of alcohol withdrawal syndrome, we analyzed effects of forced exercise by treadmill on alcohol dependent mice as an animal model. A total of 60 adult male mice were divided into 5 groups, from which 4 groups became dependent to alcohol (2 g/kg/day) for 15 days. From day 16, treatment groups were treated by diazepam (0.5mg/kg), forced exercise, and diazepam (0.5 mg/kg) concurrent with forced exercise for two weeks; And the positive control group received same dose of alcohol (2 g/kg/day) for two weeks. The negative control group received normal saline for four weeks. Finally, on day 31, all animals were observed for withdrawal signs, and Alcohol Total Withdrawal Score (ATWS) was determined. Blood cortisol levels were measured in non-fasting situations as well. Present findings showed that ATWS significantly decrease in all treatment groups in comparison with positive control group (Pdiazepam and treated by forced exercise and Pdiazepam + forced exercise). Moreover, blood cortisol level significantly decreased in all treatment groups (P<0.001). This study suggested that forced exercise and physical activity can be useful as adjunct therapy in alcoholism and can ameliorate side effects and stress situation of withdrawal syndrome periods.

  12. LEVELS OF BRAIN-SPECIFIC S-100B PROTEIN, SPECIFIC ANTIBODIES AND CYTOKINE PROFILE IN THE PATIENTS WITH ALCOHOL-INDUCED DELIRIUM STATES

    Directory of Open Access Journals (Sweden)

    N. N. Tsybikov

    2008-01-01

    Full Text Available Abstract. Present article deals with our results concerning brain-specific S-100B protein levels, anti-S-100B autoantibodies of IgM and IgG classes, like as cytokine profiles of blood serum and cerebrospinal fluid in the patients with alcohol-induced delirium state. The results obtained provide an evidence of association between alcoholic psychosis and destruction of brain tissue, development of autoimmune reactions and altered cytokine status, thus, probably, resulting into disintegration of immune and neuroendocrine systems.

  13. A study of gabapentin in the treatment of tonic-clonic seizures of alcohol withdrawal syndrome.

    Science.gov (United States)

    Rustembegovic, Avdo; Sofic, Emin; Tahirović, Ismet; Kundurović, Zlata

    2004-01-01

    In this study for thirty (30) patients with alcohol withdrawal syndrome, the response to anticolvusant gabapentin was assessed. Thirty (30) patients with median age of 57.0 years and median body weight of 79.1 kg were treated with gabapentin 3 x 300 mg daily for up 30 days. The preliminary findings of this study suggest that gabapentin is very effective against tonic-clonic seizures in alcohol withdrawal syndrome. Gabapentin was safe and well tolerated. For twenty (20) patients no side effect were observed.

  14. Role of adenosine A1 and A2A receptors in the alcohol withdrawal syndrome.

    Science.gov (United States)

    Kaplan, G B; Bharmal, N H; Leite-Morris, K A; Adams, W R

    1999-10-01

    The role of adenosine receptor-mediated signaling was examined in the alcohol withdrawal syndrome. CD-1 mice received a liquid diet containing ethanol (6.7%, v/v) or a control liquid diet that were abruptly discontinued after 14 days of treatment. Mice consuming ethanol showed a progressive increase in signs of intoxication throughout the drinking period. Following abrupt discontinuation of ethanol diet, mice demonstrated reversible signs of handling-induced hyperexcitability that were maximal between 5-8 h. Withdrawing mice received treatment with adenosine receptor agonists at the onset of peak withdrawal (5.5 h) and withdrawal signs were blindly rated (during withdrawal hours 6 and 7). Adenosine A1-receptor agonist R-N6(phenylisopropyl)adenosine (0.15 and 0.3 mg/ kg) reduced withdrawal signs 0.5 and 1.5 h after drug administration in a dose-dependent fashion. Adenosine A2A-selective agonist 2-p-(2-carboxyethyl)phenylethyl-amino-5'-N-ethylcarboxamidoadenosine (0.3 mg/kg) reduced withdrawal signs at both time points. In ethanol-withdrawing mice, there were significant decreases in adenosine transporter sites in striatum without changes in cortex or cerebellum. In ethanol-withdrawing mice, there were no changes in adenosine A1 and A2A receptor concentrations in cortex, striatum, or cerebellum. There appears to be a role for adenosine A1 and A2A receptors in the treatment of the ethanol withdrawal syndrome. Published by Elsevier Science Inc.

  15. Sex-Dependent Decrease of Sphingomyelinase Activity During Alcohol Withdrawal Treatment

    Directory of Open Access Journals (Sweden)

    Christiane Mühle

    2014-06-01

    Full Text Available Background: In vitro and in vivo studies have demonstrated the role of the acid sphingomyelinase (ASM in pathophysiological processes and alterations in response to ethanol exposure. Cellular and plasmatic ASM activities are increased in male alcohol dependent patients and decrease during physical withdrawal. Methods: Here, we analyzed the time course of ASM in male and also female acutely intoxicated patients during alcohol withdrawal and compared the activity levels to those under long-term maintenance treatment. Craving and further psychometric parameters were assessed by questionnaires. Results: The gradual decrease of serum ASM was confirmed in males (pConclusion: These data support the potential of ASM as a biomarker for the course of withdrawal therapy in males and provide the first associations of this enzyme with psychological variables such as craving and depression.

  16. Evolution of Wernicke-Korsakoff syndrome in self-neglecting alcoholics: preliminary results of relation with Wernicke-delirium and diabetes mellitus.

    Science.gov (United States)

    Wijnia, Jan W; van de Wetering, Ben J M; Zwart, Elles; Nieuwenhuis, K Gerrit A; Goossensen, M Anne

    2012-01-01

    We present a descriptive, retrospective study of initial symptoms, comorbidity, and alcohol withdrawal in 73 alcoholic patients with subsequent Korsakoff syndrome. In 25/73 (35%) of the patients the classic triad of Wernicke's encephalopathy with ocular symptoms, ataxia and confusion, was found. In at least 6/35 (17%) of the initial deliria (95% confidence interval: 10-25%) we observed no other underlying causes, thus excluding other somatic causes, medication, (recent) alcohol withdrawal, or intoxication. We suggest that these deliria may have been representing Wernicke's encephalopathy. A high frequency (15%) of diabetics may reflect a contributing factor of diabetes mellitus in the evolution of the Wernicke-Korsakoff syndrome.

  17. An attempt to evaluate diagnostic and prognostic significance of blood endogenous ethanol in alcoholics and their relatives.

    Science.gov (United States)

    Ostrovsky, Y M; Pronko, P S; Shishkin, S N; Kolesnikov, V B; Volynets, S I

    1989-01-01

    Endogenous ethanol in the blood of human subjects was measured by gas chromatography. In healthy males, 12-13-year-old boys (sons of alcoholic and nonalcoholic fathers), and alcoholic inpatients (after cessation of all drugs), the endogenous ethanol levels ranged from 0 to 4.3 mg/l. The results showed no significant differences between the groups. At the period of alcohol withdrawal reactions the concentrations of endogenous ethanol were minimal in patients with delirium tremens and maximal in patients with mild alcohol withdrawal syndrome, the dynamics of this parameter being dependent on the severity of the alcohol withdrawal syndrome and the nature of the drugs prescribed.

  18. Excitability of jcBNST neurons is reduced in alcohol-dependent animals during protracted alcohol withdrawal.

    Directory of Open Access Journals (Sweden)

    Attila Szücs

    Full Text Available Alcohol dependence and withdrawal has been shown to cause neuroadaptive changes at multiple levels of the nervous system. At the neuron level, adaptations of synaptic connections have been extensively studied in a number of brain areas and accumulating evidence also shows the importance of alcohol dependence-related changes in the intrinsic cellular properties of neurons. At the same time, it is still largely unknown how such neural adaptations impact the firing and integrative properties of neurons. To address these problems, here, we analyze physiological properties of neurons in the bed nucleus of stria terminalis (jcBNST in animals with a history of alcohol dependence. As a comprehensive approach, first we measure passive and active membrane properties of neurons using conventional current clamp protocols and then analyze their firing responses under the action of simulated synaptic bombardment via dynamic clamp. We find that most physiological properties as measured by DC current injection are barely affected during protracted withdrawal. However, neuronal excitability as measured from firing responses under simulated synaptic inputs with the dynamic clamp is markedly reduced in all 3 types of jcBNST neurons. These results support the importance of studying the effects of alcohol and drugs of abuse on the firing properties of neurons with dynamic clamp protocols designed to bring the neurons into a high conductance state. Since the jcBNST integrates excitatory inputs from the basolateral amygdala (BLA and cortical inputs from the infralimbic and the insular cortices and in turn is believed to contribute to the inhibitory input to the central nucleus of the amygdala (CeA the reduced excitability of the jcBNST during protracted withdrawal in alcohol-dependent animals will likely affect ability of the jcBNST to shape the activity and output of the CeA.

  19. Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome

    Directory of Open Access Journals (Sweden)

    Vikram K Reddy

    2014-01-01

    Full Text Available Objectives: Benzodiazepines (BZDs are the first-line drugs in alcohol-withdrawal syndrome (AWS. Baclofen, a gamma-aminobutyric acid B (GABA B agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS. Materials and Methods : This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (CEA of baclofen and chlordiazepoxide in 60 participants with uncomplicated AWS. Clinical efficacy was measured by the Clinical Institute Withdrawal Assessment for alcohol (CIWA-Ar scores. Lorazepam was used as supplement medication if withdrawal symptoms could not be controlled effectively by the study drugs alone. Both direct and indirect medical costs were considered and the CEA was analyzed in both patient′s perspective and third-party perspective. Results : The average cost-effectiveness ratio (ACER in patient′s perspective of baclofen and chlordiazepoxide was Rs. 5,308.61 and Rs. 2,951.95 per symptom-free day, respectively. The ACER in third-party perspective of baclofen and chlordiazepoxide was Rs. 895.01 and Rs. 476.29 per symptom-free day, respectively. Participants on chlordiazepoxide had more number of symptom-free days when compared with the baclofen group on analysis by Mann-Whitney test (U = 253.50, P = 0.03. Conclusion : Both study drugs provided relief of withdrawal symptoms. Chlordiazepoxide was more cost-effective than baclofen. Baclofen was relatively less effective and more expensive than chlordiazepoxide.

  20. Psychiatric complications of alcoholism: alcohol withdrawal syndrome and other psychiatric disorders

    OpenAIRE

    Cláudia Maciel; Florence Kerr-Corrêa

    2004-01-01

    A síndrome de abstinência alcoólica é um quadro agudo, caracterizado por um conjunto de sinais e sintomas autolimitados, com gravidade variada, secundário à interrupção total ou parcial do consumo de álcool, podendo ser associado a inúmeros problemas clínicos e/ou outros transtornos psiquiátricos. O objetivo deste artigo é rever as principais complicações psiquiátricas secundárias à síndrome de abstinência alcoólica, como convulsões e delirium tremens, bem como algumas outras condições psiqui...

  1. Comparison of enteral ethanol and benzodiazepines for alcohol withdrawal in neurocritical care patients.

    Science.gov (United States)

    Gipson, Gregory; Tran, Kim; Hoang, Cuong; Treggiari, Miriam

    2016-09-01

    We designed a study to evaluate the use of benzodiazepines and ethanol in patients being assessed for alcohol withdrawal and compare outcomes between the two agents. This is a retrospective chart review of patients admitted to neurocritical care or neurosurgical services who were at risk for ethanol withdrawal between June 2011 and September 2015. Patients were divided into two groups based on the first medication administered for alcohol withdrawal management, either benzodiazepine (n=50) or enteral ethanol (n=50). The primary endpoint was the maximum change in Clinical Institute Withdrawal Assessment of Alcohol scale (CIWA) score within the first 24hours. Secondary endpoints included maximum and minimum CIWA score in 5days, length of stay, and change in Glasgow Coma Scale. Study groups differed by mortality risk, level of coma at admission, and other clinical characteristics, with the ethanol group appearing less severely ill. There was no significant difference between the two groups in the maximum change in CIWA score at 24hours (-0.97, 95%CI: -3.21 to 1.27, p=0.39). Hospital and intensive care unit length of stay was 6.5 days and 1 day shorter for the ethanol group (p=0.03 and p=0.02, respectively). In summary, enteral ethanol was preferentially used in patients who are more likely to be capable of tolerating oral intake. We found that the change from baseline in CIWA score or other physiologic variables was not substantially different between the two agents. The overall utility of benzodiazepines and enteral ethanol remains unclear for this population and further study is needed to determine superiority.

  2. Efficacy of a combination of flumazenil and gabapentin in the treatment of alcohol dependence: relationship to alcohol withdrawal symptoms.

    Science.gov (United States)

    Anton, Raymond F; Myrick, Hugh; Baros, Alicia M; Latham, Patricia K; Randall, Patrick K; Wright, Tara M; Stewart, Scott H; Waid, Randy; Malcolm, Robert

    2009-08-01

    Improved treatment of alcohol dependence is a high priority, including defining subtypes that might respond differently. We evaluated a medication combination of intravenous flumazenil (FMZ) and oral gabapentin (GBP) in alcoholics who did and did not exhibit pretreatment alcohol withdrawal (AW) symptoms. Sixty alcohol-dependent individuals (44 with low AW and 16 with high AW) were randomized to receive FMZ (2 mg of incremental bolus for 20 minutes for 2 consecutive days) and GBP (up to 1200 mg nightly for 39 days) or their inactive placebos. Alcohol withdrawal was measured for the first 2 days, and drinking, sleep parameters, and adverse events were monitored during weekly evaluations, along with behavioral counseling sessions. Percent days abstinent (PDA) during treatment and time to first heavy drinking (TFHD) day were primary outcome variables. There was an interaction between the pretreatment AW status and the medication group on PDA (P = 0.0006) and TFHD (P = 0.06). Those in the high AW group had more PDA and more TFHD if treated with active medications, whereas those in the low AW group had more PDA and more TFHD if treated with placebo. This interaction remained for those totally abstinent (P = 0.03) and was confirmed by percent carbohydrate-deficient transferrin values. In addition, the pattern of response remained up to 8 weeks after treatment. In addition, in those with high AW, greater improvement in AW symptoms was observed in the active medication group compared with the placebo group. These results suggest a differential response to FMZ/GBP treatment, depending on pretreatment AW status that should be taken into account during future treatment trials.

  3. Adrenergic Inhibition with Dexmedetomidine to Treat Stress Cardiomyopathy during Alcohol Withdrawal: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Zachary M. Harris

    2016-01-01

    Full Text Available Stress (Takotsubo cardiomyopathy is a form of reversible left ventricular dysfunction with a heightened risk of ventricular arrhythmia thought to be caused by high circulating catecholamines. We report a case of stress cardiomyopathy that developed during severe alcohol withdrawal successfully treated with dexmedetomidine. The case involves a 53-year-old man with a significant history of alcohol abuse who presented to a teaching hospital with new-onset seizures. His symptoms of acute alcohol withdrawal were initially treated with benzodiazepines, but the patient later developed hypotension, and stress cardiomyopathy was suspected based on ECG and echocardiographic findings. Adjunctive treatment with the alpha-2-adrenergic agonist, dexmedetomidine, was initiated to curtail excessive sympathetic outflow of the withdrawal syndrome, thereby targeting the presumed pathophysiology of the cardiomyopathy. Significant clinical improvement was observed within one day of initiation of dexmedetomidine. These findings are consistent with other reports suggesting that sympathetic dysregulation during alcohol withdrawal produces ideal pathobiology for stress cardiomyopathy and leads to ventricular arrhythmogenicity. Stress cardiomyopathy should be recognized as a complication of alcohol withdrawal that significantly increases cardiac-related mortality. By helping to correct autonomic dysregulation of the withdrawal syndrome, dexmedetomidine may be useful in the treatment of stress-induced cardiomyopathy.

  4. Adrenergic Inhibition with Dexmedetomidine to Treat Stress Cardiomyopathy during Alcohol Withdrawal: A Case Report and Literature Review.

    Science.gov (United States)

    Harris, Zachary M; Alonso, Alvaro; Kennedy, Thomas P

    2016-01-01

    Stress (Takotsubo) cardiomyopathy is a form of reversible left ventricular dysfunction with a heightened risk of ventricular arrhythmia thought to be caused by high circulating catecholamines. We report a case of stress cardiomyopathy that developed during severe alcohol withdrawal successfully treated with dexmedetomidine. The case involves a 53-year-old man with a significant history of alcohol abuse who presented to a teaching hospital with new-onset seizures. His symptoms of acute alcohol withdrawal were initially treated with benzodiazepines, but the patient later developed hypotension, and stress cardiomyopathy was suspected based on ECG and echocardiographic findings. Adjunctive treatment with the alpha-2-adrenergic agonist, dexmedetomidine, was initiated to curtail excessive sympathetic outflow of the withdrawal syndrome, thereby targeting the presumed pathophysiology of the cardiomyopathy. Significant clinical improvement was observed within one day of initiation of dexmedetomidine. These findings are consistent with other reports suggesting that sympathetic dysregulation during alcohol withdrawal produces ideal pathobiology for stress cardiomyopathy and leads to ventricular arrhythmogenicity. Stress cardiomyopathy should be recognized as a complication of alcohol withdrawal that significantly increases cardiac-related mortality. By helping to correct autonomic dysregulation of the withdrawal syndrome, dexmedetomidine may be useful in the treatment of stress-induced cardiomyopathy.

  5. Treatment of acute alcohol withdrawal with gabapentin: results from a controlled two-center trial.

    Science.gov (United States)

    Bonnet, Udo; Banger, Markus; Leweke, F Markus; Specka, Michael; Müller, Bernhard W; Hashemi, Thilo; Nyhuis, Peter W; Kutscher, Sven; Burtscheidt, Wilhelm; Gastpar, Markus

    2003-10-01

    A few case reports and data from animal experiments point to a possible efficacy of gabapentin (GP) in the treatment of alcohol withdrawal syndrome (AWS). Because of ethical considerations, the efficacy of GP in acute AWS was tested in an add-on fashion to clomethiazole (CLO). Given that the symptom-triggered amount of CLO required to limit AWS within the first 24 hours is related to the severity of AWS, we tested this amount of CLO during placebo (P) or GP (400 mg qid) under double blind, randomized conditions. Sixty-one patients (P = 29/GP = 32) suffering from alcohol dependence (ICD-10) and without any other psychiatric condition or psychotropic medication were included. The groups were not significantly different in baseline characteristics (eg, demographic data, severity of AWS). Both ITT and completer analyses revealed no significant differences between the groups considering the primary effectiveness measure: amount of CLO required in the first 24 hours (P = 6.1 +/- 5.4/GP = 6.2 +/- 4.7 capsules). In addition, premature discontinuations (P = 3/GP = 2) and decreases in Mainz Alcohol Withdrawal Scores were not significantly different in the first 48 hours of AWS (secondary effectiveness measures). Tolerability of combined CLO/GP was studied throughout the whole treatment comprising a 5-day lasting reduction part subsequent to the first 48 hours. Throughout the whole 7-day treatment a total of 5 and 2 patients dropped out and 6 and 5 patients reported adverse clinical events in the P and GP groups, respectively. All together, GP (400 mg qid) was no better than P in saving initial consumption of CLO or decreasing initial Mainz Alcohol Withdrawal Scores suggesting that GP was ineffective in the management of acute AWS in this model. The combination of GP and CLO was safe.

  6. Emergence delirium

    DEFF Research Database (Denmark)

    Munk, Louise; Andersen, Lars Peter Holst; Gögenur, Ismail

    2013-01-01

    Emergence delirium (ED) is a well-known phenomenon in the postoperative period. However, the literature concerning this clinical problem is limited. This review evaluates the literature with respect to epidemiology and risk factors. Treatment strategies are discussed. The review concludes...

  7. [Pharmacological therapies for alcohol use disorder in Japan].

    Science.gov (United States)

    Yumoto, Yosuke; Higuchi, Susumu

    2015-09-01

    We reviewed the available pharmacological therapies for alcohol use disorder in Japan. For treatment of withdrawal delirium, therapists prefer to use antipsychotic drugs rather than benzodiazepines, which is different from other countries. Japan does not have any substantial treatment guidelines for withdrawal delirium. Therefore, so treatment strategies matching the environment of each facility need to be formulated. Moreover, current choices for prescribing anti-alcoholic drugs to cope with alcohol craving are limited to drugs such as cyanamide and disulfiram. However, the use of acamprosate has recently begun and a clinical trial for nalmefene is starting soon. We anticipate that these newer pharmacological therapies will contribute to better treatment of alcohol use disorder also in Japan.

  8. Hepatosplenic Gamma/DeltaT-Cell Lymphoma Masquerading as Alcoholic Hepatitis and Methadone Withdrawal

    Directory of Open Access Journals (Sweden)

    H.A. Lopez Morra

    2007-09-01

    Full Text Available Hepatosplenic gamma/delta T-cell lymphoma is a rare neoplasm of mature gamma/delta T-cells with sinusoidal infiltration of spleen, liver, and bone marrow. Patients are predominantly adolescent and young adult males and usually present with marked hepatosplenomegaly. Pancytopenia is another common finding. Despite an initial response to treatment, patients have a median survival of one to two years. In this report, we document a case of alcoholic hepatitis and methadone withdrawal masquerading unsuspected, hepatosplenic gamma/delta T-cell lymphoma with unusual CD20 positivity.

  9. Parameters of ante-mortem delirium

    Directory of Open Access Journals (Sweden)

    Deksnyte, Aušra

    2014-02-01

    Full Text Available Objectives. The aim of this study was to investigate the parameters of ante-mortem delirium of the patients in a closed psychiatric institution and to compare them with the ante-mortem psychopathology of the medical patients. Methods. There were 139 medical records of the patients analyzed, who died during the period of 1997-2003 at the in-patient psychiatric institution. The diagnoses were recorded according to the International Classification of Diseases, 10th Revision (ICD-10 criteria. Patients’ data included age, gender, previous psychiatric disorders, current somatic and psychiatric morbidity, and comorbidity. Results. The incidence of delirium was 83,7%. The delirium group included more elder, male persons who were more likely to have dementia and less inclined to depression. Surprisingly the incidence of delirium among non-dementia men was quite high – 76,9%, as compared to non-dementia women – 23,1% (P=0,008. The duration of delirium differed from 1 to 1335 days. Longer delirium was observed among elder than 75 years (87,7, SD 183,9 vs52,6, SD 121,4 days; P=0,019 and dementia (83,6, SD 173,6 vs 13,5, SD 11,6 days; P<0,001 patients, but did not differ in gender groups. Conclusions. Ante-mortem delirium occurred more commonly in more elder and demented patients The duration of ante-mortem delirium was shorter in younger and non-dementia patients. Patients of the psychiatric institution tend to have longer deliriums than medical patients. The patients with depression and the history of alcohol abuse were not likely to get ante-mortem delirium. Before death in many persons hyperactive and mixed delirium transformed into hypoactive.

  10. The polymorphism GABABR1 T1974C[rs29230] of the GABAB receptor gene is not associated with the diagnosis of alcoholism or alcohol withdrawal seizures.

    Science.gov (United States)

    Köhnke, Michael; Schick, Sandra; Lutz, Ulrich; Köhnke, Annette; Vonthein, Reinhard; Kolb, Werner; Batra, Anil

    2006-06-01

    As the inhibitory neurotransmitter gamma aminobutyric acid (GABA) modulates ethanol consumption, alcohol withdrawal symptoms and seizure generation by interacting with the GABAB receptor, the genes encoding for the GABAB receptor can be considered as candidate genes for alcoholism and alcohol withdrawal seizures (AWS). As the polymorphism GABABR1 T1974C[rs29230] of the GABAB receptor gene had been associated with alcoholism and EEG abnormalities in prior studies, the present examination investigated if the polymorphism is associated with the diagnosis of alcoholism or AWS. After genotyping the allele and genotype frequencies of a group of alcoholics with a history of AWS (n = 69) were compared with the results of a group of alcoholics with only mild withdrawal symptoms (n = 97). Additionally a group of healthy controls (n = 101) was compared with individuals with the diagnosis of alcoholism (n = 220). As no significant differences were found between the compared groups, this study gave no further evidence for GABABR1 T1974C[rs29230] as a candidate for alcoholism or AWS.

  11. What to Ask: Delirium

    Science.gov (United States)

    ... Join our e-newsletter! Resources What to Ask: Delirium Tools and Tips Under recognition of delirium is a major problem. It is important to ... questions you can ask your healthcare professional about delirium. What is delirium? What are its symptoms? How ...

  12. Clinical applications of sodium oxybate (GHB): from narcolepsy to alcohol withdrawal syndrome.

    Science.gov (United States)

    Busardò, F P; Kyriakou, C; Napoletano, S; Marinelli, E; Zaami, S

    2015-12-01

    Gamma-hydroxybutyrate (GHB) is a short chain fatty acid endogenously produced within the central nervous system (CNS) and acts as a precursor and metabolite of the inhibitory neurotransmitter γ-aminobutyric acid (GABA). Although, it is an illegal recreational drug of abuse, its sodium salt (sodium oxybate) has been utilized as a medication for a number of medical conditions. The first aim of this review was to focus on current applications of sodium oxybate for the treatment of narcolepsy, with a particular emphasis on the key symptoms of this disorder: cataplexy and excessive daytime sleepiness (EDS). Secondly, the effectiveness of sodium oxybate therapy for the treatment of alcohol withdrawal syndrome (AWS) and the maintenance of alcohol abstinence has been assessed. Nowadays, sodium oxybate is the first-line treatment for narcolepsy and it is highly effective in meliorating sleep architecture, decreasing EDS and the frequency of cataplexy attacks in narcoleptic patients. Sodium oxybate currently finds also application in the treatment of AWS and the maintenance of alcohol abstinence in alcoholics. Most of the studies evaluating the efficacy of GHB in the treatment of AWS use a dosage of 50 mg/kg divided in three or four administrations per day. Human studies showed that GHB (dose of 50 mg/kg, divided in three administrations per day) is capable to increase the number of abstinent days, reduce alcohol craving and decrease the number of drinks per day. However, there is limited randomized evidence and, thus, GHB cannot be reliably compared to clomethiazole or benzodiazepines. Some randomized data suggest that GHB is better than naltrexone and disulfiram regarding abstinence maintenance and prevention of craving in the medium term i.e. 3-12 months. It is recommended that GHB should be used only under strict medical supervision, since concerns about the abuse/misuse of the drug and the addiction potential have been arisen.

  13. Effect of variations in treatment regimen and liver cirrhosis on exposure to benzodiazepines during treatment of alcohol withdrawal syndrome

    OpenAIRE

    Gershkovich, Pavel; Wasan, Kishor M.; Ribeyre, Charles; Ibrahim, Fady; McNeill, John H

    2015-01-01

    Purpose: Benzodiazepines (BDZs) are the drugs of choice to prevent the symptoms of alcohol withdrawal syndrome (AWS). Various treatment protocols are published and have been shown to be effective in both office-managed and facility-managed treatment of AWS. The aim of this scientific commentary is to demonstrate the differences in the expected exposure to BDZs during AWS treatment using different treatment regimens available in the literature, in patients with or without alcoholic liver cirrh...

  14. Pharmacological activation/inhibition of the cannabinoid system affects alcohol withdrawal-induced neuronal hypersensitivity to excitotoxic insults.

    Directory of Open Access Journals (Sweden)

    Marina Rubio

    Full Text Available Cessation of chronic ethanol consumption can increase the sensitivity of the brain to excitotoxic damages. Cannabinoids have been proposed as neuroprotectants in different models of neuronal injury, but their effect have never been investigated in a context of excitotoxicity after alcohol cessation. Here we examined the effects of the pharmacological activation/inhibition of the endocannabinoid system in an in vitro model of chronic ethanol exposure and withdrawal followed by an excitotoxic challenge. Ethanol withdrawal increased N-methyl-D-aspartate (NMDA-evoked neuronal death, probably by altering the ratio between GluN2A and GluN2B NMDA receptor subunits. The stimulation of the endocannabinoid system with the cannabinoid agonist HU-210 decreased NMDA-induced neuronal death exclusively in ethanol-withdrawn neurons. This neuroprotection could be explained by a decrease in NMDA-stimulated calcium influx after the administration of HU-210, found exclusively in ethanol-withdrawn neurons. By contrast, the inhibition of the cannabinoid system with the CB1 receptor antagonist rimonabant (SR141716 during ethanol withdrawal increased death of ethanol-withdrawn neurons without any modification of NMDA-stimulated calcium influx. Moreover, chronic administration of rimonabant increased NMDA-stimulated toxicity not only in withdrawn neurons, but also in control neurons. In summary, we show for the first time that the stimulation of the endocannabinoid system is protective against the hyperexcitability developed during alcohol withdrawal. By contrast, the blockade of the endocannabinoid system is highly counterproductive during alcohol withdrawal.

  15. 食管癌术后酒精戒断综合征的防治%Prevention and Treatment of Alcohol Withdrawal Syndrome after Esophageal Cancer Surgery

    Institute of Scientific and Technical Information of China (English)

    薛杨; 罗澍; 孙小康; 赵长明; 郭向东

    2012-01-01

    Objective To investigate the causes, prevention and treatment of alcohol withdrawal syndrome after esophageal cancer surgery. Methods From January 2000 to October 2011, 935 surgeries for esophageal cancer were performed, among which 16 patients had postoperative complications of alcohol withdrawal syndrome. All the 16 patients were male, aged between 41 to 67 years old, averaging at 54. Drinking histories ranged from 16 to 47 years with an average of 27.8 years. Daily liquor quantity ranged from 250 to 1 000 g, and the alcohol content was from 162 to 590 g, averaging 321.5 g. All patients were in accordance with the diagnosis standard of alcohol withdrawal syndrome in the Chinese Spirit Disease Classification and Diagnosis Standard Third Edition (CCMD-3). In addition to conventional treatment, based on the delirium, irritability, mental disorders, and coma of the patients, we administered B vitamins, naloxone, haloperidol, chlorpromazine, and diazepam to promote brain cell metabolism and energy of the patients, and when necessary, endotracheal intubation for assisted mechanical ventilation was used after sedation. Results The withdrawal symptoms totally disappeared after treatment. The treatment time varied from 2 to 10 days with an average of 3.5 days. Thirteen patients were followed up with a time period from 4 to 18 months. All of them achieved abstinence from alcohol. One patient died from acute myocardial infarction eight months after surgery. All the other twelve patients recovered well with complete abstinence from alcohol and no recurrence of withdrawal symptoms. Conclusions Reasonable and effective perioperative treatment can significantly lower the incidence of alcohol withdrawal syndrome. Detailed history of the patients, preoperative and postoperative active prevention and timely and effective treatment are the key to healing%目的 探讨食管癌术后酒精戒断综合征的原因及有效预防治疗措施.方法 2000年1月-2011年10

  16. Chronic alcohol consumption leads to neurochemical changes in the nucleus accumbens that are not fully reversed by withdrawal.

    Science.gov (United States)

    Pereira, Pedro A; Neves, João; Vilela, Manuel; Sousa, Sérgio; Cruz, Catarina; Madeira, M Dulce

    2014-01-01

    Neuropeptide Y (NPY)- and acetylcholine-containing interneurons of the nucleus accumbens (NAc) seem to play a major role in the rewarding effects of alcohol. This study investigated the relationship between chronic alcohol consumption and subsequent withdrawal and the expression of NPY and acetylcholine in the NAc, and the possible involvement of nerve growth factor (NGF) in mediating the effects of ethanol. Rats ingesting an aqueous ethanol solution over 6months and rats subsequently deprived from ethanol during 2months were used to estimate the total number and the somatic volume of NPY and cholinergic interneurons, and the numerical density of cholinergic varicosities in the NAc. The tissue content of choline acetyltransferase (ChAT) and catecholamines were also determined. The number of NPY interneurons increased during alcohol ingestion and returned to control values after withdrawal. Conversely, the number and the size of cholinergic interneurons, and the amount of ChAT were unchanged in ethanol-treated and withdrawn rats, but the density of cholinergic varicosities was reduced by 50% during alcohol consumption and by 64% after withdrawal. The concentrations of dopamine and norepinephrine were unchanged both during alcohol consumption and after withdrawal. The administration of NGF to withdrawn rats significantly increased the number of NPY-immunoreactive neurons, the size of cholinergic neurons and the density of cholinergic varicosities. Present data show that chronic alcohol consumption leads to long-lasting neuroadaptive changes of the cholinergic innervation of the NAc and suggest that the cholinergic system is a potential target for the development of therapeutic strategies in alcoholism and abstinence.

  17. A Systems Approach Implicates a Brain Mitochondrial Oxidative Homeostasis Co-expression Network in Genetic Vulnerability to Alcohol Withdrawal

    Science.gov (United States)

    Walter, Nicole A. R.; Denmark, DeAunne L.; Kozell, Laura B.; Buck, Kari J.

    2017-01-01

    Genetic factors significantly affect vulnerability to alcohol dependence (alcoholism). We previously identified quantitative trait loci on distal mouse chromosome 1 with large effects on predisposition to alcohol physiological dependence and associated withdrawal following both chronic and acute alcohol exposure in mice (Alcdp1 and Alcw1, respectively). We fine-mapped these loci to a 1.1–1.7 Mb interval syntenic with human 1q23.2-23.3. Alcw1/Alcdp1 interval genes show remarkable genetic variation among mice derived from the C57BL/6J and DBA/2J strains, the two most widely studied genetic animal models for alcohol-related traits. Here, we report the creation of a novel recombinant Alcw1/Alcdp1 congenic model (R2) in which the Alcw1/Alcdp1 interval from a donor C57BL/6J strain is introgressed onto a uniform, inbred DBA/2J genetic background. As expected, R2 mice demonstrate significantly less severe alcohol withdrawal compared to wild-type littermates. Additionally, comparing R2 and background strain animals, as well as reciprocal congenic (R8) and appropriate background strain animals, we assessed Alcw1/Alcdp1 dependent brain gene expression using microarray and quantitative PCR analyses. To our knowledge this includes the first Weighted Gene Co-expression Network Analysis using reciprocal congenic models. Importantly, this allows detection of co-expression patterns limited to one or common to both genetic backgrounds with high or low predisposition to alcohol withdrawal severity. The gene expression patterns (modules) in common contain genes related to oxidative phosphorylation, building upon human and animal model studies that implicate involvement of oxidative phosphorylation in alcohol use disorders (AUDs). Finally, we demonstrate that administration of N-acetylcysteine, an FDA-approved antioxidant, significantly reduces symptoms of alcohol withdrawal (convulsions) in mice, thus validating a phenotypic role for this network. Taken together, these studies

  18. The associations between self-consciousness, depressive state and craving to drink among alcohol dependent patients undergoing protracted withdrawal.

    Directory of Open Access Journals (Sweden)

    Philippe de Timary

    Full Text Available CONTEXT: In order to understand how certain personality traits influence the relation between depression symptoms and craving for alcohol, trait self-consciousness (trait SC was examined during a withdrawal and detoxification program. METHODS: Craving (Obsessive and Compulsive Drinking Scale, depressive state (Beck Depression Inventory and trait SC (Revised Self-Consciousness Scale were assessed in alcohol-dependent inpatients (DSM-IV, N = 30 both at the beginning (T1: day 1 or 2 and at the end (T2: day 14 to18 of protracted withdrawal during rehabilitation. RESULTS: A significant decrease in craving and depressive symptoms was observed from T1 to T2, while SC scores remained stable. At both times, strong positive correlations were observed between craving and depression. Moreover, regression analyses indicated that trait SC significantly moderated the impact of depression on cravings for alcohol. LIMITATIONS: This study was performed on a relatively small sample size. Administration of medications during detoxification treatment can also be a confounding factor. Finally, craving could have been evaluated through other types of measurements. CONCLUSIONS: During protracted withdrawal, alcohol craving decreased with the same magnitude as depressive mood. Depressive symptoms were related to alcohol craving but only among patients with high trait SC scores. Our results suggest that metacognitive approaches targeting SC could decrease craving and, in turn, prevent future relapses.

  19. Neurophysiology of delirium

    NARCIS (Netherlands)

    van der Kooi, A.W.

    2014-01-01

    The objective of this thesis was to characterize the neurophysiology of delirium and to assess whether alterations in the neurophysiology of delirium, could provide opportunities for delirium detection. In the first part of the thesis, it is shown that by the analysis of the electroencephalogram (EE

  20. Complicações psiquiátricas do uso crônico do álcool: síndrome de abstinência e outras doenças psiquiátricas Psychiatric complications of alcoholism: alcohol withdrawal syndrome and other psychiatric disorders

    Directory of Open Access Journals (Sweden)

    Cláudia Maciel

    2004-05-01

    Full Text Available A síndrome de abstinência alcoólica é um quadro agudo, caracterizado por um conjunto de sinais e sintomas autolimitados, com gravidade variada, secundário à interrupção total ou parcial do consumo de álcool, podendo ser associado a inúmeros problemas clínicos e/ou outros transtornos psiquiátricos. O objetivo deste artigo é rever as principais complicações psiquiátricas secundárias à síndrome de abstinência alcoólica, como convulsões e delirium tremens, bem como algumas outras condições psiquiátricas associadas à dependência de álcool, como as síndromes de Wernicke Korsakoff e de Marchiava Bignami. Pretende-se, com isso, auxiliar no diagnóstico precoce e tratamento adequado, minimizando assim a morbidade e a mortalidade associadas a tais complicações.Alcohol withdrawal syndrome is an acute condition secondary to total or partial reduction of alcohol consumption, characterized by self limited signs and symptoms and different degrees of severity. It can be complicated by several clinical and/or other psychiatric related problems. The objective of this article is to review the most important psychiatric complications to alcohol withdrawal syndrome as well as other psychiatric disorders associated with alcohol dependence as Wernicke Korsakoff and Marchiava Bignami syndromes. We aim to promote early diagnosis and treatment of these conditions, minimizing morbidity and mortality associated with them.

  1. Effect of topiramate on partial excitatory amino acids in hippocampal dentate gyrus of rats after alcohol withdrawal

    Institute of Scientific and Technical Information of China (English)

    Qinghua Yang; Guang Wu; Haiying Jiang; Yuanzhe Jin; Songbiao Cui

    2006-01-01

    BACKGROUND: Many researches have indicated that the imbalances of various amino acid transmitters and neurotransmitters in brain are involved in the formation of alcohol withdrawal, especially that glutamic acid is one of the important transmitters for alcohol tolerance in central nervous system.OBJECTIVE: To observe the changes of excitatory amino acids in hippocampal dentate gyrus in rats with long-term alcohol drinking after withdrawal under consciousness, and investigate the therapeutic effect of topiramate on alcohol withdrawal.DESIGN: A randomized control animal experiment.SETTING: Department of Neurology, Affiliated Hospital of Yanbian University.MATERIALS: Thirty male Wistar rats of 4 months old, weighing 300-350 g, were purchased from the Experimental Animal Department, Medical College of Yanbian University. Topiramate was produced by Swish Cilag Company, and the batch number was 02CS063.METHODS: The experiments were carried out in the Department of Physiology, Medical College of Yanbian University from August 2005 to February 2006. ① The rats were divided randomly into three groups: control group (n=10), alcohol group (n=10) and topiramate-treated group (n=10). Rats in the alcohol group and topiramate-treated group were given intragastric perfusion of 500 g/L alcohol (10 mL/kg), once a day for 4 weeks successively, and then those in the topiramate-treated group were treated with 80 mg/kg topiramate at 24 hours after the last perfusion of alcohol, once a day for 3 days successively. Rats in the control group were intragastricly given isovolume saline. ② The withdrawal symptoms were assessed at 6, 30, 48 and 72 hours after the last perfusion of alcohol by using the withdrawal rating scale set by Erden et al,which had four observational indexes of stereotyped behaviors, agitation, tail stiffness and abnormal posture,each index was scored by 5 points, the higher the score, the more obvious the symptoms. ③ The contents of aspartic acid and glutamic acid

  2. Dexmedetomidine for the treatment of alcohol withdrawal syndrome: rationale and current status of research.

    Science.gov (United States)

    Muzyk, Andrew J; Kerns, Suzanne; Brudney, Scott; Gagliardi, Jane P

    2013-11-01

    Dexmedetomidine is currently used in the US in the treatment of alcohol withdrawal syndrome (AWS) in the intensive care unit (ICU) setting, although data to support this practice are limited. Dexmedetomidine targets the noradrenergic system, an important but frequently overlooked secondary mechanism in the development of AWS, and, in doing so, may reduce the need for excessive benzodiazepine use which can increase the risk of γ-aminobutyric acid (GABA)-mediated deliriogenesis and respiratory depression. The purpose of this narrative review is to evaluate available literature reporting on the safety and efficacy of dexmedetomidine for AWS in the ICU setting. An English-language MEDLINE search (1966 to July 2013) was performed to identify articles evaluating the efficacy and safety of dexmedetomidine for AWS. Case series, case reports and controlled trials were evaluated for topic relevance and clinical applicability. Reference lists of articles retrieved through this search were reviewed to identify any relevant publications. Studies focusing on the safety and efficacy of dexmedetomidine for AWS in humans were selected. Studies were included if they were published as full articles; abstracts alone were not included in this review. Eight published case studies and case series were identified. Based on a limited body of evidence, dexmedetomidine shows promise as a potentially safe and possibly effective adjuvant treatment for AWS in the ICU. Prospective, well-controlled studies are needed to confirm the safety and efficacy of the use of dexmedetomidine in AWS.

  3. Alcohol abuse and related disorders treatment of alcohol dependence

    Directory of Open Access Journals (Sweden)

    Yu. P. Sivolap

    2014-01-01

    Full Text Available Alcohol abuse and alcoholism are the leading causes of worse health and increased mortality rates. Excessive alcohol consumption is the third leading cause of the global burden of diseases and a leading factor for lower lifespan and higher mortality. Alcohol abuse decreases working capacity and efficiency and requires the increased cost of the treatment of alcohol-induced disorders, which entails serious economic losses. The unfavorable medical and social consequences of excessive alcohol use determine the importance of effective treatment for alcoholism. The goals of rational pharmacotherapy of alcohol dependence are to enhance GABA neurotransmission, to suppress glutamate neurotransmission, to act on serotonin neurotransmission, to correct water-electrolyte balance, and to compensate for thiamine deficiency. Alcoholism treatment consists of two steps: 1 the prevention and treatment of alcohol withdrawal syndrome and its complications (withdrawal convulsions and delirium alcoholicum; 2 antirecurrent (maintenance therapy. Benzodiazepines are the drugs of choice in alleviating alcohol withdrawal and preventing its convulsive attacks and delirium alcoholicum. Diazepam and chlordiazepoxide are most commonly used for this purpose; the safer drugs oxazepam and lorazepam are given to the elderly and patients with severe liver lesions. Anticonvulsants having normothymic properties, such as carbamazepine, valproic acid, topiramate, and lamotrigine, are a definite alternative to benzodiazepines. The traditional Russian clinical practice (clearance detoxification has not a scientific base or significant impact on alcohol withdrawal-related states in addicts. Relapse prevention and maintenance therapy for alcohol dependence are performed using disulfiram, acamprosate, and naltrexone; since 2013 the European Union member countries have been using, besides these agents, nalmefene that is being registered in Russia. Memantine and a number of other

  4. 酒精戒断综合征患者综合护理干预的对照研究%Control study of comprehensive nursing intervention in patients with alcohol withdrawal syndrome

    Institute of Scientific and Technical Information of China (English)

    赵桂霞; 梁先锋; 张振文; 陈启辉; 黄丽秀

    2008-01-01

    目的 探讨临床综合护理干预对酒精戒断综合征患者的临床疗效.方法 将60例酒精戒断性震颤谵妄患者随机分成综合护理干预组(研究组)和一般护理干预组(对照组),每组各30例.研究组在药物治疗的基础上配合一般性护理、心理护理、认知行为矫正、健康教育等措施;对照组只在药物治疗的基础上给予一般性护理措施.采用酒精戒断综合征评定量表、抑郁自评量表(SDS)、焦虑自评量表(SAS)、临床疗效总评量表(CGI)评定其疗效.结果 研究组戒断综合征评定量表和临床疗效总评量表(CGI)在治疗后第14天评分分别为(2.56±0.70),(3.10±0.20)分,对照组为(8.56±1.05),(4.10±0.20)分;抑郁自评量表(SDS)、焦虑自评量表(SAS)第14天的评分与对照组相比,均有统计学意义(P<0.01).结论 在药物治疗的基础上合并综合护理干预措施有助于提高酒精戒断综合征患者的疗效,巩固其康复效果.%Objective To explore the clinical efficacy of comprehensive nursing intervention on patients with alcohol withdrawal syndrome in clinic. Methods 60 cases of alcohol withdrawal delirium tremors were randomly divided into the integrated nursing intervention group (the research group) and the general nursing intervention group (the control group), with 30 cases in each group. On the basis of drug therapy, the general care, psychological care, cognitive behavior modification, health education and other measures were adopted in the research group. Only the general nursing measure was given in the control group on the basis of drug therapy. The efficacy was assessed using the alcohol withdrawal syndrome scale, self-rating depression scale (SDS), self-rating anxiety scale (SAS), and clinical global impression (CGI). Results The scores of the alcohol withdrawal syndrome scale and clinical global impression (CGI) in the 14th day in the research group were(2.56±0.70) and (3.10±0.20), respectively, which were

  5. [Respiratory depression in delirium tremens patients treated with phenobarbital. A retrospective study

    DEFF Research Database (Denmark)

    Lutzen, L.; Poulsen, L.M.; Ulrichsen, J.

    2008-01-01

    cases occurred in the same patient at two different admissions. It was not considered necessary to move the patient to the Intensive Care Unit (ICU). Three patients developed pneumonia and were moved to the ICU, one of whom developed a life-threatening sepsis. One patient with chronic emphysema died due...... in DT patients treated with phenobarbital. MATERIALS AND METHODS: We examined the medical records of patients who were treated as inpatients in 1998-2006 and discharged with the ICD-10 diagnoses F10.4 (alcohol withdrawal delirium) or F10.5 (alcohol induced psychotic disorder). Patients with pre....... An intensive focus on the patient's somatic condition in DT is therefore recommended, and it should always be possible to move the patient to the ICU Udgivelsesdato: 2008/6/2...

  6. DELIRIUM PADA PASIEN RAWAT INAP DENGAN SKIZOFRENIA: SEBUAH LAPORAN KASUS

    Directory of Open Access Journals (Sweden)

    Made Ayu Dwi Pradnyawati

    2014-08-01

    Full Text Available Delirium is psychiatric disorder characterized by conciousness state impairment,disorientation, and affective alteration, including cognitive and non-cognitive deficite, anddeveloped in acute onset. Delirium stand in organic mental disorder group, which has manysimilarity of signs and symptoms with psycotic mental disorder as schizophrenia. Delirium,particularly that is not related with alcohol and drug abuse, frequently found in elderly. Somecases of delirium among inpatient psychiatric patients have been reported, but just few furtherstudies have been held on those cases. This case report try to deliver a case of delirium in a65 y.o. inpatient paranoid type schizophrenia. This patient showed sign of severedisorientation during his treatment. In psychiatric assesment, stated male patient withinappropriate appearance, contact avoidance, decrease of conciousness, and severedisorientation. Mood/affect found irritable/appropriate. Patient experienced delution andhallucination. He suspected with undetected dementia as underlying disease.  

  7. 酒精所致震颤谵妄患者血液相关指标的对照研究%The measurement of blood related indexes in the patients with delirium tremens due to alcohol dependence

    Institute of Scientific and Technical Information of China (English)

    庞良俊; 尹良爽; 朱春燕; 董文文; 戴兢; 王晓玲

    2012-01-01

    Objective: To investigate the blood related indexes in the patients with delirium tremens dueto alcohol dependence and explore the high risk factors for delirium tremens. Method; 142 male inpatients with alcohol dependence were divided into two groups ( delirium tremens and non delirium tremens) in terms of delirium tremens occurrence. The blood related indexes were measured and compared between the two groups. Results; Compared non delirium tremens group, delirium tremens group showed higher levels on AST (aspartate aminotransferase) [ (183.53 ± 174. 55 ) U/L vs. (95. 83 ± 118. 38 ) U/L] , GGT ( glutamate transaminase) [(647.26 ±618. 27) U/L vs. (250.48 ±313. 91) U/L] ,CK(creatine kinase) [ (738. 85 ± 1023. 72)U/L vs. (330.59 ±433.42)U/L] and Ca [(2.34 ±0.91) mmol/1 vs. (2.22 ±0. 14)mmol/l] ,and lower levels in HGB (hemoglobin) [ (126.00 ± 17.77)g/l vs. (135.38 ± 17.85)g/l] ,RBC(red blood cell) [ (3.55 ±0.64) x 1012/L vs. (3.93 ±0.60) ×10'2/L],PLT (platelet count) [ (86.41 ±31.56) x 109/L vs. ( 173.78 ±79.44) x 109/L],K[(3.45±0.75)mmol/L vs. (3.88 ±0.55)mmol/L] and Cl [(100.94 ±5.02)mmol/L vs (104.46 ± 6.64)mmol/L]. The above index differences between the two groups were statistically significant (P<0.05 or P < 0.01). Logistic regression analysis indicated that thrombocytopenia and low serum potassium were risk factors fro delirium tremens. Conclusion;The blood related indexes in patients with alcohol dependence to some degree can predict delirium tremens onset.%目的:对酒依赖患者进行血液相关指标的观察与分析,探讨慢性酒精中毒患者发生震颤谵妄(delirium tremens,DT)的高危因素. 方法:对近4年142例首次住院的男性酒依赖住院患者按照是否出现DT分组进行血液相关指标比较. 结果:出现震颤谵妄(DT)的17例酒依赖患者与非震颤谵妄组相比,在谷草转氨酶[(183.53±174.55) U/L;(95.83±118.38) U/L]、谷氨酸转氨酶[(647.26±618.27)U/L; (250.48±313.91) U

  8. [Causes of the people death from drunkenness and alcoholism].

    Science.gov (United States)

    Erokhin, Iu A; Paukov, V S; Kirillov, Iu A

    2012-01-01

    We analyzed causes of 1008 people death, who abused by alcohol. Among them 2 groups were separated out: people died due to drunkenness and due to alcoholism. The structure of the death was similar in the both groups, however depended on alcoholism stages. The major cause of the death in group of drunkenness people was acute heart insufficiency, less commonly--lung pathology, and very rarely--brain vessels pathology and liver cirrhosis. In group of people, who died due to alcoholism, lung pathology was the major cause of these deaths, acute heart insufficiency was occurred less commonly, and very rare brain pathology because of delirium tremens or alcohol withdrawal syndrome, as so liver cirrhosis with complications. Hemorrhagic pancreonecrosis after alcoholic excess was found out in both groups, but it was more often in people, who died due to drunkenness. Obtained results show importance of chronic alcoholism identification as a disease with several stages including drunkenness and alcoholism.

  9. Delirium in Intensive Care Unit. Factors that affect the appearance of delirium and its importance to the patients’ final outcome

    Directory of Open Access Journals (Sweden)

    Olga Kadda

    2012-10-01

    Full Text Available Delirium is a common cause of acute brain dysfunction in patients treated in the Intensive Care Unit (ICU. Aim: The aim of the present study was to investigate the incidence of delirium in the ICU, to establish risk factors for its development and to determine the effect of delirium on patient’s length of the stay and mortality in the ICU.Material and Methods: The sample studied consisted of 122 patients hospitalized in the ICU of a General Hospital in Attica, having completed 48 hours of stay. In order to diagnose delirium the CAM-ICU delirium scale was used. There were recorded the demographic characteristics of the sample studied, the medical history, the type of sedation, the severity of their illness during admission, the complications, the environment and psychological factors. Moreover, the length of stay, morbidity and mortality of patients were recorded. Data analysis was performed with the statistical package SPSS-ver.17.Results: 62% (n=76 of the sample studied were male. The mean age of the sample was 57±18 years. Intubation and mechanical ventilation was applied in 90% (n=110 of the studied population and seductive drugs in 90% (n=110 of the sample. Delirium frequency was 43%. Risk factors, according to the results, seems to be arterial hypertension (p= 0.009, smoking history (p=0.023, alcohol abuse (p=0.005, severity of illness in admission Apache II (p=0.033. The age and length of stay in ICU doesn’t seem to affect delirium development in ICU. Finally, mortality was clearly increased (p=0.001.Conclusions: The increased frequency of delirium in ICU patients requires measures to prevent it. Factors that seem to be related to delirium development are: arterial hypertension, alcohol abuse, smoking, hyperpyrexia and the usage of sedative drugs., Delirium, also, increases mortality in ICU patients.

  10. Functional role of the polymorphic 647 T/C variant of ENT1 (SLC29A1 and its association with alcohol withdrawal seizures.

    Directory of Open Access Journals (Sweden)

    Jeong-Hyun Kim

    Full Text Available BACKGROUND: Adenosine is involved in several neurological and behavioral disorders including alcoholism. In cultured cell and animal studies, type 1 equilibrative nucleoside transporter (ENT1, slc29a1, which regulates adenosine levels, is known to regulate ethanol sensitivity and preference. Interestingly, in humans, the ENT1 (SLC29A1 gene contains a non-synonymous single nucleotide polymorphism (647 T/C; rs45573936 that might be involved in the functional change of ENT1. PRINCIPAL FINDINGS: Our functional analysis showed that prolonged ethanol exposure increased adenosine uptake activity of mutant cells (ENT1-216Thr compared to wild-type (ENT1-216Ile transfected cells, which might result in reduced extracellular adenosine levels. We found that mice lacking ENT1 displayed increased propensity to ethanol withdrawal seizures compared to wild-type littermates. We further investigated a possible association of the 647C variant with alcoholism and the history of alcohol withdrawal seizures in subjects of European ancestry recruited from two independent sites. Analyses of the combined data set showed an association of the 647C variant and alcohol dependence with withdrawal seizures at the nominally significant level. CONCLUSIONS: Together with the functional data, our findings suggest a potential contribution of a genetic variant of ENT1 to the development of alcoholism with increased risk of alcohol withdrawal-induced seizures in humans.

  11. Importance of recognizing and managing delirium in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    XIE Guo-hao; FANG Xiang-ming

    2009-01-01

    @@ Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units (ICU), resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors.

  12. Delirium: the invisible syndrome

    Directory of Open Access Journals (Sweden)

    Paola Gnerre

    2016-06-01

    Full Text Available Delirium is a neuropsychiatric sindrome characterized by acute onset, a fluctuating course, an altered level of consciousness, disturbances in orientation, memory, attention, thinking, perception and behaviour. One third of patients aged 70 or older were admitted to the general medical service of an acute care hospital experience delirium. The development of delirium is associated with worse outcome increased a 10-fold risk for death and a 3- to 5-fold risk for nosocomial complications, prolonged length of stay, and greater need for nursing home placement after discharge. Therefore patients with delirium have higher morbidity and mortality rates, higher re-admission rates, and a greater risk of long term institutionalization care, thereby having a significant impact on both health and social care expenditure. The cost of delirium to the health-care system is then substantial. Despite its clinical importance and health-related costs, it often remains under-recognized and inadequately managed. Recent evidence suggests that a better understanding and knowledge of delirium among health care professionals can lead to early detection, the reduction of modifiable risk factors, and better management of the condition in the acute phase.

  13. Gabapentin-induced delirium and dependence.

    Science.gov (United States)

    Kruszewski, Stefan P; Paczynski, Richard P; Kahn, David A

    2009-07-01

    Gabapentin (Neurontin) is approved by the US Food and Drug Administration for treatment of epilepsy and post-herpetic neuralgia. Despite lack of strong evidence, gabapentin is also often prescribed off-label for psychiatric conditions. The case described here involved a 38-year-old male physician with substance intoxication delirium and psychoactive substance dependence due to high self-administered doses of gabapentin, which had been prescribed at lower doses in combination with buspirone and bupropion for depression and anxiety. This unusual case of gabapentin dependence and abuse involved toxic delirium, intense cravings, and a prolonged post-withdrawal confusional state reminiscent of benzodiazepine withdrawal. Gabapentin is a central nervous system inhibitory agent with likely gamma-aminobutyric acid (GABA)-ergic and non-GABAergic mechanisms of action. The similarity between benzodiazepine withdrawal and what this patient experienced with gabapentin suggests a common role for GABA-related effects. The case reported here suggests the need for heightened concern regarding the off-label prescription of this drug to vulnerable individuals with psychiatric conditions.

  14. The three year course of alcohol use disorders in the general population: DSM-IV, ICD-10 and the Craving Withdrawal Model

    NARCIS (Netherlands)

    C. de Bruijn; W. van den Brink; R. de Graaf; W.A.M. Vollebergh

    2006-01-01

    To determine the course of alcohol use disorders (AUD) in a prospective general population study using three different classification systems: Diagnostic and Statistical Manual version IV (DSM-IV), International Classification of Diseases version 10 (ICD-10) and the craving withdrawal model (CWM). T

  15. Symptom-triggered benzodiazepine therapy for alcohol withdrawal syndrome in the emergency department: a comparison with the standard fixed dose benzodiazepine regimen.

    LENUS (Irish Health Repository)

    Cassidy, Eugene M

    2012-10-01

    The aim of the study was to compare symptom-triggered and standard benzodiazepine regimens for the treatment of alcohol withdrawal syndrome in an emergency department clinical decision unit. The authors found that the symptom-triggered approach reduced cumulative benzodiazepine dose and length of stay.

  16. Level changes of serum indicators in long-term alcohol users before and after alcohol withdrawal%长期饮酒者戒酒前后血清指标检测结果分析

    Institute of Scientific and Technical Information of China (English)

    王小琼; 邹晓静; 郝燕燕

    2012-01-01

    目的 探讨长期问题饮酒患者戒酒前后血清生化指标变化趋势.方法 对53例长期饮酒并成功戒酒的患者戒酒前和戒酒3、6、12周时血清铁蛋白(FER)、糖缺失转铁蛋白(CDT)、转铁蛋白(Tf)、γ-谷氨酰转肽酶(GGT)、丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)水平,并计算CDT在Tf中所占百分比(CDT%).对结果 进行统计学分析.结果 随着患者戒酒时间的延长,血清CDT、CDT%、GGT水平下降(P<0.05).与戒酒前相比,戒酒6周和戒酒12周血清FER水平降低(P<0.05).结论 长期饮酒者血清GGT、CDT、CDT%、FER水平随戒酒时间延长降低,但FER水平下降速度缓慢,GGT水平易受其他因素影响.因此,血清CDT及CDT%水平可以用于问题饮酒患者戒酒情况的长期监控.%Objective To explore the level changes of serum biochemical indicators in long-term alcohol users before and after alcohol withdrawal. Methods Serum levels of ferritin(FER) ,carbohydrate-deficient transferrin(CDT) , transferrin(Tf) ,y-glutamyl transpeptidase(GGT) ,alanine aminotransferase(ALT)and aspartate aminotransferase(AST) were detected in 53 cases of long-term alcohol users before and 3,6 and 12 weeks after alcohol withdrawal. The CDT% level was calculated. And all results were statistically analyzed. Results Serum levels of CDT,CDT% and GGT gradually decreased with the prolonging of alcohol withdrawal(P< 0. 05). Compared with before alcohol withdrawal,serum level of FER decreased 6 weeks after alcohol withdrawal(P<0. 05). Conclusion Serum levels of CDT,CDT% ,GGT and FER could be gradually decreased with the prolonging of alcohol withdrawal, but the rate of decay of FER might be slow and serum level of GGT might be influenced by other factors. Therefore, serum levels of CDT and CDT% could be used for long-term monitoring of alcohol withdrawal in alcohol users.

  17. Effects of chronic alcohol consumption, withdrawal and nerve growth factor on neuropeptide Y expression and cholinergic innervation of the rat dentate hilus.

    Science.gov (United States)

    Pereira, Pedro A; Rocha, João P; Cardoso, Armando; Vilela, Manuel; Sousa, Sérgio; Madeira, M Dulce

    2016-05-01

    Several studies have demonstrated the vulnerability of the hippocampal formation (HF) to chronic alcohol consumption and withdrawal. Among the brain systems that appear to be particularly vulnerable to the effects of these conditions are the neuropeptide Y (NPY)-ergic and the cholinergic systems. Because these two systems seem to closely interact in the HF, we sought to study the effects of chronic alcohol consumption (6months) and subsequent withdrawal (2months) on the expression of NPY and on the cholinergic innervation of the rat dentate hilus. As such, we have estimated the areal density and the somatic volume of NPY-immunoreactive neurons, and the density of the cholinergic varicosities. In addition, because alcohol consumption and withdrawal are associated with impaired nerve growth factor (NGF) trophic support and the administration of exogenous NGF alters the effects of those conditions on various cholinergic markers, we have also estimated the same morphological parameters in withdrawn rats infused intracerebroventricularly with NGF. NPY expression increased after withdrawal and returned to control values after NGF treatment. Conversely, the somatic volume of these neurons did not differ among all groups. On other hand, the expression of vesicular acetylcholine transporter (VAChT) was reduced by 24% in ethanol-treated rats and by 46% in withdrawn rats. The administration of NGF to withdrawn rats increased the VAChT expression to values above control levels. These results show that the effects of prolonged alcohol intake and protracted withdrawal on the hilar NPY expression differ from those induced by shorter exposures to ethanol and by abrupt withdrawal. They also suggest that the normalizing effect of NGF on NPY expression might rely on the NGF-induced improvement of cholinergic neurotransmission in the dentate hilus.

  18. Effect of variations in treatment regimen and liver cirrhosis on exposure to benzodiazepines during treatment of alcohol withdrawal syndrome

    Science.gov (United States)

    Gershkovich, Pavel; Wasan, Kishor M; Ribeyre, Charles; Ibrahim, Fady; McNeill, John H

    2015-01-01

    Purpose: Benzodiazepines (BDZs) are the drugs of choice to prevent the symptoms of alcohol withdrawal syndrome (AWS). Various treatment protocols are published and have been shown to be effective in both office-managed and facility-managed treatment of AWS. The aim of this scientific commentary is to demonstrate the differences in the expected exposure to BDZs during AWS treatment using different treatment regimens available in the literature, in patients with or without alcoholic liver cirrhosis. Methods: Diazepam and lorazepam AWS protocols were examined and reviewed in the literature, and blood plasma levels were examined and compared, respectively. Results: Considerable variation in the blood levels with the different dosing schedules was found. Because the drugs are metabolized differently, we have also shown that liver disease affects the blood levels of diazepam, but not of lorazepam. Conclusions: Differences in treatment regimens, the choice of BDZ, as well as the presence of liver cirrhosis can substantially alter the exposure of patients to drugs used for AWS treatment. Outpatient treatment of AWS has been shown to be relatively safe and effective for the treatment of AWS but patients should be carefully monitored. PMID:26322116

  19. Delirium hos kritisk syge patienter

    DEFF Research Database (Denmark)

    Strøm, Thomas; Pande-Rolfsen, Guri; Hagen, Christine;

    2009-01-01

    Interest in and the quantity of publications on delirium in critically ill patients have grown increasingly over the last decade. Critically ill patients have traditionally been sedated to facilitate mechanical ventilation. This practice impeded the recognition of delirium in the critically ill...... patients, and consequently the disorder was underdiagnosed. Delirium in the critically ill patients is associated with increased morbidity and mortality. Less sedation, guided by protocols with daily wake up trials, and validated delirium scoring systems, have improved the opportunities to diagnose...... and monitor delirium in the critically ill patients. Udgivelsesdato: 2009-Oct-19...

  20. Computerized tomographic study on the brain of patients with alcohol dependence

    Energy Technology Data Exchange (ETDEWEB)

    Kato, Akira (Biwako Hospital, Otsu, Shiga (Japan)); Tsuji, Motohiro; Nakamura, Michihiko; Nakajima, Teruo

    1991-03-01

    One hundred ten patients with alcohol dependence and 56 psychiatric patients with either senile dementia, amphetamine psychosis, epilepsy or chronic schizophrenia were investigated with a CT scan of the brain. The maximum width of the 3rd ventricle was measured, and the presence/absence of enlargement of the lateral ventricle and of atrophy of the frontal lobe was determined independently by 3 physicians. The width of the 3rd ventricle in alcoholic and the other patients examined was gradually enlarged with aging, and the width in these patients was significantly larger than that in the age-matched control patients who were selected from the patients with amphetamine psychosis, epilepsy or schizophrenia. The enlargement of the lateral ventricles observed in the alcoholic patients always accompanied the enlargement of the 3rd ventricle, but not vice versa. The alcoholic patients with frontal lobe atrophy showed a higher incidence of withdrawal delirium than the patients without atrophy. These findings suggest that the chronic intake of alcohol might affect primarily the area around the 3rd ventricle, resulting in enlargement of this ventricle and consequential enlargement of the lateral ventricles and also that the alcoholic patients with frontal lobe atrophy could have a high risk for a manifestation of alcoholic withdrawal delirium. (author).

  1. STUDY ON ALCOHOL AND ITS NEUROLOGICAL COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    Akumnaro Jamir

    2016-07-01

    Full Text Available BACKGROUND Alcoholism is characterised by alcohol tolerance, signs and symptoms of withdrawal and continued use in spite of insidious physical or psychological consequences. Chronic alcohol abuse causes several distinct diseases affecting many organs; however, the alcohol affecting the brain is the most significant factor for maintaining this alcohol abuse. The neurological complications of alcoholism include both the peripheral and the central nervous system like the alcohol withdrawal syndrome which includes alcohol withdrawal seizures, delirium tremens, alcohol hallucinosis. The other neurological complications are the alcoholic peripheral neuropathy, alcoholic myopathy, Wernicke encephalopathy, combination of Wernicke encephalopathy with Korsakoff ’s psychosis. Not all alcoholics are alike. The degree of impairment differs from individual to individual and the aetiology of a particular disease has different origins for different people. In the current scenario, it is still a subject of active research as to what characteristic features makes certain group of alcoholics more vulnerable to brain damage. MATERIALS AND METHODS The present study was undertaken under the Department of General Medicine, Govt. Stanley Hospital, Chennai. The study consists of 150 patients with history of alcohol intake satisfying the inclusion and exclusion criteria, presenting in medical OPD/wards/ICU, after proper consent were subjected to questionnaires, complete physical examination and relevant laboratory investigations as per proforma. A prospective observational study design was chosen and descriptive statistics was done for all data and suitable statistical tests of comparison for a period of 6 months. RESULTS It was found that alcohol withdrawal seizures and acute hallucinosis were the most common neurological sequelae seen. Acute hallucinosis was more prevalent in younger age group, whereas complications like alcohol polyneuropathy, Wernicke

  2. Influence of Volatile Anesthesia on the Release of Glutamate and other Amino Acids in the Nucleus Accumbens in a Rat Model of Alcohol Withdrawal: A Pilot Study

    Science.gov (United States)

    Seidemann, Thomas; Spies, Claudia; Morgenstern, Rudolf; Wernecke, Klaus-Dieter; Netzhammer, Nicolai

    2017-01-01

    Background Alcohol withdrawal syndrome is a potentially life-threatening condition, which can occur when patients with alcohol use disorders undergo general anesthesia. Excitatory amino acids, such as glutamate, act as neurotransmitters and are known to play a key role in alcohol withdrawal syndrome. To understand this process better, we investigated the influence of isoflurane, sevoflurane, and desflurane anesthesia on the profile of excitatory and inhibitory amino acids in the nucleus accumbens (NAcc) of alcohol-withdrawn rats (AWR). Methods Eighty Wistar rats were randomized into two groups of 40, pair-fed with alcoholic or non-alcoholic nutrition. Nutrition was withdrawn and microdialysis was performed to measure the activity of amino acids in the NAcc. The onset time of the withdrawal syndrome was first determined in an experiment with 20 rats. Sixty rats then received isoflurane, sevoflurane, or desflurane anesthesia for three hours during the withdrawal period, followed by one hour of elimination. Amino acid concentrations were measured using chromatography and results were compared to baseline levels measured prior to induction of anesthesia. Results Glutamate release increased in the alcohol group at five hours after the last alcohol intake (p = 0.002). After 140 min, desflurane anesthesia led to a lower release of glutamate (p < 0.001) and aspartate (p = 0.0007) in AWR compared to controls. GABA release under and after desflurane anesthesia was also significantly lower in AWR than controls (p = 0.023). Over the course of isoflurane anesthesia, arginine release decreased in AWR compared to controls (p < 0.001), and aspartate release increased after induction relative to controls (p20min = 0.015 and p40min = 0.006). However, amino acid levels did not differ between the groups as a result of sevoflurane anesthesia. Conclusions Each of three volatile anesthetics we studied showed different effects on excitatory and inhibitory amino acid concentrations. Under

  3. Severe alcohol withdrawal syndrome: Evolution of care and impact of adjunctive therapy on course and complications of 171 intensive care unit patients.

    Science.gov (United States)

    Puscas, Mircea; Hasoon, Mohammed; Eechevarria, Carlos; Cooper, Tracy; Tamura, Leslie; Chebbo, Ahmad; W Carlson, Richard

    2016-01-01

    This single site retrospective observational study assessed the evolution of sedation therapy for severe alcohol withdrawal syndrome in the intensive care unit. Patient records for 2 intervals were reviewed: Interval 1, which included 87 intensive care unit patients admitted January 2005 through September 2007, for whom benzodiazedpine monotherapy was utilized; and Interval 2, January 2010 through December 2010, for whom 54 of 84 (64.3%) intensive care unit patients, including all those intubated, received adjunctive agents, including dexmedetomidine or propofol. Clinical management was similar for both intervals, as well as prevalence of alcohol withdrawal syndrome versus total adult hospital admissions and comorbid conditions. Overall, respiratory failure (53 versus 39%), seizures (36 versus 18%), and pneumonia (51 versus 38%) were less frequent during Interval 2 (all p care unit admission are excluded, the prevalence of these complications was similar (p = ns) for Interval 1 and Interval 2. Intensive care unit and hospital length of stay were not altered by adjunctive therapy, which was typically employed for more severely affected patients. High intensity sedation with adjunctive drugs led to few cardiovascular adverse events and may have facilitated management, but did not alter intensive care unit course of severe alcohol withdrawal syndrome.

  4. DIFFERENTIAL EFFECTS OF SINGLE VERSUS REPEATED ALCOHOL WITHDRAWAL ON THE EXPRESSION OF ENDOCANNABINOID SYSTEM-RELATED GENES IN THE RAT AMYGDALA

    Science.gov (United States)

    Serrano, Antonia; Rivera, Patricia; Pavon, Francisco J.; Decara, Juan; Suárez, Juan; de Fonseca, Fernando Rodriguez; Parsons, Loren H.

    2011-01-01

    Background Endogenous cannabinoids such as anandamide and 2-arachidonoylglycerol (2-AG) exert important regulatory influences on neuronal signaling, participate in short- and long-term forms of neuroplasticity, and modulate stress responses and affective behavior in part through the modulation of neurotransmission in the amygdala. Alcohol consumption alters brain endocannabinoid levels, and alcohol dependence is associated with dysregulated amygdalar function, stress responsivity and affective control. Methods The consequence of long-term alcohol consumption on the expression of genes related to endocannabinoid signaling was investigated using quantitative RT-PCR analyses of amygdala tissue. Two groups of ethanol-exposed rats were generated by maintenance on an ethanol liquid diet (10%): one group received continuous access to ethanol for 15 days, while the second group was given intermittent access to the ethanol diet (5 days/week for 3 weeks). Control subjects were maintained on an isocaloric ethanol-free liquid diet. To provide an initial profile of acute withdrawal amygdala tissue was harvested following either 6 or 24 hours of ethanol withdrawal. Results Acute ethanol withdrawal was associated with significant changes in mRNA expression for various components of the endogenous cannabinoid system in the amygdala. Specifically, reductions in mRNA expression for the primary clearance routes for anandamide and 2-AG (FAAH and MAGL, respectively) were evident, as were reductions in mRNA expression for CB1, CB2 and GPR55 receptors. Although similar alterations in FAAH mRNA were evident following either continuous or intermittent ethanol exposure, alterations in MAGL and cannabinoid receptor-related mRNA (e.g. CB1, CB2, GPR55) were more pronounced following intermittent exposure. In general, greater withdrawal-associated deficits in mRNA expression were evident following 24 versus 6 hours of withdrawal. No significant changes in mRNA expression for enzymes involved in

  5. Assessing severity of delirium by the Delirium Observation Screening Scale

    NARCIS (Netherlands)

    Scheffer, Alice C.; van Munster, Barbara C.; Schuurmans, Marieke J.; de Rooij, Sophia E.

    2011-01-01

    Objective: Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. Assessment of the severity of delirium is important for adjusting medication. The minimal dose of medication is preferable to prevent side effects. Only few nurse based severity measures are available. Th

  6. Delirium: Issues for Older Adults

    Science.gov (United States)

    ... proper care and improve or maintain quality of life. Delirium is a common occurence that can affect the health and quality of ilfe for older persons. Delirium often occurs with other diseases, such as dementia, stroke, Parkinson's disease, or depression. Alzheimer’s Disease and Other Types ...

  7. Delirium as a complication of the surgical intensive care

    Directory of Open Access Journals (Sweden)

    Horacek R

    2016-09-01

    (hypotension 40.41±30.23 hours versus normotension 70.47±54.98 hours; Mann–Whitney U=1,512; P<0.05, administration of antipsychotics compared to other drugs (antipsychotics 72.83±40.6, benzodiazepines 42.00±20.78, others drugs, mostly piracetam 46.96±18.42 hours; Kruskal–Wallis test: 17.39, P<0.0005, and history of alcohol abuse (with a history of abuse 73.63±45.20 hours, without a history of abuse 59.54±30.61 hours; Mann–Whitney U=1,840; P<0.05. One patient had suffered from complicated postoperative hypostatic pneumonia and died due to respiratory failure (patient with hypoactive subtype. According to the backward stepwise multiple regression, the best significant predictors of duration of the delirium were the hypotension, type of psychopharmacs, type of delirium, the daily dose of opioids, a combination of psychopharmacs, history of alcohol abuse, plasma level of potassium, anemia, hyperpyrexia, and plasma level of albumin, reaching statistical significance (analysis of variance: F=5.205; df=24; P<0.005; adjusted r2=0.637.Conclusion: The hyperactive type of delirium, hypotension, usage of antipsychotics, the higher daily dose of opioids, a combination of psychopharmacs, history of alcohol abuse, low blood levels of potassium, anemia, hyperpyrexia, and hypoalbuminemia in the CICUS were associated with longer duration of delirium.Keywords: delirium, care duration, intensive care, risk factors, treatment, antipsychotics

  8. DELirium Prediction Based on Hospital Information (Delphi) in General Surgery Patients.

    Science.gov (United States)

    Kim, Min Young; Park, Ui Jun; Kim, Hyoung Tae; Cho, Won Hyun

    2016-03-01

    To develop a simple and accurate delirium prediction score that would allow identification of individuals with a high probability of postoperative delirium on the basis of preoperative and immediate postoperative data.Postoperative delirium, although transient, is associated with adverse outcomes after surgery. However, there has been no appropriate tool to predict postoperative delirium.This was a prospective observational single-center study, which consisted of the development of the DELirium Prediction based on Hospital Information (Delphi) score (n = 561) and its validation (n = 533). We collected potential risk factors for postoperative delirium, which were identified by conducting a comprehensive review of the literatures.Age, low physical activity, hearing impairment, heavy alcoholism, history of prior delirium, intensive care unit (ICU) admission, emergency surgery, open surgery, and increased preoperative C-reactive protein were identified as independent predictors of postoperative delirium. The Delphi score was generated using logistic regression coefficients. The maximum Delphi score was 15 and the optimal cut-off point identified with the Youden index was 6.5. Generated area under the (AUC) of the receiver operating characteristic (ROC) curve was 0.911 (95% CI: 0.88-0.94). In the validation study, the calculated AUC of the ROC curve based on the Delphi score was 0.938 (95% Cl: 0.91-0.97). We divided the validation cohort into the low-risk group (Delphi score 0-6) and high-risk group (7-15). Sensitivity of Delphi score was 80.8% and specificity 92.5%.Our proposed Delphi score could help health-care provider to predict the development of delirium and make possible targeted intervention to prevent delirium in high-risk surgery patients.

  9. Identification of a QTL in Mus musculus for alcohol preference, withdrawal, and Ap3m2 expression using integrative functional genomics and precision genetics.

    Science.gov (United States)

    Bubier, Jason A; Jay, Jeremy J; Baker, Christopher L; Bergeson, Susan E; Ohno, Hiroshi; Metten, Pamela; Crabbe, John C; Chesler, Elissa J

    2014-08-01

    Extensive genetic and genomic studies of the relationship between alcohol drinking preference and withdrawal severity have been performed using animal models. Data from multiple such publications and public data resources have been incorporated in the GeneWeaver database with >60,000 gene sets including 285 alcohol withdrawal and preference-related gene sets. Among these are evidence for positional candidates regulating these behaviors in overlapping quantitative trait loci (QTL) mapped in distinct mouse populations. Combinatorial integration of functional genomics experimental results revealed a single QTL positional candidate gene in one of the loci common to both preference and withdrawal. Functional validation studies in Ap3m2 knockout mice confirmed these relationships. Genetic validation involves confirming the existence of segregating polymorphisms that could account for the phenotypic effect. By exploiting recent advances in mouse genotyping, sequence, epigenetics, and phylogeny resources, we confirmed that Ap3m2 resides in an appropriately segregating genomic region. We have demonstrated genetic and alcohol-induced regulation of Ap3m2 expression. Although sequence analysis revealed no polymorphisms in the Ap3m2-coding region that could account for all phenotypic differences, there are several upstream SNPs that could. We have identified one of these to be an H3K4me3 site that exhibits strain differences in methylation. Thus, by making cross-species functional genomics readily computable we identified a common QTL candidate for two related bio-behavioral processes via functional evidence and demonstrate sufficiency of the genetic locus as a source of variation underlying two traits.

  10. DELIRIUM FROM THE GLIOCENTRIC PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Adonis eSfera

    2015-05-01

    Full Text Available Delirium is an acute state marked by disturbances in cognition, attention, memory, perception, and sleep-wake cycle which is common in elderly. Others have shown an association between delirium and increased mortality, length of hospitalization, cost, and discharge to extended stay facilities (1. Until recently it was not known that after an episode of delirium in elderly, there is a 63% probability of developing dementia at 48 months compared to 8% in patients without delirium (2(3. Currently there are no preventive therapies for delirium, thus elucidation of cellular and molecular underpinnings of this condition may lead to the development of early interventions and thus prevent permanent cognitive damage.In this article we make the case for the role of glia in the pathophysiology of delirium and describe an astrocyte-dependent central and peripheral cholinergic anti-inflammatory shield which may be disabled by astrocytic pathology, leading to neuroinflammation and delirium. We also touch on the role of glia in information processing and neuroimaging.

  11. Symptoms and aetiology of delirium: a comparison of elderly and adult patients.

    Science.gov (United States)

    Grover, S; Agarwal, M; Sharma, A; Mattoo, S K; Avasthi, A; Chakrabarti, S; Malhotra, S; Kulhara, P; Bas, D

    2013-06-01

    OBJECTIVE. To compare the symptoms of delirium as assessed by the Delirium Rating Scale-Revised-98 (DRS-R-98) and associated aetiologies in adult and elderly patients seen in a consultation-liaison service. METHODS. A total of 321 consecutive patients with a DSM-IV-TR diagnosis of delirium were assessed on the DRS-R-98 and a study-specific aetiology checklist. RESULTS. Of the 321 patients, 245 (76%) aged 18 to 64 years formed the adult group, while 76 (24%) formed the elderly group (≥ 65 years). The prevalence and severity of various symptoms of delirium as assessed using the DRS-R-98 were similar across the 2 groups, except for the adult group having statistically higher prevalence and severity scores for thought process abnormalities and lability of affect. For both groups and the whole sample, factor analysis yielded a 3-factor model for the phenomenology. In the 2 groups, the DRS-R-98 item loadings showed subtle differences across various factors. The 2 groups were similar for the mean number of aetiologies associated with delirium, the mean number being 3. However, the 2 groups differed with respect to hepatic derangement, substance intoxication, withdrawal, and postpartum causes being more common in the adult group, in contrast lung disease and cardiac abnormalities were more common in the elderly group. CONCLUSION. Adult and elderly patients with delirium are similar with respect to the distribution of various symptoms, motor subtypes, and associated aetiologies.

  12. Val158Met COMT polymorphism and risk of aggression in alcohol dependence.

    Science.gov (United States)

    Soyka, Michael; Zill, Peter; Koller, Gabi; Samochowiec, Agnieszka; Grzywacz, Anna; Preuss, Ulrich W

    2015-01-01

    Aggression, violence and antisocial behavior are common in alcoholism, but their biological basis is poorly understood. Several studies and recent meta-analyses indicate that in schizophrenia the catecholamine-O-methyltransferase (COMT) Val158Met genotype may be associated with aggression, most often in methionine allele carriers. We tested this hypothesis in a sample of treatment-seeking alcohol-dependent in-patients (293 German patients and 499 controls, and additional 190 Polish patients as replication sample). As expected, patients with a history of violent or non-violent crime were more often male, had an earlier onset of alcoholism and more withdrawal seizures and delirium tremens, and were more likely to have a history of suicide attempts. COMT genotype was not associated with a history of violent or non-violent crime. More studies are needed on the neurobiological basis of aggression and violence in alcoholism.

  13. Senile delirium with special reference to situational factors and recurrent delirium.

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    Kuroda,Shigetoshi

    1990-10-01

    Full Text Available Factors initiating senile delirium were examined in 129 elderly inpatients (65 years or older. Sixty-eight patients were males and 61 females, with a mean age of 76.3 years. Delirium developed in most cases on the first two days of admission in the hospital, and the admission appeared to be a key factor precipitating delirium in about 30% of the patients. Delirium resolved or improved in 80% of the patients, but usually persisted in patients with dementia. Senile delirium tended to reappear repeatedly in patients whose episode of delirium lasted for more than 2 weeks, was associated with dementia, or had a prior history of delirium.

  14. Delirium as a complication of the surgical intensive care

    Science.gov (United States)

    Horacek, Rostislav; Krnacova, Barbora; Prasko, Jan; Latalova, Klara

    2016-01-01

    Background The aim of this study was to examine the impact of somatic illnesses, electrolyte imbalance, red blood cell count, hypotension, and antipsychotic and opioid treatment on the duration of delirium in Central Intensive Care Unit for Surgery. Patients and methods Patients who were admitted to the Department of Central Intensive Care Unit for Surgery in the University Hospital Olomouc from February 2004 to November 2008 were evaluated using Riker sedation–agitation scale. Their blood pressure, heart rate, respiratory rate, and peripheral blood oxygen saturation were measured continually, and body temperature was monitored once in an hour. The laboratory blood tests including sodium, potassium, chlorides, phosphorus, urea and creatinine, hemoglobin, hematocrit, red and white blood cell count, and C-reactive protein, albumin levels and laboratory markers of renal and liver dysfunction were done every day. All measurements were made at least for ten consecutive days or longer until the delirium resolved. Results The sample consisted of 140 consecutive delirious patients with a mean age of 68.21±12.07 years. Delirium was diagnosed in 140 of 5,642 patients (2.48%) admitted in CICUS in the last 5 years. The median duration of delirium was 48 hours with a range of 12–240 hours. Statistical analysis showed that hyperactive subtype of delirium and treatment with antipsychotics were associated with prolonged delirium duration (hyperactive 76.15±40.53 hours, hypoactive 54.46±28.44 hours, mixed 61.22±37.86 hours; Kruskal–Wallis test: 8.022; Ppiracetam 46.96±18.42 hours; Kruskal–Wallis test: 17.39, P<0.0005), and history of alcohol abuse (with a history of abuse 73.63±45.20 hours, without a history of abuse 59.54±30.61 hours; Mann–Whitney U=1,840; P<0.05). One patient had suffered from complicated postoperative hypostatic pneumonia and died due to respiratory failure (patient with hypoactive subtype). According to the backward stepwise multiple regression

  15. Alcohol consumption increases locomotion in an open field and induces Fos-immunoreactivity in reward and approach/withdrawal-related neurocircuitries.

    Science.gov (United States)

    Wscieklica, Tatiana; de Barros Viana, Milena; Le Sueur Maluf, Luciana; Pouza, Kathlein Cristiny Peres; Spadari, Regina Célia; Céspedes, Isabel Cristina

    2016-02-01

    Drug addiction is a chronically relapsing disorder characterized by compulsion to seek and take the drug, loss of control in limiting intake and, eventually, the emergence of a negative emotional state when access to the drug is prevented. Both dopamine and corticotropin-releasing factor (CRF)-mediated systems seem to play important roles in the modulation of alcohol abuse and dependence. The present study investigated the effects of alcohol consumption on anxiety and locomotor parameters and on the activation of dopamine and CRF-innervated brain regions. Male Wistar rats were given a choice of two bottles for 31 days, one containing water and the other a solution of saccharin + alcohol. Control animals only received water and a solution of 0.2% saccharin. On the 31st day, animals were tested in the elevated plus-maze and open field, and euthanized immediately after the behavioral tests. An independent group of animals was treated with ethanol and used to measure blood ethanol concentration. Results showed that alcohol intake did not alter behavioral measurements in the plus-maze, but increased the number of crossings in the open field, an index of locomotor activity. Additionally, alcohol intake increased Fos-immunoreactivity (Fos-ir) in the prefrontal cortex, in the shell region of the nucleus accumbens, in the medial and central amygdala, in the bed nucleus of the stria terminalis, in the septal region, and in the paraventricular and dorsomedial hypothalamus, structures that have been linked to reward and to approach/withdrawal behavior. These observations might be relevant to a better understanding of the behavioral and physiological alterations that follow alcohol consumption.

  16. Zolpidem induced delirium

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    Sameeran S Chate

    2013-01-01

    Full Text Available Use of non-benzodiazepine hypnotics like zolpidem for insomnia has become a popular practice because of better safety profile and low abuse potential. However, neuropsychiatric side-effects such as headache, depression, memory deficits and abnormal dreams with zolpidem use have been reported. Delirum is a rare side-effect associated with zolpidem use. Here, we report a case of delirium, which occurred with a single dose of zolpidem. Clinicians prescribing zolpidem for insomnia should look into the risk factors/pre-disposing factors such as old age, female gender, substance abuse/dependence, systemic infections, psychiatric illness and multiple drug interactions. It is recommended to stick to the lowest dose possible whenever indicated.

  17. Post-operative delirium in elderly patients

    OpenAIRE

    Vijayakumar, B.; Elango, P; Ganessan, R

    2014-01-01

    Delirium is a common, but an often underdiagnosed complication in the elderly following major surgery. Recognising delirium in early stages and diagnosing the condition based on established criteria can improve the outcome and management. Managing delirium with environmental, supportive and pharmacological interventions will possibly reduce the incidence and side-effects associated with post-operative delirium. The purpose of this article is to provide an over view of the current knowledge ab...

  18. The genetics of deliria

    NARCIS (Netherlands)

    D. Adamis; B.C. van Munster; A.J.D. Macdonald

    2009-01-01

    Delirium not induced by alcohol or other psychoactive substance and alcohol withdrawal delirium (or delirium tremens) are both cerebral syndromes with similar presentations and are associated with various adverse outcomes. Recently, interest in identifying genetic predisposing factors that influence

  19. Post-operative delirium in elderly patients

    Directory of Open Access Journals (Sweden)

    B Vijayakumar

    2014-01-01

    Full Text Available Delirium is a common, but an often underdiagnosed complication in the elderly following major surgery. Recognising delirium in early stages and diagnosing the condition based on established criteria can improve the outcome and management. Managing delirium with environmental, supportive and pharmacological interventions will possibly reduce the incidence and side-effects associated with post-operative delirium. The purpose of this article is to provide an over view of the current knowledge about the disease, diagnosis, pathogenesis, preventive strategies, and treatment of post-operative delirium.

  20. Gamma hydroxybutyrate (GHB) and gamma butyrolactone (GBL) withdrawal: five case studies.

    Science.gov (United States)

    McDaniel, C H; Miotto, K A

    2001-01-01

    There is little medical information available about gamma-hydroxybutyrate (GHB) or gamma-butyrolactone (GBL) dependence or withdrawal. In this study the authors treated and reviewed multiple cases of GHB and GBL withdrawal in high-dose users. Five patients during nine hospitalizations were treated for GHB or GBL withdrawal. The authors describe a spectrum of GHB or GBL withdrawal from mild to severe and discuss medications used for treatment. They conclude that patients with GHB or GBL withdrawal may present with agitated psychosis, delirium, and autonomic instability. In this sample, relapse to GHB or GBL use occurred soon after treatment of withdrawal.

  1. Efficacy of midazolam in treating delirium tremens%咪达唑仑治疗酒精所致震颤谵妄效果分析

    Institute of Scientific and Technical Information of China (English)

    江红霞; 朱婉儿; 费玉娥

    2011-01-01

    目的:探讨咪达唑仑对酒精所致震颤谵妄患者的疗效及安全性.方法:65例震颤谵妄患者随机分为2组,分别给予咪达唑仑及地西泮以微泵或直接静脉推注治疗.采用自制调查表及酒精戒断状态评定量表(CIWA-Ar)评定疗效,副反应量表(TESS)评估不良反应,并观察2组在治疗过程中是否出现呼吸抑制、肺部感染、癫痫发作、死亡等并发症.结果:治疗后7天,2组完成治疗者症状都基本缓解,疗效相当.咪达唑仑组对意识、定向、注意、兴奋躁动、自主神经功能紊乱等症状的改善快于地西泮组(P<0.05),CIWA-Ar评分在治疗后1,2,3d低于地西泮组(P<0.01).2组均安全,不良反应及并发症少,差异比较无统计学意义(P>().05).结论:咪达唑仑治疗酒精所致震颤谵妄起效快,效果好,安全性较高.%OBJECTIVE To explore the efficacy and safety of midazolam in treating delirium tremens due to alcohol withdrawal. METHODS 65 patients with delirium tremens were randomly assigned to two groups and were treated with midazolam and diazepam separately by intravenous injection or minipump infusion. The efficacy was evaluated by self-made table and Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar). Side effects were measured with Treatment E-mergent Symptom Scale(TESS), and to observe whether the complications including respiratory depression, pulmonary infection, epilepsy and death occurred or not. RESULTS At the end of seventh day, two groups both got satisfactory results. The midazolam group achieved quicker effects than diazepam group in consciousness, orientation, attention, agitation, and independent nerve disfunction(P0. 05). CONCLUSION Midazolam in treating delirium tremens is safe and has quick and satisfactory effects.

  2. [Delirium in a 73-year-old man after many years of unwise use of betahistine].

    Science.gov (United States)

    Hoenders, H J R; Wilterdink, J

    2004-11-20

    A 73-year-old man was admitted because of delirium that had already persisted for 5 days. The physical examination and extensive tests did not reveal any somatic pathology. The only drug he used was betahistine, taken for several years because of supposed Ménière's disease. After withdrawal of betahistine and treatment with haloperidol the patient recovered completely within a few days. A new delirium was induced when, after discharge from the hospital, betahistine was restarted because of dizziness. There was again a complete remission after betahistine was stopped and haloperidol was restarted. Betahistine is not known to induce delirium, but an investigation in side-effects databases did reveal several cases in which delirium might have been present, even though the term was not actually used. In this case, delirium was possibly caused by the combination of an elevated betahistine plasma level and a damaged blood-brain barrier due to cerebral infarctions, which were revealed by CT and MRI.

  3. Antidepressant Withdrawal

    Science.gov (United States)

    Diseases and Conditions Depression (major depressive disorder) If you stop taking antidepressants, could you experience antidepressant withdrawal? Do withdrawal symptoms mean you were addicted to the drug? Answers from Daniel K. Hall-Flavin, M.D. Antidepressant withdrawal is possible if you ...

  4. Consensus and variations in opinions on delirium care : a survey of European delirium specialists

    NARCIS (Netherlands)

    Morandi, A; Davis, D; Taylor, J K; Bellelli, G; Olofsson, B; Kreisel, S; Teodorczuk, A; Kamholz, B; Hasemann, W; Young, J; Agar, M; de Rooij, S E; Meagher, D; Trabucchi, M; MacLullich, A M

    2013-01-01

    BACKGROUND: There are still substantial uncertainties over best practice in delirium care. The European Delirium Association (EDA) conducted a survey of its members and other interested parties on various aspects of delirium care. METHODS: The invitation to participate in the online survey was distr

  5. Using Standardized Case Vignettes to Evaluate Nursing Home Staff Recognition of Delirium and Delirium Superimposed on Dementia

    Science.gov (United States)

    Fick, Donna M.; Kolanowski, Ann M.; Hill, Nikki L.; Yevchak, Andrea; DiMeglio, Brittney; Mulhall, Paula M.

    2014-01-01

    The purpose of this study is to describe nursing home staff knowledge regarding delirium detection and the most common causes of delirium. Specific aims that guided this study include identifying the rate of nurse recognition of delirium and delirium superimposed on dementia (DSD), including different motoric subtypes of delirium, using standardized case vignettes, and exploring what nursing home staff describe as the potential causes of delirium. The study showed overall poor recognition of delirium and DSD, which did not improve over time. Interventions have the potential to increase the early detection of delirium and DSD by the staff and warrant development. PMID:25400513

  6. Alcohol detoxification in Ysbyty Gwynedd: Two small sips or one big gulp? Two-step screening more reliable for identification of alcohol dependency syndrome at risk of delirium tremens for routine care.

    Science.gov (United States)

    Salman, Muhammad; Subbe, Christian

    2015-01-01

    Compliance with pathways for hospitalised patients with alcohol dependency syndrome is often poor. A pathway for recognition and treatment of alcohol dependency was redesigned as part of a 12 month service improvement project in the acute medical unit using plan, do, study, act (PDSA) cycles. A needs assessment was undertaken: Audit data from 2013 showed over-prescription of chlordiazepoxide for detoxification treatment (DT) leading to prolonged hospital admissions with an average length of stay of 5.5 days in 2012/2013. Acceptability of screening tools was tested: Common screening tools (CEWA, AUDIT) were rejected by junior doctors due to the high number of questions as too cumbersome for routine practice. Compliance with usage in random samples over a three month period was persistently (n=10%. Testing of an abbreviated AUDIT questionnaire with only two questions and a specified threshold showed a AUROC of 1 (p<0.001 for correct identification). The screening tool was implemented in several PDSAs cycles. After the final cycle a random sample of 100 patients was reviewed for pathway compliance over a three months period. Eighty-six patients were screened with the two-question tool of these 18 were identified as possible risk. Of these 16 patients had the full AUDIT questionnaire, only eight with elevated values were started on DT. Overall compliance with the pathway increased to 84%.

  7. Delirium during Weaning from Mechanical Ventilation

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    Marcela Aparecida Leite

    2014-01-01

    Full Text Available Background. We compare the incidence of delirium before and after extubation and identify the risk factors and possible predictors for the occurrence of delirium in this group of patients. Methods. Patients weaned from mechanical ventilation (MV and extubated were included. The assessment of delirium was conducted using the confusion assessment method for the ICU and completed twice per day until discharge from the intensive care unit. Results. Sixty-four patients were included in the study, 53.1% of whom presented with delirium. The risk factors of delirium were age (P=0.01, SOFA score (P=0.03, APACHE score (P=0.01, and a neurological cause of admission (P=0.01. The majority of the patients began with delirium before or on the day of extubation. Hypoactive delirium was the most common form. Conclusion. Acute (traumatic or medical neurological injuries were important risk factors in the development of delirium. During the weaning process, delirium developed predominantly before or on the same day of extubation and was generally hypoactive (more difficult to detect. Therefore, while planning early prevention strategies, attention must be focused on neurological patients who are receiving MV and possibly even on patients who are still under sedation.

  8. Delirium and hypovitaminosis D: neuroimaging findings.

    Science.gov (United States)

    Bourgeois, James A; Hategan, Ana; Ford, Jennifer; Tisi, Daniel K; Xiong, Glen L

    2015-01-01

    The authors examined the frequency of neuroimaging findings of cortical atrophy and/or cerebrovascular disease in patients with delirium with hypovitaminosis D and normal vitamin D levels. Of 32 patients with delirium with hypovitaminosis D who were neuroimaged, 91.4% had neuroimaging findings, despite only five cases having a comorbid diagnosis of dementia. Similar frequencies of cortical atrophy and/or cerebrovascular disease were found in patients with delirium with normal vitamin D levels. Further research with a larger sample size is needed to compare neuroimaging findings between normal patients and patients with hypovitaminosis D with delirium.

  9. Postoperative Delirium after elective and emergency surgery: analysis and checking of risk factors. A study protocol

    Directory of Open Access Journals (Sweden)

    Gagliardi Stefano

    2005-05-01

    Full Text Available Abstract Background Delirum is common in hospitalized elderly patients and may be associated with increased morbidity, length of stay and patient care costs. Delirium (acute confusional state is defined as an acute disorder of attention and cognition. In elderly patients, delirium is often an early indicator of patho-physiological disturbances. Despite landmark studies dating back to the 1940s, the pathogenesis of Delirium remains poorly understood. Early investigators noted that Delirium was characterized by global cortical dysfunction that was associated predominantly with specific electroencephalographic changes. It's important to understand the risk factors and incidence of Delirium. Some of the risk factors are already identified in literature and can be summarized in the word "VINDICATE" which stands for: Vascular, Infections, Nutrition, Drugs, Injury, Cardiac, Autoimmune, Tumors, Endocrine. Aims of this study are: to re-evaluate the above mentioned clinical risk factors, adding some others selected from literature, and to test, as risk factors, a pattern of some genes associated to cognitive dysfunction and inflammation possibly related to postoperative Delirium. Design All patients admitted to our Emergency Unit who are meet our inclusion/exclusion criteria will be recruited. The arising of postoperative Delirium will select incidentally two groups (Delirium/non Delirium and the forward analysis of correlate risk factors will be performed. As in a typical observational case/control study we will consider all the exposure factors to which our population are submitted towards the outcome (presence of Delirium. Our exposures are the following: ASA, Pain (SVS; VAS, Blood gas analysis (pH; Hb; pO2; pCO2, Residence pharmacological therapy (BDZ; hypnotics; narcotic drugs; alcohol; nitrous derivates, Body temperature, Arterial pressure, Heart frequency, Breath frequency, Na, K, Creatinin, Glicemia, Albumin, Hct, White blood cells, Glasgow Coma

  10. 1 cases of acute organophosphate poisoning combined experience from the nursing of alcohol withdrawal syndrome%1例急性有机磷中毒合并酒精戒断综合征的护理体会

    Institute of Scientific and Technical Information of China (English)

    姚松楠; 徐娟

    2016-01-01

    The nursing experience of one case of acute organic phosphorus poisoning combined with alcohol withdrawal syndrome was reported. Close observation of the patient's condition changes; observe the effect and adverse reaction of drugs such as atropine, and to observe the mental symptoms of patients with alcohol withdrawal reaction, strengthen safety management, and pay attention to the patient's psychological nursing.%报道1例急性有机磷中毒合并酒精戒断综合征的护理体会。密切观察该患者病情变化,以及应用阿托品等药物的疗效和不良反应;关注患者酒精戒断反应的精神症状的观察;加强安全管理;重视患者的心理护理。

  11. Alcohol

    Science.gov (United States)

    ... that's how many accidents occur. continue What Is Alcoholism? What can be confusing about alcohol is that ... develop a problem with it. Sometimes, that's called alcoholism (say: al-kuh-HOL - ism) or being an ...

  12. Alcohol

    Science.gov (United States)

    If you are like many Americans, you drink alcohol at least occasionally. For many people, moderate drinking ... risky. Heavy drinking can lead to alcoholism and alcohol abuse, as well as injuries, liver disease, heart ...

  13. Benzodiazepine-associated delirium in critically ill adults

    NARCIS (Netherlands)

    Zaal, Irene J.; Devlin, John W.; Hazelbag, Marijn; Klein Klouwenberg, Peter M. C.; van der Kooi, Arendina W.; Ong, David S. Y.; Cremer, Olaf L.; Groenwold, Rolf H.; Slooter, Arjen J. C.

    2015-01-01

    PURPOSE: The association between benzodiazepine use and delirium risk in the ICU remains unclear. Prior investigations have failed to account for disease severity prior to delirium onset, competing events that may preclude delirium detection, other important delirium risk factors, and an adequate nu

  14. Delirium in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Suresh Arumugam

    2017-01-01

    Full Text Available Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings.

  15. Delirium in the Intensive Care Unit

    Science.gov (United States)

    Arumugam, Suresh; El-Menyar, Ayman; Al-Hassani, Ammar; Strandvik, Gustav; Asim, Mohammad; Mekkodithal, Ahammed; Mudali, Insolvisagan; Al-Thani, Hassan

    2017-01-01

    Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU) patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings.

  16. Delirium and older people: repositioning nursing care.

    Science.gov (United States)

    Neville, Stephen

    2006-06-01

    Aims.  To critically examine the nursing care offered to older people who have been delirious. Background.  Delirium occurs as a result of physiological imbalances resulting in an alteration in consciousness and cognitive impairment. Delirium is a prevalent and serious cognitive disorder experienced by older people. While there is a vast number of studies published utilizing quantitative methods, there remains a dearth of research relating to delirium in older people from a qualitative perspective. Design.  A qualitative research design that utilized a critical gerontological framework underpinned this study. This framework drew on aspects of postmodernism and Foucault's understanding of discourse. Methods.  Data sources included published documents on delirium, semi-structured taped interviews with people over the age of 65 years who had been delirious (as well as their clinical notes), family members, Registered Nurses and a hospital doctor. A postmodern discourse analytic approach was used to interrogate the 20 sets of data collected. Findings.  Textual analysis revealed the presence of two major discourses impacting on being an older person with delirium. These were identified as a nursing discourse of delirium and a personal discourse of delirium. A nursing discourse of delirium was largely focussed on the biomedical processes that resulted in a delirious episode. Conversely, a personal discourse of delirium highlights that there are other ways of 'knowing' about delirium through considering the narratives of older adults, and their families, when offering a nursing service to this group of people. Relevance to clinical practice.  Nursing needs to critically examine all aspects of nursing care as it applies to older people who have delirium to ensure the rhetorical claims of the profession become the reality for consumers of health services. The use of critical gerontology provides nurses with the tools to challenge the status quo and uncover the

  17. Clinical study of dexmedetomidine in alcohol withdrawal syndrome patients in ICU%右美托咪定用于 ICU 酒精戒断综合征患者的研究

    Institute of Scientific and Technical Information of China (English)

    王璐; 姚兰; 邹捍东; 陈伟; 周青山

    2015-01-01

    Objective It is to observe the clinical effect and adverse reaction of dexmedetomidine ( DEX) in alcohol with-drawal syndrome patients (AWS) in ICU.Methods 96 AWS patients with nystagmus, anxiety, irritability symptoms were ran-domly divided into group A(n=32), group B(n=32) and group C(n=32) by random number table method.Group A were injected intravenously of dexmedetomidine load 0.5-1.0 μg/kg within 10 minutes and maintained at 0.2-0.6 μg/kg/h, Group B were injected intravenously of propofol load 0.5-2.0 mg/kg within 10 minutes and maintained 1 -3 mg/kg/h, Group C were injected intramuscular of diazepam temporarily .The sedative effect , mean arterial pressure , heart rate , respira-tory rate, pulse oxygen saturation , arterial oxygen partial pressure , CIWA-Ar score, APACHEⅡscore before treatment and after treatment were compared in the three groups .The ICU hospitalized time and mortality were analyzed in the three groups . The incidence of adverse effects include bradycardia , hypotension and respiratory depression were observed .Results The seda-tion good control rates in group A and group B was higher than that in group C (P0.05).The onset time of sedation was the shortest and dosage of diazepam was the least in group B, the differences were significantly different among the three groups (P all0.05).CIWA-Ar score and APACHEⅡscore of three groups were decreased compared with than before treatment (P<0.05), the scores of Group A were signifi-cantly decreased especially .Group A's ICU hospitalization time was shorter than that of Group C (P<0.05).Conclusion Dexmedetomidine can effectively relieve AWS symptoms such as agitation or delirium with less adverse effects .It can be rec-ommended in sedation treatment in AWS patients .%目的:观察右美托咪定治疗ICU酒精戒断综合征患者的临床疗效及安全性。方法采用随机数字表法将出现震颤(抽搐)、焦虑、激惹等表现的96例ICU酒精戒断综合征患者分为3

  18. Delirium: a guide for the general physician.

    Science.gov (United States)

    Todd, Oliver M; Teale, Elizabeth A

    2016-12-01

    Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. Certain predisposing factors can make an individual more susceptible to delirium in the face of a stressor. Stressors include direct insults to the brain, insults peripheral to the brain or external changes in the environment of an individual. Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types.

  19. Mecanismos fisiopatológicos do delirium Pathophysiological mechanisms of delirium

    Directory of Open Access Journals (Sweden)

    Franklin Santana Santos

    2005-06-01

    Full Text Available O delirium é uma das síndromes mais fascinantes na medicina, apesar de pobremente compreendida. Apesar de sua ocorrência freqüente e de haver crescente informação sobre o diagnóstico, fenomenologia, epidemiologia e etiologias, estudos sobre os mecanismos que mediam a fisiopatologia são, freqüentemente, ausentes. O desenvolvimento de sofisticadas metodologias de imagem cerebral tem permitido ir além das considerações diagnósticas e investigar a neurobiologia dos sintomas específicos observados no delirium. Esses avanços na neuropsiquiatria e na neuroimagem têm revelado diferenças entre as regiões cerebrais, incluindo os hemisférios. O delirium é uma síndrome que pode ocorrer como o resultado de múltipla e complexa interação entre sistemas de neurotransmissores e processos patológicos. Os neurotransmissores, acetilcolina e serotonina, podem ter participação importante no delirium devido a condições clínicas comuns, bem como no delirium pós-cirúrgico. Outros neurotransmissores (dopamina e GABA e fatores neurobiológicos tais como citocinas, hormônios e radicais livres precisarão de mais estudos para definir as suas participações na gênese do delirium. Futuros estudos, centralizados na fisiopatologia do delirium, poderão levar a melhores estratégias de prevenção e tratamento.Delirium is one of the most fascinating and poorly understood syndromes in medicine. Despite its frequent occurrence and growing information on diagnosis, phenomenology, epidemiology, and aetiologies, studies on mediating pathophysiological mechanisms in delirium are largely lacking. The emergence of sophisticated brain imaging methodologies has made it possible to move beyond diagnostic consideration and investigate the neurobiology of specific symptom clusters observed in delirium. Advances in neuropsychiatry and neuroimaging have revealed differences between brain regions, including the hemispheres. Delirium is a syndrome that may

  20. Functional interrelationship of brain aging and delirium.

    Science.gov (United States)

    Rapazzini, Piero

    2016-02-01

    Theories on the development of delirium are complementary rather than competing and they may relate to each other. Here, we highlight that similar alterations in functional brain connectivity underlie both the observed age-related deficits and episodes of delirium. The default mode network (DMN) is a group of brain regions showing a greater level of activity at rest than during attention-based tasks. These regions include the posteromedial-anteromedial cortices and temporoparietal junctions. Evidence suggests that awareness is subserved through higher order neurons associated with the DMN. By using functional MRI disruption of DMN, connectivity and weaker task-induced deactivations of these regions are observed both in age-related cognitive impairment and during episodes of delirium. We can assume that an acute up-regulation of inhibitory tone within the brain acts to further disrupt network connectivity in vulnerable patients, who are predisposed by a reduced baseline connectivity, and triggers the delirium.

  1. Hematoma epidurale in patients with delirium tremens

    Directory of Open Access Journals (Sweden)

    S. Kasper

    2005-08-01

    Full Text Available In this report we presented a case of diagnostic and therapeutic treatment of the patient with delirium tremens in the Psychiatric Ward of the Cantonal Hospital in Zenica. Neuroradiologic diagnostics had shown existance of epiduralhematoma. The patient was transfered to the Neurosurgery Ward for observation and treatment. Difficultieswith differential diagnostics were caused by already present state of delirium as well as an old neurological deficitrelated to right side hemiparesis.

  2. Delirium in Critically Ill Patients Epidemiology, Pathophysiology, Diagnosis and Management

    NARCIS (Netherlands)

    Zaal, Irene J.; Slooter, Arjen J. C.

    2012-01-01

    Delirium is commonly observed in critically ill patients and is associated with negative outcomes. The pathophysiology of delirium is not completely understood. However, alterations to neurotransmitters, especially acetylcholine and dopamine, inflammatory pathways and an aberrant stress response are

  3. Hospital-Related Delirium May Help Worsen Dementia

    Science.gov (United States)

    ... medlineplus.gov/news/fullstory_163123.html Hospital-Related Delirium May Help Worsen Dementia But disorienting condition can ... WEDNESDAY, Jan. 18, 2017 (HealthDay News) -- Hospitalization-related delirium may speed mental decline in patients with dementia, ...

  4. Alcohol

    NARCIS (Netherlands)

    Hendriks, H.F.; Tol, A. van

    2005-01-01

    Alcohol consumption affects overall mortality. Light to moderate alcohol consumption reduces the risk of coronary heart disease; epidemiological, physiological and genetic data show a causal relationship. Light to moderate drinking is also associated with a reduced risk of other vascular diseases an

  5. Aspectos neurofarmacológicos do uso crônico e da Síndrome de Abstinência do Alcool Neuropharmacological aspects of chronic alcohol use and withdrawal syndrome

    Directory of Open Access Journals (Sweden)

    Marcos Zaleski

    2004-05-01

    Full Text Available O objetivo deste artigo é o de revisar e descrever as principais alterações neurofarmacológicas causadas pela exposição crônica ao álcool, assim como os fenômenos ocorridos durante o período de abstinência. São apresentados dados referentes às alterações neuroadaptativas e de tolerância ocorridas nos principais sistemas de monoaminas, aminoácidos neurotransmissores e canais de cálcio, o que está relacionado a uma piora no prognóstico de portadores de comorbidades psiquiátricas com o consumo de álcool. São também descritos alguns estudos relevantes que demonstram o envolvimento de outros mecanismos de ação do álcool no sistema nervoso central, como o envolvimento de opióides, entre outras substâncias. O artigo reafirma a importância, para clínicos e pesquisadores, de um sempre maior entendimento do mecanismo de ação central do álcool, pois dele depende a busca por novas opções farmacológicas, tanto para a redução dos danos provocados pelo seu uso crônico, como para o tratamento da síndrome de abstinência a esta substância.The objective of this paper is to review and describe the main neuropharmacological changes caused by the chronic use of alcohol and those observed during its withdrawal period. The results show international data referring to the involvement of monoamine systems, neurotransmitters and calcium channels in both neuroadaptation and tolerance to alcohol effects and withdrawal. Relevant studies showing the participation of other systems in those mechanisms, as opioids and other substances, are also shown. The article reinforces the importance, for both physicians and researchers, of an always growing understanding of alcohol central mechanisms of action. This understanding is necessary to new pharmacological options to alcohol harm reduction as well as to alcohol withdrawal treatment.

  6. Delirium in elderly people: a review

    Directory of Open Access Journals (Sweden)

    Sónia eMartins

    2012-06-01

    Full Text Available The present review aims to highlight this intricate syndrome, regarding diagnosis, pathophysiology, etiology, prevention and management in elderly people. The diagnosis of delirium is based on clinical observations, cognitive assessment, detailed family history, physical and neurological examination. Clinically, delirium occurs in hyperactive, hypoactive or mixed forms, based on psychomotor behaviour. As an acute confusional state, it is characterized by a rapid onset of symptoms, fluctuating course and an altered level of consciousness, global disturbance of cognition or perceptual abnormalities and evidence of a physical cause.In spite of pathophysiological mechanisms of delirium remaining unclear, current evidence suggests that disruption of neurotransmission, inflammation or acute stress responses might all contribute to the development of this ailment.It usually occurs as a result of a complex interaction of multiple risk factors, such as cognitive impairment/dementia, current hip fracture and presence of severe illness.Despite all of the above, delirium is frequently under-recognized and often misdiagnosed by health professionals. In particular, this happens due to its fluctuating nature, its overlap with dementia and the scarcity of routine formal cognitive assessment in general hospitals.It is also associated with multiple adverse outcomes that have been well documented, such as increased hospital stay, function/cognitive decline, institutionalization and mortality.In this context, early identification of delirium will be essential. Timely and optimal management of people with delirium, should be performed with identification of possible underlying causes, dealing with a suitable care environment and improving education of health professionals. All these can be important factors, which contribute to a decrease in adverse outcomes associated with delirium.

  7. Delirium

    Science.gov (United States)

    ... to confusion should be treated. These may include: Anemia Decreased oxygen ( hypoxia ) Heart failure High carbon dioxide levels ( hypercapnia ) Infections Kidney failure Liver failure Nutritional disorders Psychiatric conditions (such as depression or psychosis) ...

  8. Strategies to improve delirium recognition in hospitalized older adults.

    Science.gov (United States)

    Rice, Karen L; Castex, Julie

    2013-02-01

    As 24-hour caregivers, nurses' detection of delirium is critical to physician diagnosis because of the waxing and waning of delirium-related clinical features. However, nurses fail to accurately interpret delirium-related clinical features more than 30% of the time.

  9. The major risk factors for delirium in a clinical setting

    Directory of Open Access Journals (Sweden)

    Kim H

    2016-07-01

    Full Text Available Harin Kim, Seockhoon Chung, Yeon Ho Joo, Jung Sun Lee Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Objective: We aimed to determine the major risk factors for the development of delirium in patients at a single general hospital by comparison with a control group.Subjects and methods: We reviewed the medical records of 260 delirium patients and 77 control patients. We investigated age, sex, and risk factors for delirium in the total delirium group (n=260, the delirium medical subgroup (n=142, and the delirium surgical subgroup (n=118. Logistic regression analysis adjusting for age and sex was performed to identify the odds ratio.Results: The mean age and the percentage of males were significantly higher in the delirium group compared with the control group (68.9 vs 54.3 years and 70% vs 41.6%, respectively. Risk factors for the delirium group were lower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use. Plasma sodium level and hypertension were important risk factors for the delirium medical subgroup. Stroke history, hypertension, ICU care, and medication were important risk factors for the delirium surgical subgroup.Conclusion: Lower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use are important risk factors for delirium. Keywords: delirium, acute confusional state, psychiatric consultation, risk factor

  10. The Effects of Blood Transfusion on Delirium Incidence

    NARCIS (Netherlands)

    van der Zanden, Vera; Beishuizen, Sara J.; Scholtens, Rikie M.; de Jonghe, Annemarieke; de Rooij, Sophia E.; van Munster, Barbara C.

    2016-01-01

    Background: Both anemia and blood transfusion could be precipitating factors for delirium; hence in postoperative patients with anemia at high risk for delirium, it is controversial whether transfusion is the best option. The aim of this study is to investigate the association of anemia and delirium

  11. Delirium in elderly patients hospitalized in internal medicine wards.

    Science.gov (United States)

    Fortini, Alberto; Morettini, Alessandro; Tavernese, Giuseppe; Facchini, Sofia; Tofani, Lorenzo; Pazzi, Maddalena

    2014-06-01

    A prospective observational study was conducted to evaluate the impact of delirium on geriatric inpatients in internal medical wards and to identify predisposing factors for the development of delirium. The study included all patients aged 65 years and older, who were consecutively admitted to the internal medicine wards of two public hospitals in Florence, Italy. On admission, 29 baseline risk factors were examined, cognitive impairment was evaluated by Short Portable Mental Status Questionnaire, and prevalent delirium cases were diagnosed by Confusion Assessment Method (CAM). Enrolled patients were evaluated daily with CAM to detect incident delirium cases. Among the 560 included patients, 19 (3 %) had delirium on admission (prevalent) and 44 (8 %) developed delirium during hospitalization (incident). Prevalent delirium cases were excluded from the statistical analysis. Incident delirium was associated with increased length of hospital stay (p delirium during hospitalization. Results show that delirium impact is relevant to older patients hospitalized in internal medicine wards. The present study confirms cognitive impairment as a risk factor for incident delirium. The cognitive evaluation proved to be an important instrument to improve identification of patients at high risk for delirium. In this context, our study may contribute to improve application of preventive strategies.

  12. Studies on circadian rhythm disturbances and melatonin in delirium

    NARCIS (Netherlands)

    de Jonghe, A.-M.

    2014-01-01

    The circadian sleep/wake rhythm disturbances that are seen in delirium and the role of melatonin supplementation provide a new angle in delirium research. More research is needed to determine the role of melatonin in the pathophysiological mechanisms of delirium and to determine whether the restorat

  13. The Impact of Delirium | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Delirium Research The Impact of Delirium Past Issues / Fall 2015 Table of Contents Ill ... hospitalized older people can experience sudden episodes of delirium, a state of confusion and disorientation that can ...

  14. Anesthesia and postoperative delirium in older adults undergoing hip surgery

    NARCIS (Netherlands)

    Slor, C.J.; de Jonghe, J.F.M.; Vreeswijk, R.; Groot, E.; Ploeg, T.V.D.; van Gool, W.A.; Eikelenboom, P.; Snoeck, M.; Schmand, B.; Kalisvaart, K.J.

    2011-01-01

    OBJECTIVES: To examine the effects of general anesthesia on the risk of incident postoperative delirium in older adults undergoing hip surgery. DESIGN: Secondary analysis of haloperidol prophylaxis for delirium clinical trial data. Predefined risk factors for delirium were assessed prior to surgery.

  15. Delirium subtype identification and the validation of the Delirium Rating Scale - Revised-98 (Dutch version) in hospitalized elderly patients

    NARCIS (Netherlands)

    S.E. de Rooij; B.C. Munster; J.C. Korevaar; G. Casteelen; M.J. Schuurmans; R.C. van der Mast; M. Levi

    2006-01-01

    Background Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. The Dutch version of the Delirium Rating Scale-Revised-98 (DRS-R-98) appears to be a reliable method to classify delirium. The aim of this study was to determine the validity and reliability of the DRS-R-

  16. Alcohol

    Science.gov (United States)

    ... changes that come from drinking alcohol can make people do stupid or embarrassing things, like throwing up or peeing on themselves. Drinking also gives people bad breath, and no one enjoys a hangover. ...

  17. Delirium pós-operatório em idosos Delirium postoperatorio en ancianos Postoperative delirium in the elderly

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2008-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O delirium pós-operatório é complicação comum na faixa etária avançada, tem fisiopatologia pobremente esclarecida e tem como um dos sintomas o delírio. O delírio parece estar relacionado com a atividade colinérgica central. O objetivo deste artigo foi descrever a etiologia, o diagnóstico, as estratégias de prevenção e o tratamento do delirium pós-operatório por meio da revisão de literatura. CONTEÚDO: Foram descritos as prováveis etiologias, o diagnóstico, a prevenção e o tratamento do delirium pós-operatório em idosos. CONCLUSÕES: A incidência de delirium pós-operatório é maior nos pacientes idosos e as estratégias de prevenção devem ser utilizadas para redução da mortalidade associada a essa complicação anestésico-cirúrgica.JUSTIFICATIVA Y OBJETIVOS: El delirium postoperatorio es una complicación común en la franja etaria avanzada, tiene una fisiopatología muy mal aclarada y posee como uno de los síntomas, el delirio. El delirio parece estar relacionado con la actividad colinérgica central. El objetivo de este artículo fue describir la etiología, el diagnóstico, y las estrategias de prevención y tratamiento del delirium postoperatorio a través de la revisión de la literatura. CONTENIDO: Se describieron las probables etiologías, diagnóstico, prevención y tratamiento del delirium postoperatorio en ancianos. CONCLUSIONES: La incidencia de delirium postoperatorio es mayor en los pacientes ancianos y las estrategias de prevención deben ser utilizadas para la reducción de la mortalidad asociada a esa complicación anestésico-quirúrgica.BACKGROUND AND OBJECTIVES: Postoperative delirium is a common complication in the elderly whose pathophysiology is not well known. It seems to be related to central cholinergic activity. A literature review was undertaken to describe the etiology, diagnosis, prophylactic strategies, and treatment of postoperative delirium. CONTENTS

  18. Review of delirium in patients with Parkinson's disease.

    Science.gov (United States)

    Vardy, Emma R L C; Teodorczuk, Andrew; Yarnall, Alison J

    2015-11-01

    Parkinson's disease (PD) is common and has a number of associated neuropsychiatric disturbances. Of these, delirium has historically been under-recognised. Delirium is an acute disturbance of attention and awareness that fluctuates, and is accompanied by an additional disturbance of cognition. As delirium is known to carry a particularly poor prognosis in terms of morbidity and mortality, and the relationship between delirium and dementia is becoming better defined, we completed a literature review of delirium in the context of PD. A literature search was completed using the databases PubMed, Embase and Ovid Medline. PubMed (1945-2014) was searched in September 2014; Embase (1974-2014); and Ovid Medline (1946-2014) in October 2014. The search terms 'delirium' and 'Parkinsons' in combination were used. Large studies using a robust definition of delirium were lacking in PD. There is the suggestion that PD is a risk factor for delirium and that delirium negatively impacts upon the motor symptom trajectory. Deficits in the neurotransmitters dopamine and acetylcholine are implicated in the pathophysiology of delirium in PD. Systemic inflammation also appears to have a role. Treatment of delirium in PD should include medication review and cautious use of atypical antipsychotics where pharmacological treatment is indicated. Of the atypical antipsychotics studied, quetiapine has the least extrapyramidal side effects. Evidence suggests a specific link between delirium and PD but well-designed clinical studies to evaluate the prevalence, impact and treatment of delirium in PD are required. Given the potential to improve outcomes through delirium prevention we conclude that delirium in PD is an area worthy of further study.

  19. Emergency Department Management of Delirium in the Elderly

    Directory of Open Access Journals (Sweden)

    Lynn E.J. Gower, DO

    2012-05-01

    Full Text Available An increasing number of elderly patients are presenting to the emergency department. Numerousstudies have observed that emergency physicians often fail to identify and diagnose delirium in theelderly. These studies also suggest that even when emergency physicians recognized delirium, theystill may not have fully appreciated the import of the diagnosis. Delirium is not a normal manifestation ofaging and, often, is the only sign of a serious underlying medical condition. This article will review thesignificance, definition, and principal features of delirium so that emergency physicians may betterappreciate, recognize, evaluate, and manage delirium in the elderly.

  20. Delirium: a diagnostic dilemma. Part 1.

    Science.gov (United States)

    Hardy, Kersten; Brown, Michelle

    Effective symptom management for a patient with a palliative diagnosis can be challenging. There are some symptoms that may be more difficult to control and understand than others. Delirium, as a symptom, may well prove to be a significant challenge for all involved, leaving family and health professionals perplexed and exhausted. Understanding the predisposing factors and the manifestations may aid the health professional in the assessment and identification of this distressing symptom, facilitating more effective management and care of those who are approaching the end of life. This article attempts to address some of the challenges and offer a number of suggestions that may aid in identifying delirium in patients at the end of life, but also examines some of the dilemmas when attempting to treat delirium.

  1. Bedside coaching to improve nurses' recognition of delirium.

    Science.gov (United States)

    Gordon, Susan Jean; Melillo, Karen Devereaux; Nannini, Angela; Lakatos, Barbara E

    2013-10-01

    Delirium is a widespread complication of hospitalization and is frequently unrecognized by nurses and other healthcare professionals. Patients with neuroscience diagnoses are at increased risk for delirium as compared with other patients. The aims of this quality improvement project were to (1) increase neuroscience nurses' knowledge of delirium, (2) integrate coaching into evidence-based practice, and (3) evaluate the effectiveness of this combined approach to improve nurses' recognition of delirium on a neuroscience unit. Institutional review board approval was obtained. A retrospective chart review of randomly selected patients admitted before the intervention was completed. The (modified) Nurse's Knowledge of Delirium Tool was electronically administered to nursing staff (n = 47), followed within 2 weeks by a didactic presentation on delirium. Bedside coaching was performed over a period of 4 weeks. The (modified) Nurses Knowledge of Delirium Tool was electronically readministered to nurses 4 weeks later to determine the change in aggregate knowledge. A postintervention chart review was conducted. SPSS software was used to analyze descriptive statistics with regard to chart reviews, documentation, and change in questionnaire scores. Findings reveal that neuroscience nurses recognize the absence of delirium 94.4% of the time and the presence of delirium 100% of the time after a didactic session and coaching. The postintervention chart review showed a statistically significant increase (p = .000) in the documentation of delirium screening results. Expert coaching at the bedside may be a reliable method for teaching nurses to use evidence-based screening tools to detect delirium in patients with neuroscience diagnoses.

  2. Multicomponent delirium prevention: not as effective as NICE suggest?

    Science.gov (United States)

    Teale, Elizabeth; Young, John

    2015-11-01

    Multicomponent delirium prevention strategies have been shown in intervention studies consistently to reduce the occurrence of delirium. Based on this convincing evidence base, the National Institute for Health and Care Excellence has advocated the widespread adoption of multicomponent delirium prevention interventions into the routine inpatient care of older people. However, despite successful reductions in incident delirium of about a third, anticipated reductions in mortality or admissions to long-term care--both clinically important endpoints statistically correlated with the occurrence of delirium--have not been conclusively observed. We hypothesise that the reasons for this disconnection are partly methodological, due to difficulties in delirium detection and blinding of study personnel to the intervention, but predominantly due to the underlying relationship between delirium and the abnormal health state of frailty; the interaction between these two geriatric syndromes is currently poorly understood.

  3. Delirium in elderly vascular surgery patients.

    Science.gov (United States)

    Cudennec, Tristan; Goëau-Brissonnière, Olivier; Coscas, Raphaël; Capdevila, Clément; Moulias, Sophi; Coggia, Marc; Teillet, Laurent

    2014-04-01

    The elderly represent a large percentage of patients seen in departments of vascular surgery. Delirium is a frequent perioperative complication in this population and contributes to increased morbidity and mortality. Prevention of problems associated with mental confusion rests in identifying comorbidities, their severity, and the risk factors associated with delirium syndrome. The aging of our population implies management of increasing numbers of older patients who often have concomitant pathologies and, consequently, polypharmacy. Optimization of their management rests on collaboration between surgeons, anesthetists, and geriatrists.

  4. 27 CFR 19.532 - Withdrawals of spirits for use in wine production.

    Science.gov (United States)

    2010-04-01

    ... use in wine production. 19.532 Section 19.532 Alcohol, Tobacco Products and Firearms ALCOHOL AND... Withdrawals Withdrawal of Spirits Without Payment of Tax § 19.532 Withdrawals of spirits for use in wine production. Wine spirits may be withdrawn to a bonded wine cellar without payment of tax for use in...

  5. Predicting Delirium Duration in Elderly Hip-Surgery Patients: Does Early Symptom Profile Matter?

    Directory of Open Access Journals (Sweden)

    Chantal J. Slor

    2013-01-01

    Full Text Available Background. Features that may allow early identification of patients at risk of prolonged delirium, and therefore of poorer outcomes, are not well understood. The aim of this study was to determine if preoperative delirium risk factors and delirium symptoms (at onset and clinical symptomatology during the course of delirium are associated with delirium duration. Methods. This study was conducted in prospectively identified cases of incident delirium. We compared patients experiencing delirium of short duration (1 or 2 days with patients who had more prolonged delirium (≥3 days with regard to DRS-R-98 (Delirium Rating Scale Revised-98 symptoms on the first delirious day. Delirium symptom profile was evaluated daily during the delirium course. Results. In a homogenous population of 51 elderly hip-surgery patients, we found that the severity of individual delirium symptoms on the first day of delirium was not associated with duration of delirium. Preexisting cognitive decline was associated with prolonged delirium. Longitudinal analysis using the generalised estimating equations method (GEE identified that more severe impairment of long-term memory across the whole delirium episode was associated with longer duration of delirium. Conclusion. Preexisting cognitive decline rather than severity of individual delirium symptoms at onset is strongly associated with delirium duration.

  6. Delirium in cardiac surgery : a study on risk-assessment and long-term consequenses

    NARCIS (Netherlands)

    Koster, Sandra

    2011-01-01

    BACKGROUND: Delirium or acute confusion is a temporary mental disorder, which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Delirium is associated with many negative consequences. Therefore, prevention or ea

  7. Association between leptin and delirium in elderly inpatients

    Directory of Open Access Journals (Sweden)

    Sanchez JC

    2013-05-01

    Full Text Available Julio C Sánchez, Jenny P Ospina, Martha I GonzálezCell and Applied Physiology Group, Department of Basic Sciences, Faculty of Health, Universidad Tecnológica de Pereira, Pereira, ColombiaAbstract: Leptin is a hormone with significant effects on the brain, both at the cellular level and cognitive level. This study aimed to establish the association between leptin levels and delirium in a Colombian elderly population. 115 patients older than 60 years were included. Leptin was measured by enzyme-linked immunosorbent assay after overnight fasting and Mini-Mental State Examination and Confusion Assessment Method (CAM tests were employed. Delirium was diagnosed using CAM in 23.48% of patients, being most frequent in men. There were no significant differences in hematology and renal test values between patients with delirium and those without delirium, but cerebrovascular diagnoses were more frequent in patients with delirium. No correlation with any specific medication was found, but patients with delirium had a higher number of comorbidities and medications. Leptin levels were significantly lower in patients with delirium and correlated negatively with the number of diagnoses and medications, but not with age, gender, body mass index, or hematology and renal test results. Leptin levels may have a role in the pathophysiological process of delirium and low leptin could be a useful clinical biomarker to establish risk in elderly patients given the association with delirium.Keywords: delirium, elderly, hospitalization, leptin

  8. Post-anaesthetic emergence delirium in adults

    DEFF Research Database (Denmark)

    Munk, L; Andersen, G; Møller, A M

    2016-01-01

    BACKGROUND: Emergence delirium (ED) after general anaesthesia (GA) is a well-known phenomenon, yet the risk factors are still unclear. The aims of this study were to determine the incidence and independent predictors of ED and secondly to determine to which degree ED has any relevant, clinical...

  9. Dementia and delirium, the outcomes in elderly hip fracture patients

    Science.gov (United States)

    Mosk, Christina A; Mus, Marnix; Vroemen, Jos PAM; van der Ploeg, Tjeerd; Vos, Dagmar I; Elmans, Leon HGJ; van der Laan, Lijckle

    2017-01-01

    Background Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. Methods This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes. Results Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (PPatients with dementia (N=168) had a higher delirium rate (57.7%, Ppatients with (34.0%) and without dementia (26.3%). Conclusion Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent an episode of delirium were at increased risk for adverse outcomes. PMID:28331300

  10. Endogenous bufadienolide mediates pressor response to ethanol withdrawal in rats

    OpenAIRE

    Kashkin, Vladimir A.; Zvartau, Edwin E.; Fedorova, Olga V.; Bagrov, Yakov Y.; Lakatta, Edward G.; Bagrov, Alexei Y.

    2007-01-01

    An endogenous natriuretic and vasoconstrictor Na/K-ATPase inhibitor, marinobufagenin (MBG), is implicated in NaCl-induced hypertension and in ethanol addiction. In rats, MBG suppresses voluntary alcohol intake, while immunization against MBG induces alcohol-seeking behavior. Since alcohol withdrawal is associated with elevation of blood pressure (BP) and renal sodium retention, we hypothesized that MBG mediates pressor response to ethanol withdrawal. In male Sprague-Dawley rats, forced ethano...

  11. Predicting Delirium Duration in Elderly Hip-Surgery Patients: Does Early Symptom Profile Matter?

    OpenAIRE

    Slor, Chantal J; Joost Witlox; Dimitrios Adamis; Meagher, David J; Tjeerd van der Ploeg; Rene W. M. M. Jansen; Mireille F. M. Van Stijn; Alexander P.J. Houdijk; Willem A van Gool; Piet Eikelenboom; de Jonghe, Jos F. M.

    2013-01-01

    Background. Features that may allow early identification of patients at risk of prolonged delirium, and therefore of poorer outcomes, are not well understood. The aim of this study was to determine if preoperative delirium risk factors and delirium symptoms (at onset and clinical symptomatology during the course of delirium) are associated with delirium duration. Methods. This study was conducted in prospectively identified cases of incident delirium. We compared patients experiencing deliriu...

  12. Identifying and managing patients with delirium in acute care settings.

    Science.gov (United States)

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  13. Delirium: assessment and treatment of patients with cancer. PART 2.

    Science.gov (United States)

    Brown, Michelle; Hardy, Kersten

    Delirium at the end of life may present significant ethical dilemmas in clinical practice: whether to simply treat it in order to maximise symptom relief, with the resulting side effect being palliative sedation, or to attempt to reverse delirium and risk prolonging suffering. Determining whether the delirium can be reversed involves comprehensive assessment using established tools, which may or may not provide the answer to the question posed. This article examines the evidence surrounding several assessment tools that have been suggested as effective in identifying delirium, and the consequences of various approaches to the management of delirium in a patient with a cancer diagnosis. It also considers the impact delirium may have on the health professional and those close to the patient.

  14. Impact of alcohol intoxication and withdrawal syndrome on social phobia and panic disorder in alcoholic inpatients Impacto das fases de intoxicação e de abstinência de álcool sobre a fobia social e o transtorno de pânico em pacientes alcoolistas hospitalizados

    Directory of Open Access Journals (Sweden)

    Mauro Barbosa Terra

    2004-01-01

    Full Text Available PURPOSE: To investigate the impact of alcohol intoxication and withdrawal on the course of social phobia and panic disorder. METHOD: A group of 41 alcoholic inpatients undergoing detoxification therapy were interviewed using the SCID-I (DSM-IV and questions to detect fluctuations in the course of social phobia and panic disorder as a function of the different phases in alcohol dependence (intoxication, withdrawal, and lucid interval. RESULTS: Only 1 (2.4% patient presented panic disorder throughout life, and 9 (21.9% had panic attacks during alcohol intoxication or during the withdrawal syndrome. Sixteen (39% alcoholic patients showed social phobia with onset prior to drug use. However, drinking eventually became unable to alleviate social phobia symptoms or worsened such symptoms in 31.2% of social-phobic patients. While patients with social phobia reported a significant improvement in psychiatric symptoms during alcohol intoxication, patients experiencing panic attacks worsened significantly during intoxication. In the withdrawal phase, patients with social phobia tended to have more and more intense phobic symptoms. CONCLUSION: Our findings indicate that the impact of alcohol intoxication is different for social phobia as compared to panic disorder, at first decreasing the social-phobic symptoms but later aggravating them. In panic disorder, the impact of intoxication by alcohol is more harmful, at least in the short term.OBJETIVO: Estudar o impacto das fases de intoxicação e de abstinência do uso de álcool sobre o curso da fobia social e do transtorno de pânico. MÉTODO: Um grupo de 41 pacientes hospitalizados por dependência de álcool foi entrevistado com o SCID-I (DSM-IV, adicionado de perguntas para detectar as flutuações no curso da fobia social e do transtorno do pânico em função das diferentes fases do uso da droga (intoxicação, abstinência e intervalo lúcido. RESULTADOS: Apenas um (2,4% paciente, apresentou transtorno

  15. Temperature variability during delirium in ICU patients: an observational study.

    Directory of Open Access Journals (Sweden)

    Arendina W van der Kooi

    Full Text Available INTRODUCTION: Delirium is an acute disturbance of consciousness and cognition. It is a common disorder in the intensive care unit (ICU and associated with impaired long-term outcome. Despite its frequency and impact, delirium is poorly recognized by ICU-physicians and -nurses using delirium screening tools. A completely new approach to detect delirium is to use monitoring of physiological alterations. Temperature variability, a measure for temperature regulation, could be an interesting component to monitor delirium, but whether temperature regulation is different during ICU delirium has not yet been investigated. The aim of this study was to investigate whether ICU delirium is related to temperature variability. Furthermore, we investigated whether ICU delirium is related to absolute body temperature. METHODS: We included patients who experienced both delirium and delirium free days during ICU stay, based on the Confusion Assessment method for the ICU conducted by a research- physician or -nurse, in combination with inspection of medical records. We excluded patients with conditions affecting thermal regulation or therapies affecting body temperature. Daily temperature variability was determined by computing the mean absolute second derivative of the temperature signal. Temperature variability (primary outcome and absolute body temperature (secondary outcome were compared between delirium- and non-delirium days with a linear mixed model and adjusted for daily mean Richmond Agitation and Sedation Scale scores and daily maximum Sequential Organ Failure Assessment scores. RESULTS: Temperature variability was increased during delirium-days compared to days without delirium (β(unadjusted=0.007, 95% confidence interval (CI=0.004 to 0.011, p<0.001. Adjustment for confounders did not alter this result (β(adjusted=0.005, 95% CI=0.002 to 0.008, p<0.001. Delirium was not associated with absolute body temperature (β(unadjusted=-0.03, 95% CI=-0.17 to 0

  16. Pharmacological interventions for preventing delirium in the elderly.

    Science.gov (United States)

    Ford, Andrew H; Almeida, Osvaldo P

    2015-06-01

    Delirium is a common occurrence in older hospitalised patients, particularly in the setting of surgical intervention and acute illness. Delirium is associated with a number of adverse clinical and social outcomes with higher financial cost and risk of developing dementia, as well as increased likelihood of need for residential care. Current interventions for the prevention of delirium typically involve recognition and amelioration of modifiable risk factors and treatment of underlying conditions that predispose the individual to delirium. A number of pharmacological strategies for delirium prevention have been tested. Antipsychotic medications are used for treatment of agitation in the setting of delirium when other measures have failed, but their efficacy in prevention is limited by study heterogeneity and concerns about tolerability. Acetylcholinesterase inhibitors are effective in the symptomatic treatment of Alzheimer's disease but do not appear to be effective in preventing delirium. Melatonin and melatonin agonists have a rather benign side effect profile and show promise for prevention of delirium in medically unwell individuals. The alpha-2 agonist, dexmedetomidine may be helpful in the intensive care unit setting but intravenous route of administration and need for close clinical supervision limits its use in the wider hospital environment. Other agents such as benzodiazepines, corticosteroids, statins and gabapentin have been suggested but lack evidence to support their role in delirium prevention. To date, there is inconsistent and conflicting data regarding the efficacy of any particular pharmacological agent although some interventions do show promise. Larger, well-designed, placebo-controlled clinical trials are needed.

  17. Delirium: A predictor of mortality in the elderly

    Directory of Open Access Journals (Sweden)

    Matías González

    2005-09-01

    Full Text Available The frequency of delirium in elderly inpatients is high, resulting in poor hospital outcomes. The objective of this study is to assess whether delirium is an independent predictor for mortality over a three-month period. Methods: Prospective, observational study in a cohort of 171 inpatients aged over 65 years. Presence of delirium and/or dementia, severity of delirium and incapacity due to illness were assessed at baseline using DSM-IV diagnostic criteria, the Confusion Assessment Method (CAM, the MMSE, the Delirium Rating Scale (DRS and the Karnofsky Performance Status (KPS. Mortality rates were evaluated over a three-month follow-up period after enrollment. Kaplan-Meier survival curves were constructed and the adjusted effect of a set of covariates was evaluated with the Cox multiple regression analysis. Results: By 3 months after enrollment, 34.4% of the patients with delirium died, compared with 16.5% of those without delirium. The survival analysis shows a statistically significant difference between the two groups (log-rank=11.92; d.f.=1; P=0.0006. After adjustment for covariates, delirium was found to be independently associated with higher mortality. Conclusions: Delirium was found to be an independent marker for mortality in older medical patients over a three-month follow-up.

  18. Stabilizing and Managing Patients with Altered Mental Status and Delirium.

    Science.gov (United States)

    Odiari, Ebelechukwu A; Sekhon, Navdeep; Han, Jin Y; David, Elizabeth H

    2015-11-01

    Present in all patient populations, altered mental status (AMS) is a common, but nonspecific emergency department (ED) presentation that can signify serious underlying pathology. Delirium is a more defined mental status change caused by another medical condition that carries a high morbidity and mortality if missed. However, ED physicians miss the condition in more than 50% of cases. The ED physician should maintain a high index of suspicion for delirium, because if missed in the ED, delirium is more likely to be missed on the floors as well. Management of delirium is directed toward treating the underlying course.

  19. The Phenomenology of Delirium: Presence, Severity, and Relationship between Symptoms

    Directory of Open Access Journals (Sweden)

    Soenke Boettger

    2014-01-01

    Full Text Available Objective. To examine the phenomenological characteristics of delirium based on the Memorial Delirium Assessment Scale (MDAS in order to explore the presence, severity of, and relationship between symptoms. Methods. An analysis of 100 cases of delirium recruited at Memorial Sloan Kettering Cancer Center (MSKCC was performed. Sociodemographic and medical variables, the Memorial Delirium Assessment Scale (MDAS subitems, and Karnofsky Performance Status scale (KPS were analyzed of respect of the phenomenological characteristics and their interrelationship. Results. The most severe and frequent symptoms were recorded in the cognitive domain, psychomotor behavior, sleep-wake cycle, and disturbance of consciousness. Within the cognitive domain, concentration was the most severely affected task. The severity of impairment in most domains increased with delirium severity, whereas perceptual disturbances and delusions were independent of delirium severity. Advanced age and the prevalence of dementia increased with delirium severity in contrast to the functional status which declined. The presence of perceptual disturbances and delusions was independent of cognitive impairment and psychomotor abnormality, however, associated with the disturbances of consciousness and attention. Conclusion. Cognition, in particular concentration, was the most severely affected domain. Advanced age and the prevalence of dementia contributed to more severe delirium. Perceptual disturbances and delusions were independent of delirium severity; however, they were associated with disturbances of consciousness and attention.

  20. Delirium detection and improved delirium management in older patients hospitalized for hip fracture.

    Science.gov (United States)

    Todd, Kristine S; Barry, Jean; Hoppough, Susan; McConnell, Eleanor

    2015-11-01

    Delirium is a common and potentially devastating problem for older patients following hip fracture. Although early detection is recommended, description and evaluation of standardized approaches are scarce. The aims of this quality improvement project were to: (1) implement a clinical algorithm for improving delirium detection and management and (2) assess the impact of the clinical algorithm on length of stay, discharge disposition and patient satisfaction. The pilot study was implemented on an orthopedic unit to evaluate the effectiveness of a clinical protocol for delirium detection and management to improve outcomes. Outcomes of 33 elderly post-operative hip fracture patients were compared to historical controls from the same unit. Delirium was detected in 18% of patients. Length of stay was reduced by 22% (P patient satisfaction scores showed a 15% (P = .15) improvement post-intervention. Implementation of a clinical algorithm to promote early detection and treatment of delirium in post-operative hip fracture patients is feasible and associated with improved outcomes.

  1. Neuroinflammation in sepsis: sepsis associated delirium.

    Science.gov (United States)

    Piva, Simone; McCreadie, Victoria A; Latronico, Nicola

    2015-01-01

    Sepsis-associated delirium (SAD) is a clinical manifestation of the involvement of the central nervous system (CNS) during sepsis. The purpose of this review is to provide a concise overview of SAD including the epidemiology and current diagnostic criteria for SAD. We present in detail the pathophysiology with regards to blood-brain-barrier breakdown, cytokine activation and neurotransmitter deregulation. Treatment and prognosis for SAD are also briefly discussed. SAD is the most common form of delirium acquired in the ICU (Intensive Care Unit), and is described in about 50% of septic patients. Clinical features include altered level of consciousness, reduced attention, change in cognition and perceptual disturbances. Symptoms can reversible, but prolonged deficits can be observed in older patients. Pathophysiology of SAD is poorly understood, but involves microvascular, metabolic and, not least, inflammatory mechanisms leading to CNS dysfunction. These mechanisms can be different in SAD compared to ICU delirium associated with other conditions. SAD is diagnosed clinically using validated tools such as CAM-ICU (Confusion Assessment Method for the Intensive Care Medicine) or ICDSC (The Intensive Care Delirium Screening Checklist), which have good specificity but low sensitivity. Neuroimaging studies and EEG (Electroencephalography) can be useful complement to clinical evaluation to define the severity of the condition. Prompt diagnosis and eradication of septic foci whenever possible is vital. Preventive measures for SAD in the critically ill patient requiring long-term sedation include maintaining light levels of sedation using non-benzodiazepine sedatives (either propofol or dexmedetomidine). Early mobilization of patients in the ICU is also recommended. Antipsychotic drugs (haloperidol and atypical antipsychotics) are widely used to treat SAD, but firm evidence of their efficacy is lacking.

  2. Postoperative delirium: diagnostic evaluation and treatment

    Directory of Open Access Journals (Sweden)

    C. Mussi

    2013-05-01

    Full Text Available BACKGROUND Postoperative delirium (POD is an acute, transient and fluctuating disturbance of consciousness that occurs shortly after surgery. Its clinical importance is high, since it increases mortality, length of stay, institutionalization, and it is related to poor prognosis. AIM OF THE REVIEW The aim of this short review is to describe the epidemiology of POD, to assess risk factors of POD, to define the diagnosis and to focus on the possible pharmacologic and non pharmacologic therapies.

  3. 酒精戒断状态评定量表中文译本的效度和信度测试%Validity and reliability of Chinese version of alcohol withdrawal scale(AWS)

    Institute of Scientific and Technical Information of China (English)

    禚传君; 黄悦勤; 唐毅; 杨磊; 耿俊; 李继涛; 高向阳; 李冰

    2010-01-01

    目的 评价酒精戒断状态评定量表(AWS)中文译本的信度和效度.方法 选取175例符合ICD-10诊断标准的酒精依赖患者为研究对象,进行AWS量表评定,计算组内相关系数(ICC)评价评定者间一致性;计算克朗巴赫α系数评价量表内部一致性;采用主成份分析方法计算条目的因子负荷考评量表结构效度;通过AWS与临床总体印象量表(CGI)以及CIWA-Ar(CIWA-Ar)的相关分析来评价量表的效标效度;以临床标准为参考标准,根据ROC曲线下面积(Area Under Curve,AUC)来判断量表的区分效度以及划定量表的划界分.结果 (1)信度:评定者一致性ICC为0.93;量表总克朗巴赫α系数为0.83.(2)效度:AWS量表与两个分量表之间相关系数为0.78,0.83,两个分量表之间的相关系数为0.81,通过因子分析,量表的每个条目都在主因子上有较高的负荷值(0.409~0.926);入院时AWS总分与CGI评分严重程度呈显著正相关(r=0.71,P<0.05),与CIWA-Ar总分呈正相关(r=0.86,P<0.05).随治疗进行,AWS总分呈减分趋势,治疗第1周结束时AWS与CGI疗效评分呈显著相关(r=0.62,P<0.05).以临床评估标准为参考在区分轻度戒断状态时界值分为≥3时灵敏度特异度最好,分别为92.1%和73.5%,AUC为0.91,区分中度戒断状态时AWS总分≥7分灵敏度特异度最高,分别为94.3%,89.7%,AUC为0.94;在区分重度戒断状态时AWS总分≥10分灵敏度特异度最高,分别为94.9%,92.6%,AUC为0.93.结论 AWS中文译本具有较好的信度和效度,能够区分戒断状态的严重程度及反映治疗的疗效.%Objective To evaluate the validity and reliability of the Chinese version of Alcohol Withdrawal Scale (AWS). Methods Totally 175 patients diagnosed as alcohol dependence according to the criteria of ICD-10 were studied. Intraclass correlation coefficient (ICC) analysis was applied for examining interrater consistency and Cronbach' s α for internal consistency. Factor analysis was used to

  4. Risk factors for intensive care delirium: A systematic review.

    NARCIS (Netherlands)

    Rompaey, B. van; Schuurmans, M.J.; Shortridge-Baggett, L.M.; Truijen, S.; Bossaert, L.

    2007-01-01

    Delirium has been a recognised syndrome in the intensive care unit for some years. This systematic review reports risk factors for delirium studied in the intensive care unit. Four predisposing and 21 precipitating factors, including nine laboratory blood values and seven items relating to the use o

  5. A relational ethical approach to end-of-life delirium.

    Science.gov (United States)

    Wright, David Kenneth; Brajtman, Susan; Macdonald, Mary Ellen

    2014-08-01

    Delirium is a condition of acute onset and fluctuating course in which a person's level of consciousness and cognition become disturbed. Delirium is a common and distressing phenomenon in end-of-life care, yet it is underrecognized and undertreated. In this article, we review qualitative descriptions of the delirium experience in end-of-life care, found through a systematic search of academic databases, to generate insight into the intersubjective nature of the delirium experience. Our analysis of retrieved studies advances an understanding of the relational ethical dimensions of this phenomenon, that is, how delirium is lived by patients, families, and health care providers and how it affects the relationships and values at stake. We propose three themes that explain the distressing nature of delirium in palliative care: 1) experiences of relational tension; 2) challenges in recognizing the delirious person; and 3) struggles to interpret the meaning of delirious behaviors. By approaching end-of-life delirium from a perspective of relational ethics, attention is focused on the implications for the therapeutic relationship with patients and families when delirium becomes part of the dying trajectory.

  6. Epidemiology of Delirium in the Intensive Care Unit

    NARCIS (Netherlands)

    Zaal, I.J.

    2014-01-01

    Delirium is a common neuropsychiatric syndrome in critically ill patients, characterized by a disturbance in attention and cognition. Delirium is not an inevitable consequence of critical illness itself, however, it is associated with poor patient outcomes such as an increased ICU length of stay and

  7. Frailty and Delirium in the Elderly Surgical Patient

    OpenAIRE

    Raats, Jelle

    2017-01-01

    markdownabstractThe aims of the research in this thesis were to explore the role of conservative therapies in frail elderly patients in need for (extensive) surgery. Also, delirium incidence and predictive factors of delirium in elderly patients having surgery were examined.

  8. Mental Status Change in the Elderly: Recognizing and Treating Delirium.

    Science.gov (United States)

    Morency, Catherine Reilly

    1990-01-01

    Discusses delirium and how it differs from other types of mental status changes seen in the elderly and what interventions are most appropriate in affected individuals. Presents data from a study regarding nursing assessment of patients with delirium and outlines an educational model. (JOW)

  9. Dementia and delirium, the outcomes in elderly hip fracture patients

    Directory of Open Access Journals (Sweden)

    Mosk CA

    2017-03-01

    Full Text Available Christina A Mosk,1 Marnix Mus,1 Jos PAM Vroemen,1 Tjeerd van der Ploeg,2 Dagmar I Vos,1 Leon HGJ Elmans,3 Lijckle van der Laan1 1Department of Surgery, Amphia Hospital, Breda, 2Department of Public Health, Erasmus MC–University Medical Center, Rotterdam, 3Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands Background: Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium.Methods: This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes.Results: Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9. Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001, increased association with complications (P<0.001, institutionalization (P<0.001, and 6-month mortality (P<0.001. Patients with dementia (N=168 had a

  10. Incidence and risk factors of postoperative delirium in elderly patients undergoing transurethral resection of prostate: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Xue P

    2016-01-01

    Full Text Available Peng Xue,1 Ziyu Wu,2 Kunpeng Wang,1 Chuanquan Tu,1 Xiangbo Wang1 1Department of Urology, First People’s Hospital of Lianyungang, Lianyungang, 2Department of Urology, No 2 Hospital of Huaian, Huaian, Jiangsu Province, People’s Republic of China Aim: The aim of the present study was to investigate the occurrence of postoperative delirium (POD in elderly patients undergoing transurethral resection of prostate (TURP and to identify those factors associated with delirium.Methods: From July 2010 to February 2015, 358 patients, aged ≥65 years and undergoing TURP were prospectively enrolled. Personal, medical and cognitive data, laboratory assessments, pain intensity, preoperative medications, and details of hemodynamic control were collected as predictors of delirium. POD was assessed using the Confusion Assessment Method.Results: In the present study, POD occurred in 28 out of 358 cases (7.8% after TURP, with duration of 1–4 days. The multivariate analysis showed that old age and visual analog scale pain scores were associated with POD. Marital status, body mass index, education, alcohol consumption, smoking history, preoperative psychotropic medication usage, activities of daily living scores, preoperative Mini-Mental Status Examination score, anesthesia type, American Society of Anesthesiologists classification, or hypotensive episodes during surgery did not significantly correlate with the occurrence of POD.Conclusion: Old age and pain intensity after surgery were found as the risk factors for the development of delirium in elderly patients undergoing TURP. These findings might help develop preventive strategies to decrease POD through targeted evaluation. Keywords: elderly, postoperative delirium, risk factors, transurethral resection of prostate

  11. Delirium is associated with early postoperative cognitive dysfunction

    DEFF Research Database (Denmark)

    Rudolph, J.L.; Marcantonio, E.R.; Culley, D.J.

    2008-01-01

    The purpose of this analysis was to determine if postoperative delirium was associated with early postoperative cognitive dysfunction (at 7 days) and long-term postoperative cognitive dysfunction (at 3 months). The International Study of Postoperative Cognitive Dysfunction recruited 1218 subjects......). Postoperative cognitive dysfunction was defined as a composite Z-score > 2 across tests or at least two individual test Z-scores > 2. Subjects with delirium were significantly less likely to participate in postoperative testing. Delirium was associated with an increased incidence of early postoperative...... cognitive dysfunction (adjusted risk ratio 1.6, 95% CI 1.1-2.1), but not long-term postoperative cognitive dysfunction (adjusted risk ratio 1.3, 95% CI 0.6-2.4). Delirium was associated with early postoperative cognitive dysfunction, but the relationship of delirium to long-term postoperative cognitive...

  12. Prevalence of delirium among patients at a cancer ward

    DEFF Research Database (Denmark)

    Grandahl, Mia Gall; Nielsen, Svend Erik; Kørner, Ejnar Alex;

    2016-01-01

    Background Delirium is a frequent psychiatric complication to cancer, but rarely recognized by oncologists. Aims 1. To estimate the prevalence of delirium among inpatients admitted at an oncological cancer ward 2. To investigate whether simple clinical factors predict delirium 3. To examine...... the value of cognitive testing in the assessment of delirium. Methods On five different days, we interviewed and assessed patients admitted to a Danish cancer ward. The World Health Organization International Classification of Diseases Version 10, WHO ICD-10 Diagnostic System and the Confusion Assessment...... Method (CAM) were used for diagnostic categorization. Clinical information was gathered from medical records and all patients were tested with Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test. Results 81 cancer patients were assessed and 33% were diagnosed with delirium. All delirious...

  13. No association between the TaqI A1 RFLP of the D2 receptor gene and alcoholism in a Mexican population

    Energy Technology Data Exchange (ETDEWEB)

    Cruz-Fuentes, C.; Carmarena, B.; Eroza, V. [and others

    1994-09-01

    The suggested association of the A1 allele of the D2 dopamine receptor (DRD2) human gene with alcoholism was studied by comparing the DRD2/TaqI genotypes of 36 healthy controls and 38 individuals who met the DSM-III-R diagnostic criteria for alcohol dependence. All subjects were unrelated, with parents and grandparents of Mexican origin. The alcoholics in our sample suffered one of the following conditions: delirium tremens (16.6%), alcohol hallucinosis (56.6%) or uncomplicated alcohol withdrawal (26.4%). Eight-eight percent of the controls carried the A1 allele. The frequency of the DRD2 A1 allele in the Mexican urban sample (pA1 = 0.61) was 2 to 3-fold higher than reported in Caucasian populations from the USA and Europe, but similar to the allele frequencies found in defined Amerindian populations. There were not significant differences in the prevalence or allele frequency between alcoholics (pA1 = 0.64) and controls, regardless if the alcoholics were subtyped accordingly to severity, age of onset or positive family history. Alcoholics had higher scores than controls in the neuroticism (N) and psychoticism (P) subscales on the Eysenck personality test: alcoholics P = 6.2 {+-} 2.9, N = 16.0 {+-} 4.2 vs. controls P = 2.5 {+-} 2.3, N = 5.7 {+-} 5.1; p<0.001 and p<0.001, respectively. However, no relationship between personality traits and genotypes was found. Our results do not support a consistent association between the TaqI A1 RFLP for the DRD2 gene and alcoholism.

  14. [Effective Dexmedetomidine Administration for the Prevention of Emergence Agitation and Postoperative Delirium in Patients with a History of Postoperative Delirium].

    Science.gov (United States)

    Fujisawa, Takanobu; Komasawa, Nobuyasu; Fujiwara, Atsushi; Kido, Haruki; Minami, Toshiaki

    2016-04-01

    We successfully performed intraoperative dexmedetomidine (DEX) administration for the prevention of emergence agitation or postoperative delirium after lung resection in four patients (71.3 ± 5.7 year old, 3 males and 1 female) with a past history of postoperative delirium. DEX was started at 0.35-0.45 μg x kg(-1) x hr(-1) continuously without loading. The average time from DEX initiation to extubation was 141.3 ± 94.4 minutes. No patient had emergence agitation, and DEX administration was continued until the following morning with monitoring in all patients without any symptoms of delirium. Intraoperative DEX administration may be beneficial for the prevention of emergence agitation or postoperative delirium in patients with a past history of postoperative delirium.

  15. Delirium: uma perspectiva histórica Delirium a historical perspective

    Directory of Open Access Journals (Sweden)

    Priscilla Wacker

    2005-06-01

    Full Text Available O delirium corresponde a uma das primeiras doenças mentais descritas na literatura médica, há mais de 2.500 anos. Nas classificações psiquiátricas, permaneceu como categoria nosológica independente até o final do século XIX, quando foi redefinida com base nos seus aspectos fenomenológicos e etiológicos, precipitando a reclassificação das insanidades funcionais em psicoses. os estados confusionais passaram a se referir a uma síndrome mais ampla que incluía o delirium, enfatizando a desorganização dos processos cognitivos e do pensamento, e tendo no turvamento da consciência e na desorientação temporoespacial a condição de base. Com o objetivo de descrever a evolução histórica do conceito de delirium, foram realizados levantamentos da literatura médica através do sistema Medline, além da pesquisa em publicações literárias específicas sobre os temas história da medicina e história da psiquiatria. Partiu-se de algumas observações dogmáticas praticadas na Antigüidade e Idade Média, para atingir as definições e práticas atuais, oferecendo uma análise crítica dos critérios diagnósticos vigentes (DSM-III, DSM-IIIR, DSM-IV e CID-10. Não obstante a evolução conceitual, o delirium continua sendo mal compreendido, do ponto de vista fisiopatológico e são poucas as opções terapêuticas. o diagnóstico de delirium é ato eminentemente clínico: baseia-se na observação cautelosa das manifestações psíquicas e comportamentais dos pacientes acometidos, além da análise dos fatores predisponentes e precipitantes. É freqüente o seu subdiagnóstico em contextos clínicos e cirúrgicos. o diagnóstico do delirium é estabelecido em apenas 30% a 50% dos pacientes, sendo a omissão diagnóstica menos freqüente em serviços que contam com a interconsulta psiquiátrica. o delirium é uma das complicações mais comuns entre pacientes idosos hospitalizados e está associado a maior morbimortalidade. Isso

  16. Gabapentin for the treatment of ethanol withdrawal.

    Science.gov (United States)

    Voris, John; Smith, Nancy L; Rao, Subba M; Thorne, Diana L; Flowers, Queen J

    2003-06-01

    Benzodiazepines (BZDs) are the drug of choice for the suppression of alcohol withdrawal symptoms. Gabapentin, a drug approved for use as adjunctive therapy in the treatment of partial seizures, has none of the BZD-type difficulties (drug interactions, abuse potential). We retrospectively report on the use of gabapentin for ethanol withdrawal in 49 patients. Thirty-one patients were treated in the outpatient program and 18 in the general inpatient psychiatric unit. Positive outcomes as evidenced by completion of gabapentin therapy were achieved in 25 out of 31 outpatients and 17 out of 18 inpatients. Statistical significance was reached regarding the positive relationship between prior ethanol use and inpatient "as needed" benzodiazepine use. Both sets of data suggest that gabapentin works well for the mild to moderate alcohol withdrawal patient.

  17. Genetic correlations with ethanol withdrawal severity.

    Science.gov (United States)

    Crabbe, J C; Young, E R; Kosobud, A

    1983-01-01

    A major goal of pharmacogenetic research on alcoholism remains the identification of some "marker" that could predict the liability of a particular individual for a genetic susceptibility to develop alcoholism. The present paper presents evidence that the severity of withdrawal from physical dependence on ethanol varies widely among inbred strains of mice, and that withdrawal severity is negatively genetically correlated with initial sensitivity and magnitude of tolerance to ethanol hypothermia. These correlations are supported by differences in hypothermic response between replicate lines of mice genetically selected for susceptibility and resistance to ethanol withdrawal seizures. The genetic relationships reported suggest that the effects of ethanol on thermoregulation in mice may offer a predictive marker for susceptibility to ethanol physical dependence.

  18. Detection of delirium by nurses among long-term care residents with dementia

    Directory of Open Access Journals (Sweden)

    Danjou Christine

    2008-02-01

    Full Text Available Abstract Background Delirium is a prevalent problem in long-term care (LTC facilities where advanced age and cognitive impairment represent two important risk factors for this condition. Delirium is associated with numerous negative outcomes including increased morbidity and mortality. Despite its clinical importance, delirium often goes unrecognized by nurses. Although rates of nurse-detected delirium have been studied among hospitalized older patients, this issue has been largely neglected among demented older residents in LTC settings. The goals of this study were to determine detection rates of delirium and delirium symptoms by nurses among elderly residents with dementia and to identify factors associated with undetected cases of delirium. Methods In this prospective study (N = 156, nurse ratings of delirium were compared to researcher ratings of delirium. This procedure was repeated for 6 delirium symptoms. Sensitivity, specificity, positive and negative predictive values were computed. Logistic regressions were conducted to identify factors associated with delirium that is undetected by nurses. Results Despite a high prevalence of delirium in this cohort (71.5%, nurses were able to detect the delirium in only a minority of cases (13%. Of the 134 residents not identified by nurses as having delirium, only 29.9% of them were correctly classified. Detection rates for the 6 delirium symptoms varied between 39.1% and 58.1%, indicating an overall under-recognition of symptoms of delirium. Only the age of the residents (≥ 85 yrs was associated with undetected delirium (OR: 4.1; 90% CI: [1.5–11.0]. Conclusion Detection of delirium is a major issue for nurses that clearly needs to be addressed. Strategies to improve recognition of delirium could result in a reduction of adverse outcomes for this very vulnerable population.

  19. Delirium in fast-track colonic surgery

    DEFF Research Database (Denmark)

    Kurbegovic, Sorel; Andersen, Jens; Krenk, Lene

    2015-01-01

    BACKGROUND: Postoperative delirium (PD) is a common but serious problem after major surgery with a multifactorial pathogenesis including age, pain, opioid use, sleep disturbances and the surgical stress response. These factors have been minimised by the "fast-track methodology" previously...... demonstrated to enhance recovery and reduce morbidity. METHODS: Clinical symptoms of PD were routinely collected three times daily from preoperatively until discharge in a well-defined enhanced recovery program after colonic surgery in 247 consecutive patients. RESULTS: Total median length of hospital stay...... postoperative recovery program may decrease the risk and duration of PD after colonic surgery....

  20. 酒精戒断综合征:机制、评估及药物治疗进展%Alcohol Withdrawal Syndrome:Updates on Mechanism, Assessment and Pharmacotherapy

    Institute of Scientific and Technical Information of China (English)

    杨雪; 盛利霞; 郝伟; 汤宜朗

    2014-01-01

    Objective:To review the updates on mechanism of,and assessment and pharmacotherapy for alcohol Withdrawal syn-drome(AWS). Methods:Literature review and hand-picked literature. Results:We reviewed the time-course,mechanism(espe-cially mechanism related to GABA and NMDA systems),assessment and medications for AWS. Detailed discussions are provided re-garding fixed-dosed and symptom-triggered methods when using benzodiazepines for AWS. Role of other medications is also discussed. Conclusion:AWS is common and of diagnostic value in alcohol dependence. Alterations in GABA/ NMDA system after prolonged ex-posure to alcohol is believed to be the primary mechanism for AWS and long-acting benzodiazepines are the first-line pharmacotherapy, though other medications have been tried. Either fixed-dose or symptom-triggered method can be used,depending on the setting,clini-cians’preference and staff training.%目的:介绍酒精戒断综合征(AWS)的机制、评估及药物治疗方面的进展。方法:对近年相关文献进行复习。结果:本文对 AWS 的时程、机制(尤其是涉及 GABA 及 NMDA 递质系统)、评估及药物治疗进行了介绍。详细讨论了固定剂量法及对症给药法的具体细节。对其他药物的使用也略有介绍。结论:AWS 比较常见且对酒精将具有诊断意义。长期饮酒导致的GABA/ NMDA 系统的改变是 AWS 的主要机制,长效苯二氮□类药是控制 AWS 的一线药物,不过其他药物也有使用。具体是使用固定剂量法还是对症给药法则以治疗环境、医生的偏好以及员工的培训情况而定。

  1. Melatonin and melatonin agonist for delirium in the elderly patients.

    Science.gov (United States)

    Chakraborti, Dwaipayan; Tampi, Deena J; Tampi, Rajesh R

    2015-03-01

    The objective of this review is to summarize the available data on the use of melatonin and melatonin agonist for the prevention and management of delirium in the elderly patients from randomized controlled trials (RCTs). A systematic search of 5 major databases PubMed, MEDLINE, PsychINFO, Embase, and Cochrane Library was conducted. This search yielded a total of 2 RCTs for melatonin. One study compared melatonin to midazolam, clonidine, and control groups for the prevention and management of delirium in individuals who were pre- and posthip post-hip arthroplasty. The other study compared melatonin to placebo for the prevention of delirium in older adults admitted to an inpatient internal medicine service. Data from these 2 studies indicate that melatonin may have some benefit in the prevention and management of delirium in older adults. However, there is no evidence that melatonin reduces the severity of delirium or has any effect on behaviors or functions in these individuals. Melatonin was well tolerated in these 2 studies. The search for a melatonin agonist for delirium in the elderly patients yielded 1 study of ramelteon. In this study, ramelteon was found to be beneficial in preventing delirium in medically ill individuals when compared to placebo. Ramelteon was well tolerated in this study.

  2. Delirium in hospitalized elderly patients and post-discharge mortality

    Directory of Open Access Journals (Sweden)

    Danielle Pessoa Lima

    2010-01-01

    Full Text Available OBJECTIVE: To determine the impact of delirium on post-discharge mortality in hospitalized older patients. INTRODUCTION: Delirium is frequent in hospitalized older patients and correlates with high hospital mortality. There are only a few studies about its impact on post-discharge mortality. METHODS: This is a prospective study of patients over 60 years old who were hospitalized in the Geriatric Unit at Hospital das Clínicas of São Paulo between May 2006 and March 2007. Upon admission, demographics, comorbidities, number of drugs taken, and serum albumin concentration were evaluated for each patient. Delirium was diagnosed according to the DSM-IV criteria. Patients were divided into group A (with delirium and group B (without delirium. One year after discharge, the patients or their caregivers were contacted to assess days of survival. RESULTS: The sample included 199 patients, 66 (33% of whom developed delirium (Group A. After one year, 33 (50% group A patients had died, and 45 (33.8% group B patients had died (p = 0.03. There was a significant statistical difference in average age (p = 0.001 and immobility (p 80 years (p = 0.029, albumin concentration < 3.5 g/dl (p = 0.001 and immobility (p = 0.007. CONCLUSION: Delirium is associated with higher post-discharge mortality as a dependent predictor.

  3. Knowns and Unknowns About Delirium in Stroke: A Review.

    Science.gov (United States)

    Klimiec, Elzbieta; Dziedzic, Tomasz; Kowalska, Katarzyna; Slowik, Agnieszka; Klimkowicz-Mrowiec, Aleksandra

    2016-12-01

    Delirium is a transient condition characterized by sudden and fluctuating disturbances in cognitive function. The condition can be considered a sign of the brain's vulnerability and diminished resilience to insult. Among the many clinical manifestations are cognitive, psychomotor, and sleep disturbances. Delirium is associated with longer hospital stays, worse functional outcomes, and higher mortality. Although up to 48% of patients who have had a stroke develop delirium, the condition has been studied much less in these patients than in general medicine, surgical, and intensive care patients. Coexisting neurologic deficits in patients with stroke limit the use of screening tools that are widely accepted in other populations. The variability of reported assessment methods highlights the need for delirium screening guidelines in stroke. Further, risk factors that are specific to stroke may play an important role in the etiology of delirium, along with such well-known factors as older age and infections. The delirium literature lacks data on differences in clinical manifestations and course in the various types of stroke. Here we review predisposing factors, diagnostic methods, and biomarkers of delirium in stroke and discuss aspects that need further research.

  4. EFFICACY AND ADVERSE EFFECTS OF DIAZEPAM OF DIFFERENT DOSES FOR ALCOHOL WITHDRAWAL SYNDROME%不同剂量地西泮治疗酒依赖戒断综合征疗效和副作用比较

    Institute of Scientific and Technical Information of China (English)

    闫社因; 龙瑞芳; 牛艳; 陈家民; 任海岗

    2011-01-01

    目的:比较不同剂量地西泮治疗酒依赖戒断综合征的疗效和副作用.方法:将94例酒依赖戒断综合征患者随机分为高(38% (V/V)白酒500 ml·d-1=地西泮40 mg·d-1)、中等(38% (V/V)白酒500 ml · d-1=地西泮30mg·d-1)、低(38%(V/V)白酒500 ml·d-1=地西泮20 mg·d-1)剂量三组,按不同换算模式计算地西泮剂量.用酒精戒断综合征评定量表(AWS)评定疗效.用自编的《地西泮替代治疗副作用记录单》详细记录治疗过程中出现的不良事件.结果:治疗后d1,d2,d3,d5各组与治疗前AWS评分比较,除低剂量组治疗d1与治疗前比较差异无显著性外(P>0.05),其余各组各天差异均有显著性(P =0.001).治疗后高、中等剂量组之间AWS评分差异无显著性(P>0.05).治疗d1,d2,d3高、中等剂量组AWS评分明显低于低剂量组,差异有显著性(P<0.001).治疗d5三组间AWS评分差异无显著性(P>0.05).治疗中出现的不良事件记录显示,高剂量组较低剂量组过度镇静,肌无力共济失调的发生率明显高,差异均有显著性(x2 =8.036,P=0.008; x2 =4.778,P=0.041).结论:高、中等剂量地西泮治疗酒依赖戒断综合征较低剂量疗效好,高、中等剂量组副作用虽较低剂量组明显,但未见严重毒副作用.%Objective; To study the efficacy and adverse effects of diazepam of different doses for alcohol withdrawal syndrome. Methods-.Ninety -four patients with alcohol dependence were randomly divided into three groups treated with high, medium, low doses of diazepam according to the different conversion pattems(38% (V/V) alcohol 500 ml·d"1 = diazepam 40 mg·d-1,30 mg·d-1 and 20 mg·d-1, respectively). The efficacy and adverse effects were assessed with alcohol withdrawal syndrome( AWS) and self - made adverse effects records of diazepam replacement therapy, respectively. Results: Except the low dose group on day 1 ,the AWS scores obtained on treatment dayl ,day2,day3 ,day5 in each group showed

  5. 危重患者谵妄发生的危险因素分析%Analysis of risk factors of delirium in critically ill patients

    Institute of Scientific and Technical Information of China (English)

    冯传江; 姚琴琴; 欧丹丹; 王雅楠; 李澜涛; 袁荆; 鲁卫华; 金孝岠

    2016-01-01

    Objective To investigate the risk factors of ICU delirium in critically ill patients. Methods A total of 1 74 critically ill patients in ICU who were older than 18 yrs and stayed in ICU exceeding 24 hs from January 201 5 to June 201 5 were enrolled.Patients were divided into delirium group and non delirium group.Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM-ICU)during the first 7 days.The factors such as history of alcoholism and other 12 factors were analyzed by univariate and multivariate logistic regression analysis to identify those risk factors associated with delirium.Results With 22 cases of delirium in 1 74 patients,the in-cidence of delirium was 12.64% (delirium group).Variables associated with delirium were coronary heart history,operation,tracheal intubation,clinical use of mechanical ventilation,hypoxemia and Benzodiazepine.Multivariate logistic regression analysis showed that coronary heart disease (OR 3.932,95%CI 1.225-12.61 7),surgery(OR 9.691,95%CI 2.103-44.657),hypoxemia(OR 6.595, 95%CI 1.377-31.585),Benzodiazepine use (OR 7.620,95%CI 1.713-33.899)was independent risk factors of delirium in critically ill patients (P < 0.05 or P < 0.01 ).Conclusion Coronary heart disease,surgery,hypoxemia and Benzodiazepine are independent risk factors of ICU delirium in criti-cally ill patients.Early screening and prevention of delirium should be given to reduce the occurrence of delirium for patients in ICU.%目的:探讨危重患者 ICU 谵妄发生的危险因素。方法选择2015年1~6月我院ICU 收治的年满18周岁,ICU 停留时间大于24 h 的174例患者,采用 CAM-ICU 每天两次对患者进行评估,并将患者分为谵妄组与非谵妄组。采用单因素和多因素 logistic 回归对酗酒史等12个因素与谵妄发生之间的关系进行分析。结果174例患者中谵妄发生率为22例(12.64%)(谵妄组),非谵妄组为152例(87.36%)。Logistic 回归分析结果显示:冠心病史(OR 3

  6. Documentation of delirium in elderly patients with hip fracture.

    Science.gov (United States)

    Milisen, Koen; Foreman, Marquis D; Wouters, Bert; Driesen, Ronny; Godderis, Jan; Abraham, Ivo L; Broos, Paul L O

    2002-11-01

    This study determined the accuracy of diagnosis and documentation of delirium in the medical and nursing records of 55 elderly patients with hip fracture (mean age = 78.4, SD = 8.4). These records were reviewed retrospectively on a patient's discharge for diagnosis of delirium, and for description of clinical indicators or symptoms of delirium. Additionally, all patients were monitored by one of the research members on days 1, 3, 5, 8, and 12 postoperatively for signs of delirium, as measured by the Confusion Assessment Method (CAM). Clinicians were blinded to the purpose of the study. According to the CAM criteria, the incidence of delirium was 14.5% on postoperative Day 1; 9.1% on postoperative Day 3; 10.9% on postoperative Day 5; 7.7% on postoperative Day 8; and 5.6% on postoperative Day 12. For those same days, no formal diagnosis of delirium or a description of clinical indicators was found in the medical records. In the nursing records, a false-positive documentation of 8.5%, 4%, 4.1%, 4.2%, and 5.9%, respectively was noted. False-negative documentation was found in 87.5%, 80%, 66.7%, 75%, and 50% of the cases on the respective days. Documentation of essential symptoms--namely onset and course of the syndrome--and disturbances in consciousness, attention, and cognition, were seldom or never found in the nursing records. However, behaviors of the hyperactive variant of delirium and which are known to interfere with nursing care were documented more often (e.g., 13.4% restless, 10.3% fidget with materials, 7.2% annoying behavior). Both medical and nursing records showed poor documentation and under-diagnosis of delirium. However, a correct diagnosis and early recognition of delirium may enhance the management of this syndrome.

  7. Risk factors for postoperative delirium in patients undergoing spine operation under total intravenous anesthesia%全凭静脉麻醉下脊柱手术患者术后谵妄的危险因素

    Institute of Scientific and Technical Information of China (English)

    张承华; 麻伟青; 杨云丽; 董发团; 王慧明; 魏辉明

    2010-01-01

    Objective To investigate the risk factors for postoperative delirium in patients undergoing spine operation under total intravenous anesthesia. Methods Two hundred patients undergoing elective spine operation were included in this study. Patients' perioperative informations were recorded. The diagnosis of delirium was based on Confusion Assessment Method (CAM). The patients were divided into 2 groups according to the occurrence of delirium within 3 days after operation: postoperative delirium group and no postoperative delirium group. Multivariate logistic regression was used to analyze the risk factors for postoperative delirium. Results Postoperative delirium developed in 39 patients during the first three postoperative days. The incidence of postoperative delirium was 19.5%. The logistic stepwise regression analysis indicated that the risk factors for delirium included age, intraoperative blood loss and alcohol abuse. Conclusion Age, large amount of intraoperative blood loss and alcohol abuse are risk factors for postoperative delirium in patients undergoing spine operation under total intravenous anesthesia.%目的 筛选全凭静脉麻醉下脊柱手术患者发生术后谵妄的危险因素.方法 择期行脊柱手术患者200例,年龄18~70岁,根据术后3 d内是否发生谵妄分为术后谵妄组和非术后谵妄组.可疑危险因素进行组间比较后,将差异有统计学意义的因素进行logistic回归分析,筛选发生术后谵妄的危险因素.结果 39例患者术后发生谵妄,发生率为19.5%.logistic回归分析结果显示,年龄、术中失血量、经常饮酒是发生术后谵妄的独立危险因素(P<0.05).相对危险度依次为1.882、0.999、1.715.结论 老龄、术中大量失血、长期饮酒是全凭静脉麻醉下脊柱手术患者发生术后谵妄的危险因素.

  8. Patient with intractable delirium successfully treated with electroconvulsive therapy

    DEFF Research Database (Denmark)

    Lindgren, Eske; Hageman, Ida

    2014-01-01

    Delirium is a frequent and serious condition often seen in hospitalized patients, especially the elderly. Treatment of the somatic illness causing the delirium, and antipsychotic medication will usually resolve the condition. Sometimes, however, the condition is refractory towards medical treatment...... and in this situation electroconvulsive therapy (ECT) can be a quick and efficient treatment. In this case report of a 26-year-old man a post-operative intractable delirium persisting for three weeks was efficiently and swiftly relieved by three consecutive ECTs. The patient was discharged without need for further...

  9. Thyroid Storm in Postoperative Delirium Etiology: Case Report

    Directory of Open Access Journals (Sweden)

    Nermin Kelebek Girgin

    2016-08-01

    Full Text Available Delirium is an acute organic brain syndrome of different physical and pathophysiological etiologies characterized by a disturbance in consciousness with accompanying change in cognition. Delirium causes prolonged length of stay in hospital and intensive care unit, also increased morbidity and mortality. Thyroid storm is a severe, life-threatening type of thyrotoxicosis and is one of a few endocrine disorders that cause delirium. It is mostly occured suddenly after acute infection, surgical stress or trauma. This condition occurs due to excess production of thyroid hormone and 20-50% mortality rate depends on early diagnosis and treatment. In this study it was aimed to present the diagnosis and treatment of a previously unknown hyperthyroid patient who underwent suspension laryngoscopy under general anesthesia and was post-operatively admitted to the intensive care unit because of pulmonary edema and proceeded to develop severe delirium caused by hyrotoxicosis.

  10. [Delirium prevention and treatment in elderly hip fracture].

    Science.gov (United States)

    Robles, María José; Formiga, Francesc; Vidán, M Teresa

    2014-04-22

    The fracture of the proximal femur or hip fracture in the elderly usually happens after a fall and carries a high morbidity and mortality. One of the most common complications during hospitalization for hip fracture is the onset of delirium or acute confusional state that in elderly patients has a negative impact on the hospital stay, and prognosis, worsening functional ability, cognitive status and mortality. Also the development of delirium during hospitalization increases health care costs. Strategies to prevent and treat delirium during hospitalization for hip fracture have been less studied. In this context, this paper aims to conduct a review of the literature on strategies that exist in the prevention and treatment of delirium in elderly patients with hip fracture.

  11. Delirium after a traumatic brain injury: predictors and symptom patterns

    Science.gov (United States)

    Maneewong, Jutaporn; Maneeton, Benchalak; Maneeton, Narong; Vaniyapong, Tanat; Traisathit, Patrinee; Sricharoen, Natthanidnan; Srisurapanont, Manit

    2017-01-01

    Background Delirium in traumatic brain injury (TBI) is common, may be predictable, and has a multifaceted symptom complex. This study aimed to examine: 1) the sum score of Glasgow Coma Scale (GCS) and if its component scores could predict delirium in TBI patients, and 2) the prominent symptoms and their courses over the first days after TBI. Methods TBI patients were recruited from neurosurgical ward inpatients. All participants were hospitalized within 24 hours after their TBI. Apart from the sum score of GCS, which was obtained at the emergency department (ED), the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for delirium were applied daily. The severity of delirium symptoms was assessed daily using the Delirium Rating Scale – Revised-98 (DRS-R-98). Results The participants were 54 TBI patients with a mean GCS score of 12.7 (standard deviation [SD] =2.9). A total of 25 patients (46.3%) met the diagnosis of delirium and had a mean age of 36.7 years (SD =14.8). Compared with 29 non-delirious patients, 25 delirious patients had a significantly lower mean GCS score (P=0.04), especially a significantly lower verbal component score (P=0.03). Among 18 delirious patients, four symptoms of the DRS-R-98 cognitive domain (orientation, attention, long-term memory, and visuospatial ability) were moderate symptoms (score ≥2) at the first day of admission. After follow-up, three cognitive (orientation, attention, and visuospatial ability) and two noncognitive symptoms (lability of affect and motor agitation) rapidly resolved. Conclusion Almost half of patients with mild to moderate head injuries may develop delirium in the first 4 days after TBI. Those having a low GCS score, especially the verbal component score, at the ED were likely to have delirium in this period. Most cognitive domains of delirium described in the DRS-R-98 were prominent within the first 4 days of TBI with delirium. Three cognitive and two noncognitive

  12. [Delirium in elderly inpatients. An 18 month follow-up].

    Science.gov (United States)

    Vázquez, Fernando J; Benchimol, Javier; Giunta, Diego; Cafferata, Carlos; Freixas, Antonio; Vallone, Marcelo; Andresik, Diego; Pollan, Javier; Aprile, Ana; Lorenzo, Jimena; Waisman, Gabriel; Camera, Luis

    2010-01-01

    Delirium usually hardens care during hospitalization and increases morbidity during hospital stay and after discharge. The objective of this study was to describe the prevalence of delirium in elderly inpatients in a Buenos Aires hospital, its morbidity and mortality during hospital stay and the next 18 month follow-up. Patients aged 70 or older admitted to internal medicine unit between September 2005 and May 2006 were enrolled. Delirium was assessed with the Spanish version of Confusion Assessment Method. Demographic data, cause of admition and length of stay, destination after discharge and mortality were registered. A new evaluation was made 18 months after discharge. We evaluated 194 patients and 74 were excluded. Of the 120 included, 52 (43.3%) presented delirium. We found significant differences between patients with and without delirium in previous placement in nursing home (17.3% vs. 1.5%; p < 0.002), dementia (40.4% vs. 8.8%; p < 0.001), median activity of daily living (5 vs. 6; p < 0.001), length-of-stay (7 vs. 5; p = 0.04) and mortality rate (21.2% vs. 1.5%; p < 0.001). Evaluation 18 months later showed differences between patients with and without delirium in median of activity of daily living (1/6 vs. 5/6), patients living in nursing homes (27.5% vs. 7.9%), estimated survival 35.3% (CI 95%: 24-49%) at day 569 and 49% (CI 95%: 32.9-65.4%) at day 644. The difference between survival curves was statistically significant (p = 0.027). Delirium increases morbidity and mortality during hospital stay. Elderly with delirium are at risk of worsening disability and of becoming dependent after discharge and it is a risk factor for higher mortality during the following months after discharge.

  13. In-hospital delirium risk assessment, diagnosis and management; medications to avoid

    Directory of Open Access Journals (Sweden)

    Andrew Clegg

    2013-03-01

    Full Text Available Background: Delirium is a common, but potentially preventable complication of acute illness that is associated with important adverse outcomes including increased length of hospital admission, risk of dementia and admission to long-term care. In-hospital risk assessment and diagnosis: Age over 65, severe illness, current hip fracture and presence of cognitive impairment or dementia are important risk factors for delirium. Assess people with any of these risk factors for recent changes or fluctuations in behaviour that might indicate delirium. If any indicators are present, complete a full cognitive assessment to confirm the diagnosis of delirium. In-hospital risk management: Multicomponent delirium prevention interventions can reduce the incidence of delirium in hospital by around one third and should be provided to people with any of the important risk factors that do not have delirium at admission. A medication review that considers both the number and type of prescribed medications is an important part of the multicomponent delirium prevention intervention. Which medications to avoid in people at risk of delirium: For people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H1 antagonists for people at risk of delirium and considered individual patient assessment is advocated. Conclusion: Delirium is common, distressing to patients, relatives and carers and is associated with important adverse outcomes. Multicomponent delirium prevention interventions can reduce the incidence of delirium by approximately one third and usually incorporate a medication review. Identification of which medications to avoid in people at

  14. Symptoms of Posttraumatic Stress after Intensive Care Delirium

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    Helle Svenningsen

    2015-01-01

    Full Text Available Introduction. Long-term psychological consequences of critical illness are receiving more attention in recent years. The aim of our study was to assess the correlation of ICU-delirium and symptoms of posttraumatic stress disorder (PTSD anxiety and depression after ICU-discharge in a Danish cohort. Methods. A prospective observational cohort study assessing the incidence of delirium in the ICU. Psychometrics were screened by validated tools in structured telephone interviews after 2 months (n=297 and 6 months (n=248 after ICU-discharge. Results. Delirium was detected in 54% of patients in the ICU and symptoms of PTSD in 8% (2 months and 6% (6 months after ICU-discharge. Recall of ICU stay was present in 93%. Associations between ICU-delirium and post-discharge PTSD-symptoms were weak and insignificant. Memories of delusions were significantly associated with anxiety after two months. Remaining associations between types of ICU-memories and prevalence of post-discharge symptoms of PTSD, anxiety, and depression were insignificant after adjusting for age. Incidence of ICU-delirium was unaffected by preadmission use of psychotropic drugs. Prevalence of PTSD-symptoms was unaffected by use of antipsychotics and sedation in the ICU. Conclusion. ICU-delirium did not increase the risk of PTSD-symptoms at 2 and 6 months after ICU discharge.

  15. Delirium as a marker of vulnerability in the elderly

    Directory of Open Access Journals (Sweden)

    Giuseppe Bellelli

    2015-11-01

    Full Text Available Delirium is the clinical expression of an acute cerebral dysfunction caused by various noxious insults. Its prevalence is very high in the elderly, especially in the hospital setting, and in geriatric patients it can be the clinical manifestation of almost every acute disease. Delirium is associated to a number of adverse clinical and functional outcomes, to a higher risk of cognitive decline, institutionalization, and short- and long-term mortality. It is thus necessary to increase the attention on this issue: in fact, it is clearly demonstrated that delirium can be prevented in a large proportion of cases. Delirium is not only a marker of patient vulnerability and clinical instability, but also an index of the quality of care and the efficiency of its organization. By systematically assessing the presence of delirium during the whole length of hospital stay, physicians may closely monitor the patient’s clinical status. The aims of this review are to review the current clinical practice in delirium, focusing particularly on elderly individuals. The topics covered include epidemiology and outcomes, causes, clinical features and diagnosis, prevention and treatment. Finally, implications for clinical practice are discussed.

  16. Relationship between alcohol craving levels and sleep disorders in the initial stage of withdrawal of alcohol dependence patients%酒依赖患者戒断初期酒精渴求程度与睡眠障碍的关系

    Institute of Scientific and Technical Information of China (English)

    杜好瑞; 李拴荣; 穆俊林; 徐建强; 王传升; 崔二龙; 李冲

    2014-01-01

    Objective To explore the characteristic of sleep disorders in the initial stage of withdrawal and their relationships with alcohol craving levels in alcohol dependence (AD) patients,and provide support for diagnosis and prevention of re-drinking.Methods Thirty-two AD inpatients were assigned to AD group and 20 male healthy volunteers to control group.Alcohol craving was assessed with the Pennsylvania Alcohol Craving Scale (PACS) within the 2nd week after alcohol withdrawal for AD patients,and then the whole-night polysomnogram (PSG) tracings were conducted on the day of the night.Results The five item scores of the PACS were from 3.48 to 4.26 in AD patients.The sleep latency was(42.48±22.42) min,total sleep time was(289.61± 103.22)min,sleep efficiency was(71.45± 19.86) %,S1 sleep was (23.47± 11.07) %,arousal frequencies was (8.01 ± 2.77),S3+4 sleep was(6.26±5.35)% in AD group.Compared with control group((19.65±8.57) min,(407.33±21.29) min,(81.52 ± 6.46) %,(8.79± 1.83) %,(2.17 ± 1.04),(15.87 ± 5.24) % respectively),the differences had statistical significances(t=2.206-9.082,P< 0.05-0.001).Alcohol craving levels were positively related to sleep latency,arousal frequencies and S1 sleep (r=0.424-0.898,P<0.05-0.01) and negatively to total sleep time,sleep efficiency and S3+4 sleep (r=-0.416--0.662,P<0.05-0.01) in AD group.Conclusion AD patients have sleep continuity and structure disturbances in the initial stage of alcohol withdrawal,sleep continuity and structure disturbances are related to alcohol craving.Improvements of sleep disorders should be paid during clinical alcohol dependence treatment.%目的 探讨酒依赖患者酒精戒断初期睡眠障碍的特点,及其与饮酒渴求程度的关系,为临床诊治和防止复饮提供帮助.方法 以32例住院治疗的酒依赖患者为酒依赖组,20例男性健康志愿者为对照组,在酒精戒断后第2周内,酒依赖组采用宾夕

  17. A new delirium phenotype with rapid high amplitude onset and nearly as rapid reversal: Central Coast Australia Delirium Intervention Study

    Directory of Open Access Journals (Sweden)

    Regal PJ

    2015-02-01

    Full Text Available Paul J RegalGeriatric Medicine, University of Newcastle, Callaghan, AustraliaBackground: Traditional models for delirium based on the Diagnostic and Statistical Manual for Mental Disorders and its 1990 offspring, the Confusion Assessment Method (CAM, were not designed to distinguish behavioral and psychological symptoms of dementia from rapid cognitive decline. We examined a new diagnostic criterion for delirium plus exclusion of behavioral and psychological symptoms of dementia and recent inattention with a 25% decline in digit span forward (DSF.Methods: This was a prospective, randomized controlled trial comparing management of prevalent delirium in general medical with that in geriatric medical wards in a 370-bed hospital north of Sydney. Inclusion criteria were age ≥65 years and prevalent delirium in the emergency department based on: CAM; proof that CAM elements were not better explained by behavioral and psychological symptoms of dementia; proof of recent inattention on DSF; evidence of cognitive decline not due to sedatives or antipsychotics in the emergency department. Measurements included the Instrumental Activities of Daily Living (IADL, 22-item, Selective IADL (8-item, Mini-Mental State Examination, DSF daily, Delirium Index daily, and Apathy Evaluation Scale. Pre-delirium scores from past cognitive tests and best scores were imputed after admission. Relative change (RC was calculated as absolute change/test range and RC/MPC ratio was calculated as RC after admission/maximal possible change.Results: A total of 130 subjects were recruited but 14 with subsyndromal delirium were excluded, leaving 116 subjects (mean age 83.6 years. Forty-eight percent had prior dementia. RC from pre-delirium to admission was 42% for the Mini-Mental State Examination, 41% for Selective IADL, 34% for 5-DSF, 54% for 6-DSF, and 37% for the Apathy Evaluation Scale. Improvements after admission (RC and RC/MPC ratios were 32%/98% for 5-DSF, 54%/82% for 6-DSF

  18. Delirium in the hospital, a narrative review

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    Felipe Martínez Lomakin

    2013-04-01

    Full Text Available Delirium is a common complication in hospitalized patients, particularly the elderly and those with cognitive impairment. It has been associated with higher mortality, prolonged hospitalization, cognitive impairment, higher rates of institutionalization at discharge and higher costs for healthcare systems. Its pathophysiology is poorly understood, and more recently a predominantly inflammatory origin has been proposed, which could explain its pervasiveness and association with underlying conditions. Clinically, it is characterized by acute onset with fluctuating course, inattention, disorganized thinking and altered level of consciousness. Diagnostic approach is based on the systematic search for triggering factors as well as the manifestations of the syndrome. Symptomatic treatment is based neuroleptics as first line treatment, and lorazepam when the former cannot be used or there are special indications. There is evidence that the condition can be prevented by resorting to multi-component strategies.

  19. Biomarkers of postoperative delirium and cognitive dysfunction

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    Ganna eAndrosova

    2015-06-01

    Full Text Available Elderly surgical patients frequently experience postoperative delirium (POD and the subsequent development of postoperative cognitive dysfunction (POCD. Clinical features include deterioration in cognition, disturbance in attention and reduced awareness of the environment and result in higher morbidity, mortality and greater utilization of social financial assistance. The aging Western societies can expect an increase in the incidence of POD and POCD. The underlying pathophysiological mechanisms have been studied on the molecular level albeit with unsatisfying small research efforts given their societal burden. Here, we review the known physiological and immunological changes and genetic risk factors, identify candidates for further studies and integrate the information into a draft network for exploration on a systems level. The pathogenesis of these postoperative cognitive impairments is multifactorial; application of integrated systems biology has the potential to reconstruct the underlying network of molecular mechanisms and help in the identification of prognostic and diagnostic biomarkers.

  20. Benzodiazepine dependence: focus on withdrawal syndrome.

    Science.gov (United States)

    Authier, N; Balayssac, D; Sautereau, M; Zangarelli, A; Courty, P; Somogyi, A A; Vennat, B; Llorca, P-M; Eschalier, A

    2009-11-01

    Benzodiazepines are potentially addictive drugs: psychological and physical dependence can develop within a few weeks or years of regular or repeated use. The socioeconomic costs of the present high level of long-term benzodiazepine use are considerable. These consequences could be minimised if prescriptions for long-term benzodiazepines were decreased. However, many physicians continue to prescribe benzodiazepines and patients wishing to withdraw receive little advice or support. Particular care should be taken in prescribing benzodiazepines for vulnerable patients such as elderly persons, pregnant women, children, alcohol- or drug-dependent patients and patients with comorbid psychiatric disorders. The following update gives recent research results on the withdrawal pathophysiology and practical information in order to treat or prevent benzodiazepine withdrawal syndrome.

  1. Fluctuations in sedation levels may contribute to delirium in ICU patients

    DEFF Research Database (Denmark)

    Svenningsen, H; Egerod, Ingrid Eugenie; Videbech, P;

    2013-01-01

    Delirium in patients admitted to the intensive care unit (ICU) is a serious complication potentially increasing morbidity and mortality. The aim of this study was to investigate the impact of fluctuating sedation levels on the incidence of delirium in ICU.......Delirium in patients admitted to the intensive care unit (ICU) is a serious complication potentially increasing morbidity and mortality. The aim of this study was to investigate the impact of fluctuating sedation levels on the incidence of delirium in ICU....

  2. Dexmedetomidine infusion to facilitate opioid detoxification and withdrawal in a patient with chronic opioid abuse

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    Surjya Prasad Upadhyay

    2011-01-01

    Full Text Available Many patients are admitted to the intensive care unit (ICU for acute intoxication, serious complication of overdose, or withdrawal symptoms of illicit drugs. An acute withdrawal of drugs with addiction potential is associated with a sympathetic overactivity leading to marked psychomimetic disturbances. Acute intoxication or withdrawal of such drugs is often associated with life-threatening complications which require ICU admission and necessitate prolonged sedative analgesic medications, weaning from which is often complicated by withdrawal and other psychomimetic symptoms. Dexmedetomidine, an alpha-2 (α2 agonist, has been used successfully to facilitate withdrawal and detoxification of various drugs and also to control delirium in ICU patients. Herein, we report a case of a chronic opioid abuse (heroin patient admitted with acute overdose complications leading to a prolonged ICU course requiring sedative-analgesic medication; the drug withdrawal-related symptoms further complicated the weaning process. Dexmedetomidine infusion was successfully used as a sedative-analgesic to control the withdrawal-related psychomimetic symptoms and to facilitate smooth detoxification and weaning from opioid and other sedatives.

  3. Risk factors and outcomes for postoperative delirium after major surgery in elderly patients

    NARCIS (Netherlands)

    J.W. Raats (Jelle); W.A. Van Eijsden (Wilbert A.); R.M.P.H. Crolla (Rogier); E.W. Steyerberg (Ewout); L. van der Laan (Lyckle)

    2015-01-01

    textabstractBackground: Early identification of patients at risk for delirium is important, since adequate well timed interventions could prevent occurrence of delirium and related detrimental outcomes. The aim of this study is to evaluate prognostic factors for delirium, including factors describin

  4. Occurrence of delirium is severely underestimated in the ICU during daily care

    NARCIS (Netherlands)

    Spronk, P.E.; Riekerk, B.; Hofhuis, J.; Rommes, J.H.

    2009-01-01

    Delirium is associated with prolonged intensive care unit (ICU) stay and higher mortality. Therefore, the recognition of delirium is important. We investigated whether intensivists and ICU nurses could clinically identify the presence of delirium in ICU patients during daily care. All ICU patients i

  5. Alcoholism and Alcohol Abuse

    Science.gov (United States)

    ... their drinking causes distress and harm. It includes alcoholism and alcohol abuse. Alcoholism, or alcohol dependence, is a disease that causes ... groups. NIH: National Institute on Alcohol Abuse and Alcoholism

  6. Homocysteine and alcoholism.

    Science.gov (United States)

    Bleich, S; Degner, D; Javaheripour, K; Kurth, C; Kornhuber, J

    2000-01-01

    Chronic alcohol consumption can induce alterations in the function and morphology of most if not all brain systems and structures. However, the exact mechanism of brain damage in alcoholics remains unknown. Partial recovery of brain function with abstinence suggests that a proportion of the deficits must be functional in origin (i.e. plastic changes of nerve cells) while neuronal loss from selected brain regions indicates permanent and irreversible damage. There is growing evidence that chronic alcoholism is associated with a derangement in the sulfur amino acid metabolism. Recently, it has been shown that excitatory amino acid (EAA) neurotransmitters and homocysteine levels are elevated in patients who underwent withdrawal from alcohol. Furthermore, it has been found that homocysteine induces neuronal cell damage by stimulating NMDA receptors as well as by producing free radicals. Homocysteine neurotoxicity via overstimulation of N-methyl-D-aspartate receptors may contribute to the pathogenesis of both brain shrinkage and withdrawal seizures linked to alcoholism.

  7. Delirium: moving beyond the clinical diagnosis Delirium: além do diagnóstico clínico

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    Brett S Coulson

    2002-04-01

    Full Text Available Delirium is a common mental disorder that has been associated with increased length of hospital stay and health costs, as well as higher morbidity and mortality rates in later life. To date, psychiatric interventions have mostly been limited to the clinical diagnosis of delirium and treatment of the behavioural and psychological complications of the acute episode, although this seems to have a negligible impact on the course and long-term outcome of patients. This paper reviews the development of recent strategies designed to reduce the incidence and complications of delirium, and proposes that an effective management plan must always include the basic components of primary, secondary and tertiary prevention.Delirium é um transtorno mental comum que tem sido associado a permanência hospitalar prolongada, aumento nos custos com cuidados médicos e maior morbidade e mortalidade entre idosos. De forma geral, o manejo de pacientes tem se limitado ao tratamento das complicações advindas do episódio agudo e dos distúrbios comportamentais e psicológicos associados ao delirium, embora isto pareça ter um impacto desprezível sobre o curso da doença e o prognóstico dos pacientes no longo prazo. Este artigo revisa o desenvolvimento de estratégias desenhadas com o objetivo de reduzir a incidência e as complicações clínicas do delirium e propõe que um tratamento efetivo de pacientes com delirium deve sempre incluir medidas básicas de prevenção primária, secundária e terciária.

  8. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors.

    Science.gov (United States)

    Kain, Zeev N; Caldwell-Andrews, Alison A; Maranets, Inna; McClain, Brenda; Gaal, Dorothy; Mayes, Linda C; Feng, Rui; Zhang, Heping

    2004-12-01

    Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

  9. Delirium in the elderly: Current problems with increasing geriatric age.

    Science.gov (United States)

    Kukreja, Deepti; Günther, Ulf; Popp, Julius

    2015-12-01

    Delirium is an acute disorder of attention and cognition seen relatively commonly in people aged 65 yr or older. The prevalence is estimated to be between 11 and 42 per cent for elderly patients on medical wards. The prevalence is also high in nursing homes and long term care (LTC) facilities. The consequences of delirium could be significant such as an increase in mortality in the hospital, long-term cognitive decline, loss of autonomy and increased risk to be institutionalized. Despite being a common condition, it remains under-recognised, poorly understood and not adequately managed. Advanced age and dementia are the most important risk factors. Pain, dehydration, infections, stroke and metabolic disturbances, and surgery are the most common triggering factors. Delirium is preventable in a large proportion of cases and therefore, it is also important from a public health perspective for interventions to reduce further complications and the substantial costs associated with these. Since the aetiology is, in most cases, multifactorial, it is important to consider a multi-component approach to management, both pharmacological and non-pharmacological. Detection and treatment of triggering causes must have high priority in case of delirium. The aim of this review is to highlight the importance of delirium in the elderly population, given the increasing numbers of ageing people as well as increasing geriatric age.

  10. Delirium in the elderly: Current problems with increasing geriatric age

    Directory of Open Access Journals (Sweden)

    Deepti Kukreja

    2015-01-01

    Full Text Available Delirium is an acute disorder of attention and cognition seen relatively commonly in people aged 65 yr or older. The prevalence is estimated to be between 11 and 42 per cent for elderly patients on medical wards. The prevalence is also high in nursing homes and long term care (LTC facilities. The consequences of delirium could be significant such as an increase in mortality in the hospital, long-term cognitive decline, loss of autonomy and increased risk to be institutionalized. Despite being a common condition, it remains under-recognised, poorly understood and not adequately managed. Advanced age and dementia are the most important risk factors. Pain, dehydration, infections, stroke and metabolic disturbances, and surgery are the most common triggering factors. Delirium is preventable in a large proportion of cases and therefore, it is also important from a public health perspective for interventions to reduce further complications and the substantial costs associated with these. Since the aetiology is, in most cases, multfactorial, it is important to consider a multi-component approach to management, both pharmacological and non-pharmacological. Detection and treatment of triggering causes must have high priority in case of delirium. The aim of this review is to highlight the importance of delirium in the elderly population, given the increasing numbers of ageing people as well as increasing geriatric age.

  11. Delirium in Prolonged Hospitalized Patients in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Vahedian Azimi

    2015-05-01

    Full Text Available Background Prolonged hospitalization in the intensive care unit (ICU can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. Objectives The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. Patients and Methods This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014. All prolonged hospitalized patients and their families were eligible participants. From the 34 eligible patients and 63 family members, the final numbers of actual patients and family members were 9 and 16, respectively. Several semi-structured interviews were conducted face-to-face with patients and their families in a private room and data were gathered. Results Two main themes from two different perspectives emerged, 'patients' perspectives' (experiences during ICU hospitalization and 'family members' perspectives' (supportive-communicational experiences. The main results of this study focused on delirium, Patients' findings were described as pleasant and unpleasant, factual and delusional experiences. Conclusions Family members are valuable components in the therapeutic process of delirium. Effective use of family members in the delirium caring process can be considered to be one of the key non-medical nursing components in the therapeutic process.

  12. Delirium and concomitant use of lithium+electroconvulsive therapy (ECT

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    Sadeghi M

    2001-09-01

    Full Text Available Concomitant use of lithium and E.C.T has always been accused to cause delirium in patients receiving such a combination. In this study incidence of delirium in patients who receive lithium+E.C.T. concurrently has been compared with those who have been treated with E.C.T. only. Of 49 patients who had Bipolar Mood Disorder (B.M.D. 1 disorder (manic episode 24 were given E.C.T.+lithium and 25 were treated with E.C.T. Only, 3 patients of the first group and 2 patients of the second group developed delirium. The difference between two groups was not statistically significant. Another finding was that all cases of delirium developed in patients who were above 35 years old (P value=0.001. These findings show that combination of E.C.T. and Lithium may not be so harmful as it was once considered. On the other hand it could be concluded that increased age may be a risk factor for delirium in such a combination.

  13. Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients.

    Directory of Open Access Journals (Sweden)

    Jelle W Raats

    Full Text Available Early identification of patients at risk for delirium is important, since adequate well timed interventions could prevent occurrence of delirium and related detrimental outcomes. The aim of this study is to evaluate prognostic factors for delirium, including factors describing frailty, in elderly patients undergoing major surgery.We included patients of 65 years and older, who underwent elective surgery from March 2013 to November 2014. Patients had surgery for Abdominal Aortic Aneurysm (AAA or colorectal cancer. Delirium was scored prospectively using the Delirium Observation Screening Scale. Pre- and peri-operative predictors of delirium were analyzed using regression analysis. Outcomes after delirium included adverse events, length of hospital stay, discharge destination and mortality.We included 232 patients. 51 (22% underwent surgery for AAA and 181 (78% for colorectal cancer. Postoperative delirium occurred in 35 patients (15%. Predictors of postoperative delirium included: delirium in medical history (Odds Ratio 12 [95% Confidence Interval 2.7-50], advancing age (Odds Ratio 2.0 [95% Confidence Interval 1.1-3.8] per 10 years, and ASA-score ≥3 (Odds Ratio 2.6 [95% Confidence Interval 1.1-5.9]. Occurrence of delirium was related to an increase in adverse events, length of hospital stay and mortality.Postoperative delirium is a frequent complication after major surgery in elderly patients and is related to an increase in adverse events, length of hospital stay, and mortality. A delirium in the medical history, advanced age, and ASA-score may assist in defining patients at increased risk for delirium. Further attention to prevention of delirium is essential in elderly patients undergoing major surgery.

  14. Effects of a screening and treatment protocol with haloperidol on post-cardiotomy delirium

    DEFF Research Database (Denmark)

    Schrøder Pedersen, Sofie; Kirkegaard, Thomas; Balslev Jørgensen, Martin;

    2014-01-01

    Post-cardiotomy delirium is common and associated with increased morbidity and mortality. No gold standard exists for detecting delirium, and evidence to support the choice of treatment is needed. Haloperidol is widely used for treating delirium, but indication, doses and therapeutic targets vary....... Moreover, doubt has been raised regarding overall efficacy. The purpose of this study was to assess the effect of a combination of early detection and standardized treatment with haloperidol on post-cardiotomy delirium, with the hypothesis that the proportion of delirium- and coma-free days could...

  15. A Quality Assurance Study to Assess the One-Day Prevalence of Delirium in Elderly Hospitalized Patients

    OpenAIRE

    McAiney, Carrie A.; Patterson, Christopher; Coker, Esther; Pizzacalla, Anne

    2012-01-01

    Background Research indicates that 40% of hospital-acquired delirium cases may be preventable. However, despite its clinical significance, delirium often goes unrecognized or is misdiagnosed. The purpose of this study was to assess the need for delirium education in acute care hospitals in Hamilton, Ontario. Methods Approximately 100 health professionals were trained as delirium screeners. On ‘Delirium Day’, all patients ≥ 65 years of age in non-critical care areas in all acute care sites in ...

  16. Alterações clínicas e laboratoriais anteriores ao desenvolvimento do delirium tremens Clinical and laboratorial alterations previous at the delirium tremens

    Directory of Open Access Journals (Sweden)

    Paulo Borini

    1997-01-01

    Full Text Available Duzentos e trinta pacientes alcoolistas crônicos do sexo masculino internados em hospital psiquiátrico para tratamento do alcoolismo foram examinados clínica e laboratorialmente dentro das primeiras 24 horas da internação. Treze pacientes que desenvolveram delirium tremens (DT após a internação (grupo I constituem a casuística deste estudo que visa avaliar a ocorrência de alterações clínicas, hematológicas, bioquímicas hepáticas e eletrolíticas que antecedem ao aparecimento das manifestações do DT. Para análises comparativas foram estudados dois grupos de 26 pacientes cada um, constituídos de pacientes que não entraram em DT na internação atual mas com história pregressa de DT (grupo II e pacientes aleatoriamente arrolados - amostra aleatória simples obtida empregando tabela de números aleatórios fornecida por computador - que nunca entraram em DT (grupo III. Os pacientes do grupo I apresentavam média de idade significativamente mais baixa e fisicamente encontravam-se em pior estado geral que os do grupo III. As frequências de taxas elevadas de aminotransferases e de hipomagnesemia foram significativamente maiores nos grupos I e II que no grupo III. Os valores plasmáticos médios das aminotransferases, especialmente da aspartato-aminotransferase, estavam significativamente mais elevados nos grupos I e II que no grupo III.Thirteen alcoholic male patients that developed delirium tremens (DT after admission in a psychiatric hospital for treatment of alcoholism (group I had their clinical and laboratorial records examined. The laboratory samples were taken during the phase previous at the DT. Data on this group were compared to those of two other groups of alcoholics - 26 patients each - that did not develop DT in the present admission, with (group II or without (group III previous history of DT. The patients of group I had significantly lower average age and worse general conditions than the patients of group III. The

  17. Pharmacological interventions for delirium in intensive care patients

    DEFF Research Database (Denmark)

    Barbateskovic, Marija; Larsen, Laura Krone; Oxenbøll-Collet, Marie;

    2016-01-01

    of reviews is to critically assess the evidence of reviews of randomised clinical trials on the effect of pharmacological management and prevention of delirium in ICU patients. METHODS/DESIGN: We will search for reviews in the following databases: Cochrane Library, MEDLINE, EMBASE, Science Citation Index...... for the management and prevention of delirium in ICU patients. The conclusions of the reviews showed conflicting results. Despite this unclear evidence, antipsychotics, in particular, haloperidol is often the recommended pharmacological intervention for delirium in ICU patients. The objective of this overview...... of the included systematic reviews using the ROBIS tool. Any disagreement will be resolved by consensus. We will present the data as a narrative synthesis and summarise the main results of the included reviews. In addition, we will present an overview of the bias risk assessment of the systematic reviews...

  18. Symptoms of posttraumatic stress after intensive care delirium

    DEFF Research Database (Denmark)

    Svenningsen, Helle; Egerod, Ingrid; Christensen, Doris;

    2015-01-01

    Introduction. Long-term psychological consequences of critical illness are receiving more attention in recent years. The aim of our study was to assess the correlation of ICU-delirium and symptoms of posttraumatic stress disorder (PTSD) anxiety and depression after ICU-discharge in a Danish cohort...... and symptoms of PTSD in 8% (2 months) and 6% (6 months) after ICU-discharge. Recall of ICU stay was present in 93%. Associations between ICU-delirium and post-discharge PTSD-symptoms were weak and insignificant. Memories of delusions were significantly associated with anxiety after two months. Remaining...... associations between types of ICU-memories and prevalence of post-discharge symptoms of PTSD, anxiety, and depression were insignificant after adjusting for age. Incidence of ICU-delirium was unaffected by preadmission use of psychotropic drugs. Prevalence of PTSD-symptoms was unaffected by use...

  19. Symptoms of Posttraumatic Stress after Intensive Care Delirium

    DEFF Research Database (Denmark)

    Svenningsen, Helle; Egerod, Ingrid; Christensen, Doris

    2015-01-01

    Introduction. Long-term psychological consequences of critical illness are receiving more attention in recent years. The aim of our study was to assess the correlation of ICU-delirium and symptoms of posttraumatic stress disorder (PTSD) anxiety and depression after ICU-discharge in a Danish cohort...... in the ICU and symptoms of PTSD in 8% (2 months) and 6% (6 months) after ICU-discharge. Recall of ICU stay was present in 93%. Associations between ICU-delirium and post-discharge PTSD-symptoms were weak and insignificant. Memories of delusions were significantly associated with anxiety after two months....... Remaining associations between types of ICU-memories and prevalence of post-discharge symptoms of PTSD, anxiety, and depression were insignificant after adjusting for age. Incidence of ICU-delirium was unaffected by preadmission use of psychotropic drugs. Prevalence of PTSD-symptoms was unaffected by use...

  20. The Neuropsychological Course of Acute Delirium in Adult Hematopoietic Stem Cell Transplantation Patients

    Science.gov (United States)

    Beglinger, Leigh J.; Mills, James A.; Vik, Stacie M.; Duff, Kevin; Denburg, Natalie L.; Weckmann, Michelle T.; Paulsen, Jane S.; Gingrich, Roger

    2011-01-01

    Although delirium is a common medical comorbidity with altered cognition as its defining feature, few publications have addressed the neuropsychological prodrome, profile, and recovery of patients tested during delirium. We characterize neuropsychological performance in 54 hemapoietic stem cell/bone marrow transplantation (BMT) patients shortly before, during, and after delirium and in BMT patients without delirium and 10 healthy adults. Patients were assessed prospectively before and after transplantation using a brief battery. BMT patients with delirium performed more poorly than comparisons and those without delirium on cross-sectional and trend analyses. Deficits were in expected areas of attention and memory, but also in psychomotor speed and learning. The patients with delirium did not return to normative “average” on any test during observation. Most tests showed a mild decline in the visit before delirium, a sharp decline with delirium onset, and variable performance in the following days. This study adds to the few investigations of neuropsychological performance surrounding delirium and provides targets for monitoring and early detection; Trails A and B, RBANS Coding, and List Recall may be useful for delirium assessment. PMID:21183605

  1. A pilot study of rivastigmine in the treatment of delirium after stroke: A safe alternative

    Directory of Open Access Journals (Sweden)

    Jansen Ben PW

    2008-09-01

    Full Text Available Abstract Background Delirium is a common disorder in the early phase of stroke. Given the presumed cholinergic deficiency in delirium, we tested treatment with the acetylcholinesterase inhibitor rivastigmine. Methods This pilot study was performed within an epidemiological study. In 527 consecutive stroke patients presence of delirium was assessed during the first week with the confusion assessment method. Severity was scored with the delirium rating scale (DRS. Sixty-two patients developed a delirium in the acute phase of stroke. Only patients with a severe and persistent delirium (defined as a DRS of 12 or more for more than 24 hours were enrolled in the present study. In total 26 fulfilled these criteria of whom 17 were treated with orally administered rivastigmine with a total dose between 3 and 12 mg a day. Eight patients could not be treated because of dysphagia and one because of early discharge. Results No major side effects were recorded. In 16 patients there was a considerable decrease in severity of delirium. The mean DRS declined from 14.8 on day one to 8.5 after therapy and 5.6 after tapering. The mean duration of delirium was 6.7 days (range; 2–17. Conclusion Rivastigmine is safe in stroke patients with delirium even after rapid titration. In the majority of patients the delirium improved after treatment. A randomized controlled trial is needed to establish the usefulness of rivastigmine in delirium after stroke. Trial registration Nederlands Trial Register NTR1395

  2. American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults.

    Science.gov (United States)

    2015-01-01

    The abstracted set of recommendations presented here provides essential guidance both on the prevention of postoperative delirium in older patients at risk of delirium and on the treatment of older surgical patients with delirium, and is based on the 2014 American Geriatrics Society (AGS) Guideline. The full version of the guideline, American Geriatrics Society Clinical Practice Guideline for Postoperative Delirium in Older Adults is available at the website of the AGS. The overall aims of the study were twofold: first, to present nonpharmacologic and pharmacologic interventions that should be implemented perioperatively for the prevention of postoperative delirium in older adults; and second, to present nonpharmacologic and pharmacologic interventions that should be implemented perioperatively for the treatment of postoperative delirium in older adults. Prevention recommendations focused on primary prevention (i.e., preventing delirium before it occurs) in patients who are at risk for postoperative delirium (e.g., those identified as moderate-to-high risk based on previous risk stratification models such as the National Institute for Health and Care Excellence (NICE) guidelines, Delirium: Diagnosis, Prevention and Management. Clinical Guideline 103; London (UK): 2010 July 29). For management of delirium, the goals of this guideline are to decrease delirium severity and duration, ensure patient safety and improve outcomes.

  3. Use of aripiprazole for delirium in the elderly: a short review.

    Science.gov (United States)

    Kirino, Eiji

    2015-03-01

    The effects and tolerability of antipsychotics in delirium treatment remain controversial. Compared to other antipsychotics, aripiprazole differs in pharmacological activity because it exerts its effect as a dopamine D2 partial agonist. The guidelines of the American Psychiatric Association rank aripiprazole highly among antipsychotics with regard to safety, and this drug is likely to be useful for delirium treatment. Here, we reviewed the efficacy and safety of aripiprazole for delirium. The results of our literature review on the efficacy and safety of delirium treatments suggest that aripiprazole is an effective treatment option for delirium in the elderly. Aripiprazole is as effective as other antipsychotics in improving delirium symptoms, and it is safer because it is less likely to cause extrapyramidal symptoms, excessive sedation, and weight gain. However, these findings are based on only a few clinical studies of elderly patients with delirium. Therefore, further investigations are necessary.

  4. [Effect of anaesthesia on incidence of postoperative delirium after major abdominal surgery in elderly patients].

    Science.gov (United States)

    Zabolotskikh, I B; Trembach, N V

    2013-01-01

    Delirium can be caused by haemodynamics abnormalities during anaesthesia. The main role in delirium appearance is given to decreasing of cerebral perfusion pressure. Especially it can happen in patients with underlying intracranial hypertension. Anaesthetics effects on intracranial pressure are different therefore cerebral hypoperfusion can happens in these patients even without systemic hypotension. Purpose of the study was to define an effect of cerebral perfusion pressure decreasing during different technics of anaesthesia on frequency of delirium in elderly patients after major abdominal surgery. The article deals with results of study of 182 patients (medium age 69 y.o.) underwent elective major abdominal surgery. Delirium frequency was 11%, continuing of delirium was 3 days. The frequency of delirium was higher in patients who had got anaesthesia based on sevoflurane. Additionally these patients had higher frequency of cerebral perfusion pressure decreasing. Conclusions; Anaesthesia based on sevoflurane is characterized by higher frequency of postoperative delirium in elderly patients after major abdominal surgery.

  5. [Preventive program for postoperative delirium in the elderly].

    Science.gov (United States)

    Ocádiz-Carrasco, Jesús; Gutiérrez-Padilla, Ruth Alicia; Páramo-Rivas, Frida; Serrano, Alejandro Tovar; Hernández-Ortega, José Luis

    2013-01-01

    Antecedentes: el delirium es un padecimiento poco reconocido en los pacientes quirúrgicos que frecuentemente se confunde con deterioro cognitivo o demencia. Es de vital importancia conocer las medidas que pueden disminuir su incidencia y reconocerlo de manera temprana para iniciar el tratamiento específico. Objetivo: implementar un programa educativo en delirium para el equipo de salud, con el propósito de disminuir su incidencia. Material y métodos: estudio observacional, longitudinal y analítico basado en medidas no farmacológicas y con apoyo de los familiares con quienes se tuvieron sesiones educativas, material didáctico, cuestionarios y estrategias específicas para todos los pacientes mayores de 65 años. Se realizaron dos evaluaciones al personal médico y de enfermería antes y después de implementar el programa.Resultados: se observó mejoría en la capacidad para dentificar el delirium (22% inicial vs 93%; p= 0.000). Se incluyeron 200 pacientes en el grupo de ensayo a un año y se encontró un solo caso de delirium que mostró reducción importante respecto a la incidencia previa en el hospital (10 vs 0.5% p= 0.000), mientras que en el subgrupo de 98 pacientes quirúrgicos no hubo ningún caso de delirium (4.8% inicial vs 0% p= 0.01, NNT= 21). Conclusiones: la implementación de un programa preventivo para el delirium es factible. Los resultados fueron satisfactorios, por lo que puede considerarse una estrategia efectiva para reducir la incidencia de esta afección que puede causar gran morbilidad y mortalidad postoperatoria.

  6. Management and treatment of gamma butyrolactone withdrawal syndrome: a case report and review.

    Science.gov (United States)

    Ghio, Lucio; Cervetti, Alice; Respino, Matteo; Belvederi Murri, Martino; Amore, Mario

    2014-07-01

    Gamma butyrolactone (GBL) is an increasingly popular drug of abuse that is readily available in most countries, and it is often purchased over the Internet. In addition to the acute hazards of intoxication and overdose, users who are dependent on GBL can also experience severe withdrawal reactions, including hallucinations, agitation, confusion, delusions, delirium, rhabdomyolysis, and seizures. Most of the existing literature suggests the use of a high-dose benzodiazepine as a first-line treatment for GBL withdrawal. However, several cases of resistance to benzodiazepines have been observed, which likely reflect some pharmacological differences between benzodiazepines and GBL. Specifically, the effects of benzodiazepines are primarily mediated by gamma-aminobutyric acid (GABA)-A receptors, while GBL and its analogues act mainly at GABA-B receptors, with possible additional effects via the ionotropic GABA-A receptors. In this regard, recent studies have found that GBL and its analogues possess a high affinity for a specific form of extrasynaptic GABA-A receptors that are strongly activated by barbiturates, such as phenobarbital, but that are insensitive to benzodiazepines. Taken together, these findings suggest that barbiturates could be evaluated as first-choice agents for the treatment of GBL/gamma hydroxybutyrate (GHB) withdrawal instead of benzodiazepines. In support of this view, we describe a clinical case of difficult to manage GBL withdrawal symptoms in a 42-year-old male. We also review the literature on treatment options for GBL/GHB withdrawal, including benzodiazepine-resistant withdrawal.

  7. Nicotine addiction and withdrawal

    Science.gov (United States)

    ... Hg Possibly cause sweating, nausea, and diarrhea Stimulate memory and alertness; people who use tobacco often depend on it to help them accomplish certain tasks and perform well Symptoms of nicotine withdrawal appear within 2 to 3 hours after ...

  8. Suspected Delirium Predicts the Thoroughness of Catatonia Evaluation.

    Science.gov (United States)

    Llesuy, Joan Roig; Coffey, M Justin; Jacobson, Kristen C; Cooper, Joseph J

    2016-11-30

    Although commonly linked to psychiatric disorders, catatonia is frequently identified secondary to neurological and general medical conditions (GMCs). The present study aimed to characterize the diagnostic workup of cases of catatonia in a general hospital setting. The authors performed a retrospective chart review of 54 cases of catatonia, over 3 years. Clinical suspicion of comorbid delirium was the strongest predictor of a more thorough general medical workup. Attribution of catatonia to a psychiatric etiology was associated with significantly less diagnostic workup. Prospective studies should help clarify the relationship between catatonia and delirium and standardize the diagnostic approach to patients presenting with catatonia.

  9. Markers of cerebral damage during delirium in elderly patients with hip fracture

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    Zwinderman Aeilko H

    2009-05-01

    Full Text Available Abstract Background S100B protein and Neuron Specific Enolase (NSE can increase due to brain cell damage and/or increased permeability of the blood-brain-barrier. Elevation of these proteins has been shown after various neurological diseases with cognitive dysfunction. Delirium is characterized by temporal cognitive deficits and is an important risk factor for dementia. The aim of this study was to compare the level of S100B and NSE of patients before, during and after delirium with patients without delirium and investigate the possible associations with different subtypes of delirium. Methods The study population were patients aged 65 years or more acutely admitted after hip fracture. Delirium was diagnosed by the Confusion Assessment Method and the subtype by Delirium Symptom interview. In maximal four serum samples per patient S100B and NSE levels were determined by electrochemiluminescence immunoassay. Results Of 120 included patients with mean age 83.9 years, 62 experienced delirium. Delirious patients had more frequently pre-existing cognitive impairment (67% vs. 18%, p Conclusion Delirium was associated with increased level of S100B which could indicate cerebral damage either due to delirium or leading to delirium. The possible association between higher levels of S100B during delirium and the higher risk of developing dementia after delirium is an interesting field for future research. More studies are needed to elucidate the role of S100B proteins in the pathophysiological pathway leading to delirium and to investigate its possibility as biomarker for delirium.

  10. Psychosis following Tramadol Withdrawal

    OpenAIRE

    Rajabizadeh, Ghodratolah; Kheradmand, Ali; Nasirian, Mansoureh

    2009-01-01

    Background: Tramadol is a centrally acting opioid analgesic used to treat moderate to sever pain. It has more advantage and less opioid adverse effects than conventional opioid analgesia. Case Report: This article reports a patient with tramadol dependency that had psychosis after tramadol withdrawal. Conclusion: By the increase of tramadol usage for relief of chronic pain, tramadol abuse and dependency is increased. Some of tramadol withdrawal symptoms are not related to opioid, for example ...

  11. Delirium en ancianos hospitalizados: Seguimiento de 18 meses Delirium in elderly inpatients: An 18 month follow-up

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    Fernando J. Vázquez

    2010-02-01

    Full Text Available El objetivo de este trabajo fue describir la prevalencia de síndrome confusional agudo en ancianos hospitalizados, la evolución durante la internación y a los 18 meses. Se evaluó en forma prospectiva a pacientes de 70 años de edad o mayores, internados en el Servicio de Clínica Médica de nuestro hospital, entre septiembre de 2005 y mayo de 2006. Se utilizó una versión validada en español del Confussion Assessment Method para diagnosticar delirium. A los 18 meses se evaluó el estado vital, lugar de residencia, actividades de la vida diaria, dependencia de cuidadores y reinternaciones. Se evaluaron 194 pacientes y 74 fueron excluidos. De los 120 casos incluidos, 52 (43.3% presentaron delirium. La edad media fue de 82.6 años (DS: 7.4 en el grupo de pacientes con síndrome confusional agudo y de 80.4 años (DS: 5.6 en el grupo de pacientes sin delirium. Al comparar estos dos grupos encontramos diferencias significativas en las características, siendo más frecuentes en el grupo con delirium la residencia previa en un centro de tercer nivel (17.3% vs. 1.5%; p Delirium usually hardens care during hospitalization and increases morbidity during hospital stay and after discharge. The objective of this study was to describe the prevalence of delirium in elderly inpatients in a Buenos Aires hospital, its morbidity and mortality during hospital stay and the next 18 month follow-up. Patients aged 70 or older admitted to internal medicine unit between September 2005 and May 2006 were enrolled. Delirium was assessed with the Spanish version of Confusion Assessment Method. Demographic data, cause of admition and length of stay, destination after discharge and mortality were registered. A new evaluation was made 18 months after discharge. We evaluated 194 patients and 74 were excluded. Of the 120 included, 52 (43.3% presented delirium. We found significant differences between patients with and without delirium in previous placement in nursing home

  12. Sepsis associated delirium mimicking postoperative delirium as the initial presenting symptom of urosepsis in a patient who underwent nephrolithotomy.

    Science.gov (United States)

    Nag, Deb Sanjay; Chatterjee, Abhishek; Samaddar, Devi Prasad; Singh, Harprit

    2016-05-16

    We report a case of 70 years old male who underwent percutaneous nephrolithotomy for renal calculi. After an uneventful recovery from anaesthesia, the patient developed delirium which manifested as restlessness, agitation, irritability and combative behavior. All other clinical parameters including arterial blood gas, chest X-ray and core temperature were normal and the patient remained haemodynamically stable. But 45 min later the patient developed florid manifestations of septic shock. He was aggressively managed in a protocolized manner as per the Surviving Sepsis Guidelines in the Critical Care Unit and recovered completely. There are no case reports showing postoperative delirium as the only initial presentation of severe sepsis, with other clinical parameters remaining normal. Both urosepsis and sepsis associated delirium have very high mortality. High index of suspicion and a protocolized approach in the management of sepsis can save lives.

  13. Time of delirium onset and prognosis amongst Southern Brazilian hospitalized elderly patients

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    André Luiz Moschetta

    Full Text Available Abstract The prognostic significance of delirium in hospitalized elderly has not yet been fully clarified. Objectives: The present study was designed to evaluate the relationship between prevalent delirium (PrD, incident delirium (InD and final outcome. Methods: A historical cohort of 261 patients was selected. delirium was diagnosed using the Confusion Assessment Method. Results: The total frequency of delirium detected was 42.5%-31.4% PrD and 16.2% InD. Among patients with InD, the average length of hospital stay was 9.1 days longer than for patients without delirium (p=0.002, and the hospital mortality associated with InD was 48% versus 2.7% for those without delirium (p<0.001. However, no difference was observed between patients with PrD and those without delirium. Conclusions: These results suggest that, when investigating delirium and prognosis amongst hospitalized elderly, it is fundamental to differentiate in terms of time of onset. Furthermore, the absence of delirium seems to be an important protective factor.

  14. A Family-Focused Delirium Educational Initiative With Practice and Research Implications.

    Science.gov (United States)

    Paulson, Christina May; Monroe, Todd; McDougall, Graham J; Fick, Donna M

    2016-01-01

    Delirium is burdensome and psychologically distressing for formal and informal caregivers, yet family caregivers often have very little understanding or knowledge about delirium. As part of a large multisite intervention study, the Early Nurse Detection of Delirium Superimposed on Dementia (END-DSD), the authors identified a need for family educational materials. This educational initiative's purpose was to develop a delirium admission brochure for family members to aid in the prevention and earlier identification of delirium during hospitalization. A brochure was developed using an iterative approach with an expert panel. Following three iterations, a final brochure was approved. The authors found that an iterative expert consensus approach can be used to develop a brochure for families. Major content areas were helping families understand the difference between delirium and dementia, signs and symptoms of delirium, causes of delirium, and strategies family members can use to prevent delirium. A caregiver-focused educational brochure is one intervention to use in targeting older adults hospitalized with delirium.

  15. Survey of attitudes and behaviors of healthcare professionals on delirium in ICU

    Institute of Scientific and Technical Information of China (English)

    GONG Zhi-ping; LIU Xi-wang; ZHUANG Yi-yu; CHEN Xiang-ping; XIE Guo-hao; CHENG Bao-li; JIN Yue; FANG Xiang-ming

    2009-01-01

    Objective: To assess the medical community's awareness and practice regarding delirium in the intensive care unit (ICU). Methods: One hundred and ten predesigned questionnaires were distributed to ICU practitioners in the affiliated hospitals of Zhejiang University. Results: A total of 105 valid questionnaires were collected. Totally, 55.3% of the clinicians considered that delirium was common in the ICU. Delirium was believed to be a significant or serious problem by 70.5% of respondents, and under-diagnosis was acknowledged by 56.2% of the respondents. The incidence of ICU delirium is even more under-estimated by the pediatric doctors compared with their counterparts in adult ICU (P<0.05). Primary disease of the brain (agreed by 82.1% of the respondents) was believed to be the most common risk factor for delirium. None of the ICU professionals screened delirium or used a specific tool for delirium assessment routinely. The vast majority (92.4%) of respondents had little knowledge on the diagnosis and the standard treatment of delirium.Conclusions: Although delirium is considered as a serious problem by a majority of the surveyed ICU professionals, it is still under-recognized in routine critical care practice. Data from this survey show a disconnection between the perceived significance of delirium and the current practices of monitoring and treatment in ICU in China.

  16. Delirium and Resistance: activist art and the crisis of capitalism

    NARCIS (Netherlands)

    Sholette, G.G.

    2017-01-01

    Delirium and Resistance: Activist Art and the Crisis of Capitalism is an investigation into specific cultural changes that have taken place in a period of intense socio-economic change and instability beginning roughly in the late 1970s with the era of globalization and counter-globalization protest

  17. PROTEOMIC AND EPIGENOMIC MARKERS OF SEPSIS-INDUCED DELIRIUM (SID

    Directory of Open Access Journals (Sweden)

    Adonis eSfera

    2015-10-01

    Full Text Available In elderly population sepsis is one of the leading causes of intensive care unit (ICU admissions in the United States. Sepsis-induced delirium (SID is the most frequent cause of delirium in ICU (1. Together delirium and SID represent under recognized public health problems which place an increasing financial burden on the US health care system, currently estimated at 143 to 152 billion dollars per year (2. The interest in SID was recently reignited as it was demonstrated that, contrary to prior beliefs, cognitive deficits induced by this condition may be irreversible and lead to dementia (3-4. Conversely, it is construed that diagnosing SID early or mitigating its full blown manifestations may preempt geriatric cognitive disorders. Biological markers specific for sepsis and SID would facilitate the development of potential therapies, monitor the disease process and at the same time enable elderly individuals to make better informed decisions regarding surgeries which may pose the risk of complications, including sepsis and delirium.This article proposes a battery of peripheral blood markers to be used for diagnostic and prognostic purposes in sepsis and SID. Though each individual marker may not be specific enough, we believe that together as a battery they may achieve the necessary accuracy to answer two important questions: who may be vulnerable to the development of sepsis, and who may develop SID and irreversible cognitive deficits following sepsis?

  18. Severe delirium on a background of Alzheimer’s dementia - A devastating acute illness; report of a case

    Institute of Scientific and Technical Information of China (English)

    Michael Charlesworth; Abhirami Kanapathyraja; Susie Waddingham; John D Holmes

    2012-01-01

    Delirium is an acute and reversible condition that is common in hospitalised patients. Patients with delirium have extended lengths of stay, double the mortality of matched controls and an increased risk of permanent cognitive decline. We present the case of a patient with severe hypoactive delirium on a background of Alzheimer’s dementia with a significant lasting cognitive deficit. This case presents the devastating impact of delirium on the lives of patients and relatives. The need for more awareness of delirium amongst health care professionals, more routine risk assessment and more studies aimed at managing hospitalised patients with delirium is also implicated.

  19. Severe delirium on a background of Alzheimer's dementia – A devastating acute illness; report of a case

    Directory of Open Access Journals (Sweden)

    Michael Charlesworth

    2012-01-01

    Full Text Available Delirium is an acute and reversible condition that is common in hospitalised patients. Patients with delirium have extended lengths of stay, double the mortality of matched controls and an increased risk of permanent cognitive decline. We present the case of a patient with severe hypoactive delirium on a background of Alzheimer's dementia with a significant lasting cognitive deficit. This case presents the devastating impact of delirium on the lives of patients and relatives. The need for more awareness of delirium amongst health care professionals, more routine risk assessment and more studies aimed at managing hospitalised patients with delirium is also implicated.

  20. Relationship between cobalamin deficiency and delirium in elderly patients undergoing cardiac surgery

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    Sevuk U

    2015-08-01

    Full Text Available Utkan Sevuk,1 Erkan Baysal,2 Nurettin Ay,3 Yakup Altas,2 Rojhat Altindag,2 Baris Yaylak,2 Vahhac Alp,3 Ertan Demirtas4 1Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 2Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 3Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 4Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey Background: Delirium is common after cardiac surgery and is independently associated with increased morbidity, mortality, prolonged hospital stays, and higher costs. Cobalamin (vitamin B12 deficiency is a common cause of neuropsychiatric symptoms and affects up to 40% of elderly people. The relationship between cobalamin deficiency and the occurrence of delirium after cardiac surgery has not been examined in previous studies. We examined the relationship between cobalamin deficiency and delirium in elderly patients undergoing coronary artery bypass grafting (CABG surgery.Material and methods: A total of 100 patients with cobalamin deficiency undergoing CABG were enrolled in this retrospective study. Control group comprised 100 patients without cobalamin deficiency undergoing CABG. Patients aged 65 years or over were included. Diagnosis of delirium was made using Intensive Care Delirium Screening Checklist. Delirium severity was measured using the Delirium Rating Scale-revised-98.Results: Patients with cobalamin deficiency had a significantly higher incidence of delirium (42% vs 26%; P=0.017 and higher delirium severity scores (16.5±2.9 vs 15.03±2.48; P=0.034 than patients without cobalamin deficiency. Cobalamin levels were significantly lower in patients with delirium than patients without delirium (P=0.004. Delirium severity score showed a moderate correlation with cobalamin levels (Ρ=-0.27; P=0.024. Logistic regression analysis demonstrated that

  1. Withdrawing benzodiazepines in primary care.

    Science.gov (United States)

    Lader, Malcolm; Tylee, Andre; Donoghue, John

    2009-01-01

    The use of benzodiazepine anxiolytics and hypnotics continues to excite controversy. Views differ from expert to expert and from country to country as to the extent of the problem, or even whether long-term benzodiazepine use actually constitutes a problem. The adverse effects of these drugs have been extensively documented and their effectiveness is being increasingly questioned. Discontinuation is usually beneficial as it is followed by improved psychomotor and cognitive functioning, particularly in the elderly. The potential for dependence and addiction have also become more apparent. The licensing of SSRIs for anxiety disorders has widened the prescribers' therapeutic choices (although this group of medications also have their own adverse effects). Melatonin agonists show promise in some forms of insomnia. Accordingly, it is now even more imperative that long-term benzodiazepine users be reviewed with respect to possible discontinuation. Strategies for discontinuation start with primary-care practitioners, who are still the main prescribers.This review sets out the stratagems that have been evaluated, concentrating on those of a pharmacological nature. Simple interventions include basic monitoring of repeat prescriptions and assessment by the doctor. Even a letter from the primary-care practitioner pointing out the continuing usage of benzodiazepines and questioning their need can result in reduction or cessation of use. Pharmacists also have a role to play in monitoring the use of benzodiazepines, although mobilizing their assistance is not yet routine. Such stratagems can avoid the use of specialist back-up services such as psychiatrists, home care, and addiction and alcohol misuse treatment facilities.Pharmacological interventions for benzodiazepine dependence have been reviewed in detail in a recent Cochrane review, but only eight studies proved adequate for analysis. Carbamazepine was the only drug that appeared to have any useful adjunctive properties for

  2. Evaluation of the Prevalence and Risk Factors of Delirium in Cardiac Surgery ICU

    Directory of Open Access Journals (Sweden)

    Kamran Shadvar

    2013-12-01

    Results: The prevalence of delirium in these patients was 23.5% (47 patients. The mean age of patients with delirium was more than other patients (P=0.001. The Incidence of delirium in the patients with cardiopulmonary bypass surgery (CPB was higher than the patients without CPB (P=0.01. The Incidence of delirium in the patients with Atrial fibrillation was higher than patients without it (P=0.002. The Incidence of delirium in the patients with CVA history was higher than the patients without CVA history (P=0.032. The mean time of mechanical ventilation in the delirious patients was more than other patients (P=0.01. Conclusion: Older Age, CPB, history of CVA, Atrial Fibrillation, and prolonged mechanical ventilation are considered as the risk factors of delirium in cardiac surgery patients.

  3. [Emergence delirium in children - prophylaxis and treatment].

    Science.gov (United States)

    Wermelt, Julius Z; Ellerkmann, Richard K

    2016-07-01

    Emergence Delirium in children after general anesthesia is a common and self limitating event. Although it might be seen as being harmless it can cause other serious complications and might leave both parents and other caregivers with a negative impression behind. Although the cause may still not be clear, potential predictors can be named: preschool age, the use of fast acting volatile anesthestics, higher preoperative anxiety levels and postoperative pain.A child-focused approach to reduce preoperative anxiety focusing on distraction methods rather than pharmacological sedation may be the key as well as sufficient postoperative pain control and the use of total intravenous anesthesia. Parenteal presence during induction of anaesthesia (PPIA) may be beneficial to reduce preoperative anxiety levels, but has failed to prove a better outcome regarding ED.The use of age adopted scores/scales to diagnose ED and Pain are mandatory.In the case of an ED event it is most important to protect the child from self injury and the loss of the iv-line. Postoperative pian needs to be ruled out before treating ED. Most cases can be treated by interrupting the situation and putting the child "back to sleep". Short acting drugs as Propofol have been used successfully due to its pharmacodynamics and short acting profile. Alternatively alpha-agonists or ketamin may be preferred by other authors. If potential predictors and a positive history are present, prophylactic treatment should be considered. A TIVA or the use of alpha-2-agonists have proven to be successful in reducing the risk of an ED. Midazolam may reduce preoperative anxiety but not the incidence of ED and should therefore be used carefully and is not a good choice in PACU for the treatment of ED.Parents who witnessed ED in their children should be guided and followed up. Explaining this phenomenon to parents beforehand should be part of the pre anaesthesia clinic talk and written consent.Standard protocols should be in

  4. [Gamma-hydroxybutyric acid (GHB) dependence and the GHB withdrawal syndrome: diagnosis and treatment].

    Science.gov (United States)

    van Noorden, Martijn S; Kamal, Rama; de Jong, Cor A J; Vergouwen, A C M Ton; Zitman, Frans G

    2010-01-01

    Gamma-hydroxybutyric acid (GHB) is a neurotransmitter that occurs naturally in the brain and is increasingly being used as a 'party drug' because of its relaxing and euphoria-inducing effects. GHB has a limited medical use in the treatment of narcolepsy. GHB-intoxications occur often in non-medical use, and generally result in a coma of short duration. GHB use several times a day can lead to tolerance and dependence. After sudden cessation or reduction of intensive GHB use, a severe withdrawal syndrome may occur with symptoms varying from tremor, anxiety and agitation to autonomic instability, hallucinations and delirium. Treatment of the GHB withdrawal syndrome consists of supportive care and benzodiazepines, often in high doses. The controlled detoxification of GHB using pharmaceutical GHB in an adjusted dose is currently being investigated in the Netherlands. There is no literature concerning the treatment of patients following GHB intoxication or after detoxification.

  5. Unusual presentation of a patient with GBL withdrawal: a case report.

    Science.gov (United States)

    Kashyap, Gursharan Lal; Patel, Ashok G

    2011-09-01

    GBL (gamma-butyro-lactone) is converted to Gamma hydroxyl butyrate (GHB) in the body. GBL and GHB are available in liquid form and powder form. Once categorised under "legal highs", these two are not associated with any dependence or withdrawal in animal studies. But there are case reports indicating their high dependence potential in humans. We here present a case of a 29 year old who came to the attention of psychiatric services with very bizarre presentation and needed a host of investigations and expert views from various medical disciplines. He was treated mainly symptomatically followed by a sudden dramatic recovery on the 11th day after presentation. GBL is getting popular as a recreational drug and its withdrawal should be seriously considered in the list of medical causes leading to Delirium.

  6. 19 CFR 144.36 - Withdrawal for transportation.

    Science.gov (United States)

    2010-04-01

    ... transportation to another port of entry if withdrawal for consumption or exportation can be accomplished at the... immediately for consumption or exportation, or designate a warehouse to which it may be sent and, upon his... paragraph (d) of this section. With the exception of alcohol and tobacco products, this procedure shall...

  7. Add-on gabapentin in the treatment of opiate withdrawal.

    Science.gov (United States)

    Martínez-Raga, José; Sabater, Ana; Perez-Galvez, Bartolome; Castellano, Miguel; Cervera, Gaspar

    2004-05-01

    Gabapentin is an antiepileptic drug shown to be effective in the treatment of pain disorders and appears to be useful as well for several psychiatric disorders, including bipolar disorder, anxiety disorders, alcohol withdrawal and cocaine dependence. Gabapentin, at a dose of 600 mg three times a day, was evaluated as an add-on medication to a standard detoxification regime in seven heroin dependent individuals undergoing outpatient opiate withdrawal treatment. All seven patients successfully completed opiate detoxification and commenced opiate antagonist treatment with naltrexone on day five of withdrawal treatment, as scheduled. No adverse event was noted. Gabapentin appeared to lead a reduction in symptomatic medication and an overall beneficial effect on symptoms of heroin withdrawal.

  8. Dovish Candidate Withdraws

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Former Japanese Chief Cabinet Secretary Yasuo Fukuda formally announced on July 21 his withdrawal from the upcoming Liberal Democratic Party's (LDP) presidential election in September, citing his opposition to officials' visits to the war-related Yasukuni Shrine and his advanced age.

  9. Hypertension after clonidine withdrawal.

    Science.gov (United States)

    Husserl, F E; deCarvalho, J G; Batson, H M; Frohlich, E D

    1978-05-01

    Rebound hypertension occurred in two patients upon clonidine withdrawal. Treatment of the hypertensive crisis consists of both alpha- and beta-adrenergic receptor blockade, reserpine, or the reintroduction of clonidine. With effective control of pressure during the crisis, long-term antihypertensive therapy must be resumed.

  10. Delayed onset, protracted delirium and aspiration pneumonitis associated with a combination of clozapine and electroconvulsive therapy

    Directory of Open Access Journals (Sweden)

    N Manjunatha

    2011-01-01

    Full Text Available Few studies reported the efficacy and safety in combination of clozapine and electroconvulsive therapy (ECT in schizophrenia; systematic studies are lacking. Side effects like seizure, and confusional state are reported. Authors report two cases of delayed onset/protracted delirium with ECT and clozapine in schizophrenia, one of whom developed aspiration pneumonitis possibly due to clozapine hyper-salivation. Delirium improved with stopping of ECT and clozapine. Clozapine monotherapy restarted to previous dosages in both cases without recurrence of delirium. Authors recommend for careful monitoring for delirium in ECT augmentation on high dose clozapine. Unilateral ECT may be preferred for augmenting clozapine.

  11. Diagnosis and Management of Delirium in Critically Ill Infants: Case Report and Review.

    Science.gov (United States)

    Brahmbhatt, Khyati; Whitgob, Emily

    2016-03-01

    Delirium in children is common but not widely understood by pediatric practitioners, often leading to underdiagnosis and lack of treatment. This presents a significant challenge in the young patients in the PICU who are most at risk for delirium and in whom the core features of delirium are difficult to assess and treat. However, because of the potential increased morbidity and mortality associated with untreated delirium in adults and children, it remains important to address it promptly. The literature for delirium in this age group is limited. Here we present the case of an infant with multiple underlying medical risk factors who exhibited waxing and waning motor restlessness with disrupted sleep-wake cycles contributing significantly to destabilization of vital parameters. Making a diagnosis of delirium was key to guiding further treatment. After appropriate environmental interventions are implemented and underlying medical causes are addressed, antipsychotic medications, although not Food and Drug Administration-approved in infants, are the mainstay of pharmacotherapy for delirium in older age groups. They may lengthen corrected QT interval (QTc) intervals, presenting a challenge in infants who frequently have other coexisting risks for QTc prolongation, as in our case. The risk from QTc prolongation needs to be balanced against that from untreated delirium. Low doses of risperidone were successfully used in this patient and without side effects or worsening of QTc interval. This case illustrates the importance of increased recognition of delirium in children, including infants, and the role for cautious consideration of atypical antipsychotics in the very young.

  12. Treatment of post-electroconvulsive therapy delirium and agitation with donepezil.

    Science.gov (United States)

    Logan, Christopher J; Stewart, Jonathan T

    2007-03-01

    Delirium and agitation are commonly encountered after administration of electroconvulsive therapy (ECT). Management is generally fairly straightforward, although some patients may have a severe, prolonged, or refractory course. We recently cared for a 65-year-old man who consistently developed severe and very prolonged post-ECT delirium that did not respond to typical pharmacological agents; the duration of delirium was dramatically shortened by the addition of donepezil. Cholinesterase inhibitors may have a place in mitigating severe and prolonged post-ECT delirium.

  13. Effect of Acetaldehyde Intoxication and Withdrawal on NPY Expression: Focus on Endocannabinoidergic System Involvement.

    Science.gov (United States)

    Plescia, Fulvio; Brancato, Anna; Marino, Rosa Anna Maria; Vita, Carlotta; Navarra, Michele; Cannizzaro, Carla

    2014-01-01

    Acetaldehyde (ACD), the first alcohol metabolite, plays a pivotal role in the rewarding, motivational, and addictive properties of the parental compound. Many studies have investigated the role of ACD in mediating neurochemical and behavioral effects induced by alcohol administration, but very little is known about the modulation of neuropeptide systems following ACD intoxication and withdrawal. Indeed, the neuropeptide Y (NPY) system is altered during alcohol withdrawal in key regions for cerebrocortical excitability and neuroplasticity. The primary goal of this research was to investigate the effects of ACD intoxication and withdrawal by recording rat behavior and by measuring NPY immunoreactivity in hippocampus and NAcc, two brain regions mainly involved in processes which encompass neuroplasticity in alcohol dependence. Furthermore, on the basis of the involvement of endocannabinoidergic system in alcohol and ACD reinforcing effects, the role of the selective CB1 receptor antagonist AM281 in modulating NPY expression during withdrawal was assessed. Our results indicate that (i) ACD intoxication induced a reduction in NPY expression in hippocampus and NAcc; (ii) symptoms of physical dependence, similar to alcohol's, were scored at 12 h from the last administration of ACD; and (iii) NPY levels increased in early and prolonged acute withdrawal in both brain regions examined. The administration of AM281 was able to blunt signs of ACD-induced physical dependence, to modulate NPY levels, and to further increase NPY expression during ACD withdrawal both in hippocampus and NAcc. In conclusion, the present study shows that complex plastic changes take place in NPY system during ACD intoxication and subsequent withdrawal in rat hippocampal formation and NAcc. The pharmacological inhibition of CB1 signaling could counteract the neurochemical imbalance associated with ACD, and alcohol withdrawal, likely boosting the setting up of homeostatic functional recovery.

  14. Absence of association between whole blood viscosity and delirium after cardiac surgery : A case-controlled study

    NARCIS (Netherlands)

    CheheiliSobbi, Shokoufeh; van den Boogaard, Mark; Slooter, Arjen J C; van Swieten, Henry A.; Ceelen, Linda; Pop, Gheorghe; Abdo, Wilson F.; Pickkers, Peter

    2016-01-01

    Background : Delirium after cardiothoracic surgery is common and associated with impaired outcomes. Although several mechanisms have been proposed (including changes in cerebral perfusion), the pathophysiology of postoperative delirium remains unclear. Blood viscosity is related to cerebral perfusio

  15. Preoperative CSF Melatonin Concentrations and the Occurrence of Delirium in Older Hip Fracture Patients : A Preliminary Study

    NARCIS (Netherlands)

    Scholtens, Rikie M; de Rooij, Sophia E J A; Vellekoop, Annelies E; Vrouenraets, Bart C; van Munster, Barbara C

    2016-01-01

    BACKGROUND: Delirium is characterized by disturbances in circadian rhythm. Melatonin regulates our circadian rhythm. Our aim was to compare preoperative cerebrospinal fluid (CSF) melatonin levels in patients with and without postoperative delirium. METHODS: Prospective cohort study with hip fracture

  16. Factors associated with excited delirium deaths in police custody.

    Science.gov (United States)

    Ross, D L

    1998-11-01

    Increasingly, police respond to confrontations in which the individual demonstrates violent and combative behavior as a result of drug-induced delirium. From medical, legal, and police documents, 61 cases of excited delirium decedents in police custody between 1988 and 1997 are analyzed. In all of the cases, the person fought with and was restrained by police; the person was more likely to die at the scene of the incident or during police transport; and the police were likely to be responding to a disturbance call. In a number of cases, survival time was less than 1 hour. In a majority of cases, acute cocaine toxicity and physical restraint in police custody were contributory to death. The literature is reviewed, analyses of case circumstances are provided, and recommendations for medicolegal investigators and police personnel are discussed.

  17. Pharmacological management of anticholinergic delirium - theory, evidence and practice.

    Science.gov (United States)

    Dawson, Andrew H; Buckley, Nicholas A

    2016-03-01

    The spectrum of anticholinergic delirium is a common complication following drug overdose. Patients with severe toxicity can have significant distress and behavioural problems that often require pharmacological management. Cholinesterase inhibitors, such as physostigmine, are effective but widespread use has been limited by concerns about safety, optimal dosing and variable supply. Case series support efficacy in reversal of anticholinergic delirium. However doses vary widely and higher doses commonly lead to cholinergic toxicity. Seizures are reported in up to 2.5% of patients and occasional cardiotoxic effects are also recorded. This article reviews the serendipitous path whereby physostigmine evolved into the preferred anticholinesterase antidote largely without any research to indicate the optimal dosing strategy. Adverse events observed in case series should be considered in the context of pharmacokinetic/pharmacodynamic studies of physostigmine which suggest a much longer latency before the maximal increase in brain acetylcholine than had been previously assumed. This would favour protocols that use lower doses and longer re-dosing intervals. We propose based on the evidence reviewed that the use of cholinesterase inhibitors should be considered in anticholinergic delirium that has not responded to non-pharmacological delirium management. The optimal risk/benefit would be with a titrated dose of 0.5 to 1 mg physostigmine (0.01-0.02 mg kg(-1) in children) with a minimum delay of 10-15 min before re-dosing. Slower onset and longer acting agents such as rivastigmine would also be logical but more research is needed to guide the appropriate dose in this setting.

  18. Association between leptin and delirium in elderly inpatients

    OpenAIRE

    Sanchez JC; Ospina JP; Gonzalez MI

    2013-01-01

    Julio C Sánchez, Jenny P Ospina, Martha I GonzálezCell and Applied Physiology Group, Department of Basic Sciences, Faculty of Health, Universidad Tecnológica de Pereira, Pereira, ColombiaAbstract: Leptin is a hormone with significant effects on the brain, both at the cellular level and cognitive level. This study aimed to establish the association between leptin levels and delirium in a Colombian elderly population. 115 patients older than 60 years were includ...

  19. Acute delirium in an elderly woman following zoledronate administration

    Directory of Open Access Journals (Sweden)

    Mohammad Nasiruddin

    2014-01-01

    Full Text Available Zoledronate is a third-generation bisphosphonate having distinctive profile of high potency as well as prolonged duration of action. Intravenous zoledronate is the recently approved bisphosphonate for the treatment of osteoporosis and has an attractive once-yearly regimen for the treatment of osteoporosis. Here we report, for the first time, a case of acute delirium following zoledronate administration for osteoporosis. An 86-year-old female patient presented to orthopedics out-patient department (OPD with complaints of pain and unable to bear weight on left thigh with history of fall from bed 2 months back. She was diagnosed as fracture neck of femur with severe osteoporosis and treated conservatively. She was given zoledronate IV 5 mg infusion over 30 min. After 10-12 h of zoledronate infusion, patient became confused, disorientated, and agitated. A septic work-up was negative. Electrolyte disturbances were excluded with normal sodium, potassium, calcium, and magnesium levels. Computed tomography of the brain was unremarkable. A metabolic cause could not be found for the change in her mental state. Patient was referred to medicine department where she was diagnosed as drug-induced acute delirium probably due to zoledronate. Patient was advised injections haloperidol and torsemide. In the following 48 h, her confusion got cleared and mental status was improved. According to the Naranjo′s scale, the effect of zoledronate in our patient was scored 6 indicating a probable likelihood of causing delirium. It was a probable cause of acute delirium according to World Health Organization (WHO causality scale.

  20. A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

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    Chong Mei

    2011-08-01

    Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

  1. Risk factors for delirium in acutely admitted elderly patients: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    van Munster Barbara C

    2005-04-01

    Full Text Available Abstract Background Delirium is a neuropsychiatric syndrome frequently observed in elderly hospitalised patients and can be found in any medical condition. Due to the severe consequences, early recognition of delirium is important in order to start treatment in time. Despite the high incidence rate, the occurrence of delirium is not always identified as such. Knowledge of potential risk factors is important. The aim of the current study is to determine factors associated with the occurrence of a prevalent delirium among elderly patients acutely admitted to an internal medicine ward. Methods All consecutive patients of 65 years and over acutely admitted to the Department of Internal Medicine of the Academic Medical Centre, Amsterdam, a university hospital, were asked to participate. The presence of delirium was determined within 48 hrs after admission by an experienced geriatrician. Results In total, 126 patients were included, 29% had a prevalent delirium after acute admission. Compared to patients without delirium, patients with delirium were older, more often were cognitively and physically impaired, more often were admitted due to water and electrolyte disturbances, and were less often admitted due to malignancy or gastrointestinal bleeding. Independent risk factors for having a prevalent delirium after acute admission were premorbid cognitive impairment, functional impairment, an elevated urea nitrogen level, and the number of leucocytes. Conclusions In this study, the most important independent risk factors for a prevalent delirium after acute admission were cognitive and physical impairment, and a high serum urea nitrogen concentration. These observations might contribute to an earlier identification and treatment of delirium in acutely admitted elderly patients.

  2. The diurnal profile of melatonin during delirium in elderly patients--preliminary results.

    Science.gov (United States)

    Piotrowicz, Karolina; Klich-Rączka, Alicja; Pac, Agnieszka; Zdzienicka, Anna; Grodzicki, Tomasz

    2015-12-01

    Delirium is an acute-onset syndrome that exacerbates patients' condition and significantly increases consequential morbidity and mortality. There is no comprehensive, cellular and tissue-level, pathophysiological theory. The melatonin hormone imbalance has been shown to be linked to circadian rhythms, sleep-wake cycle disturbances, and delirium incidence. There has been relatively little research about melatonin in delirium, and there has been no such study done in the group of elderly patients of a general medicine ward yet. The aim of our study was to compare melatonin hormone concentration in relation to the presence of delirium in elderly patients hospitalized in the general medicine ward. Blood samples were collected four times a day for two days (at 12:00, 18:00, 00:00 and 6:00), on the day when delirium was diagnosed and 72 h after the delirium resolution. Delirium was diagnosed with the Confusion Assessment Method and the criteria of the Diagnostic and Statistic Manual of Mental Disorders, 4th Revision. The mean age of 30 patients (73.3% women) was 86.5 ± 5.2 years. Delirium was diagnosed most often on the second and third day of hospitalization. A lot of predisposing and precipitating factors for delirium were identified. There was a significant difference in the melatonin hormone concentration measurement at 12:00 when patients had acute delirium and after its resolution [18.5 (13.8, 27.5) vs 12.9 (9.8, 17.8), ppatients' diagnosis of dementia. We found that the delirium recovery was, in fact, associated with the alteration of the daily profile of melatonin.

  3. Identifying Barriers to Delirium Screening and Prevention in the Pediatric ICU: Evaluation of PICU Staff Knowledge.

    Science.gov (United States)

    Flaigle, Melanie Cooper; Ascenzi, Judy; Kudchadkar, Sapna R

    2016-01-01

    Delirium in the pediatric intensive care unit (PICU) setting is often unrecognized and undertreated. The importance of screening and identification of ICU delirium has been identified in both adult and pediatric literature. Delirium increases ICU morbidity, length of mechanical ventilation and length of stay. The objective of this study was to determine the current knowledge level about delirium and its risk factors among pediatric critical care nurses through a short questionnaire. We hypothesized that before a targeted educational intervention, PICU care providers do not have an adequate knowledge base for accurate screening and diagnosis of delirium in critically ill children. A 17 question online survey was given to all nurses in a tertiary 36-bed PICU to assess current knowledge about delirium in children. The response rate was 73% (105/143). When asked to identify the correct way to diagnose pediatric delirium, 11.4% of nurses surveyed (12/105) incorrectly believed that Glasgow Coma Score is the appropriate screening tool. A large proportion of respondents (40/105) believed that benzodiazepines are helpful in treatment of delirium. The results of the survey identified specific knowledge gaps about risk factors and treatment of pediatric delirium in the critically ill child. There is a critical need for education about pediatric delirium and its risk factors among PICU staff prior to unit-wide implementation of a delirium screening and prevention program, specifically with regards to screening methods and pharmacologic risk factors. These results are likely generalizable to all physicians, nurses and staff who care for critically ill children.

  4. Comparison of incidence and risk factors of delirium between general and regional anesthesia in elderly patients after lower extremity surgery

    Directory of Open Access Journals (Sweden)

    ilke Kupeli

    2016-03-01

    Conclusion: We found that the incidence of delirium is 12.5% in elderly patients undergoing total hip or knee arthroplasty and femur fracture surgery. Advanced age and polypharmacy are risk factors of delirium. Delirium increases the hospital stay and cost. [Cukurova Med J 2016; 41(1.000: 34-40

  5. CONSUMER'S RIGHT TO WITHDRAW

    Directory of Open Access Journals (Sweden)

    ANCA NICOLETA GHEORGHE

    2013-05-01

    Full Text Available The right of withdrawal (of a contract belongs to the consumer, and is an essential means for the improvement of regulations that protect the consumer.. Right of withdrawal is not a recent creation and is not even specific to the consumer field. He was previously recognized in civil and commercial law (without special regulation. The right to withdraw may even have as ground the parties will. Thus, based on the contractual freedom, the parties may agree that one of them has the right to terminate the contract unilaterally The possibility of unilateral denunciation of the contract, gives the consumer, added protection by being able to reflect the decision and to check how the trader fulfil its obligations. In this context, through its effects, the right of denunciation, forces the professional parties to conduct themselves as fair as possible to the consumer and to execute the contract properly. In the study of the consumer protection, the time of conclusion is essential because in this stage is manifested, the inequality between the consumer and professional. Thus, the lack of information, the major of products and activities, commercial practices, influence the formation of consumer will, preventing the expression of a freely and knowingly consent.

  6. The Antiandrogen Withdrawal Syndrome

    Institute of Scientific and Technical Information of China (English)

    华立新; 吴宏飞; 眭元庚; 程双管; 徐正铨; 张炜; 钱立新

    2002-01-01

    Objective To evaluate the response to antiandrogen withdrawal in patients with advanced prostate cancer treated with combined androgen blockade. Methods Twenty-four cases of advanced prostate cancer (10 in stage C and 14 in stage D) were retrospectively studied. All the patients were treated with combined androgen blockade (bilateral orchiectomy and flutamide ). After initial response to hormone therapy for 7 to 36 months, flutamide was discontinued because of deterioration of the disease. Serum prostate specific antigen ( PSA ) levels were checked every 2 to 4 weeks and symptoms observed. Results The results following withdrawal of flutamide were as follows: 8 patients showed a decline in PSA (mean 7 4. 8 o% ), of whom 6 cases had the PSA decline greater than 5 0 %. Clinical symptoms improved in 4 cases. The nodules of the prostate were smaller than before in cases. The mean duration of response was 4. 3 months. Conclusion In patients with hormone refractory advanced prostate cancer after initial combined androgen blockade therapy, a trial of "antiendrogen withdrawal" is a reasonable choice of therapeutic maneuver.

  7. Delirium e demência no idoso: existem fatores de risco comuns? Delirium and dementia in the elderly: are there common risk factors?

    Directory of Open Access Journals (Sweden)

    Priscilla Wacker

    2005-06-01

    Full Text Available Delirium é uma síndrome neurocomportamental decorrente da quebra transitória da homeostase cerebral. Deve-se, invariavelmente, a perturbações sistêmicas ou do sistema nervoso central. No contexto médico geral, a ocorrência de delirium está associada à maior incidência de complicações clínico-cirúrgicas, maior tempo de permanência hospitalar e pior recuperação funcional. O envelhecimento e o comprometimento cognitivo são fatores de risco conhecidos para o delirium. Em pacientes idosos, a ocorrência aumenta o reconhecimento de quadros demenciais preexistentes. Em contrapartida, indivíduos idosos não-demenciados que desenvolvem um episódio de delirium durante uma dada internação hospitalar têm incidência aumentada de demência na evolução em longo prazo. Estudos prospectivos e controlados demonstraram uma associação significativa entre o diagnóstico prévio de delirium e o ulterior desenvolvimento de síndromes demenciais. Essa associação parece ser ainda maior em indivíduos muito idosos. O presente estudo de revisão aborda criticamente a natureza da associação entre delirium e demência. Hipotetiza-se que a sua ocorrência em indivíduos idosos cognitivamente preservados é fator preditivo de deterioração cognitiva, e de risco aumentado para o desenvolvimento de demência, no seguimento de longo termo. As bases neurobiológicas da associação entre delirium e demência são discutidas à luz da hipótese colinérgica da doença de Alzheimer, uma vez que o comprometimento da neurotransmissão colinérgica é denominador comum a essas duas perturbações neuropsíquicas.Delirium is a neurobehavioral syndrome caused by the transient disruption of cerebral homeostasis, which is invariably subsequent to systemic or central nervous system insults. In general medical settings, the occurrence of delirium is also associated with a higher incidence of post-operative complications, longer hospital stays, and poor

  8. Postoperative delirium and factors related in a cardiac surgery unit care

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    Julia de las Pozas Abril

    2011-07-01

    Full Text Available Objective: Describe the incidence of postoperative delirium and related risk factors associated with this complication in patients undergoing cardiac surgery. Method: Cohort study conducted for 3 months in a sample of 105 patients undergoing cardiac surgery in a hospital in Madrid. The emergence of delirium with scale ICDSC (Intensive Care Delirium Screening Checklist was measured during the first five days of postoperative and collected data on preoperative, intra-operative and post-operative factors to relate to the emergence of delirium. Results: 95 Patients studied, 15 of them developed delirium, which means an incidence of 15.7%. We found that there was a significant relationship between delirium appearance and age of the patients, the presence of atrial fibrillation, intubation orotraqueal time and the administration of adrenaline during the immediate post-operative management. The multivariable model showed the duration of orotraqueal intubation to be independently associated with delirium. Conclusions: The incidence of delirium found in this study as well as the identification of the time of orotraqueal intubation as independent risk factor supposes a new contribution to the knowledge of this postoperative complication and allow us to begin to evaluate its importance in the unit of cardiac surgery.

  9. The impact of delirium on the prediction of in-hospital mortality in intensive care patients.

    NARCIS (Netherlands)

    Boogaard, M.H.W.A. van den; Peters, S.A.; Hoeven, J.G. van der; Dagnelie, P.C.; Leffers, P.; Pickkers, P.; Schoonhoven, L.J.

    2010-01-01

    INTRODUCTION: Predictive models, such as acute physiology and chronic health evaluation II (APACHE-II), are widely used in intensive care units (ICUs) to estimate mortality. Although the presence of delirium is associated with a higher mortality in ICU patients, delirium is not part of the APACHE-II

  10. Polymorphisms in the melatonin receptor 1B gene and the risk of delirium

    NARCIS (Netherlands)

    de Jonghe, A; de Rooij, S; Tanck, M W T; Sijbrands, E J G; van Munster, B C V

    2012-01-01

    BACKGROUND/AIMS: A disturbed sleep-wake rhythm cycle can be seen in delirium and as melatonin regulates this cycle via melatonin receptors, genetic variations in these receptors may contribute to susceptibility to delirium. The purpose of this study was to investigate whether genetic variants in the

  11. Glucocorticoid receptor haplotype is associated with a decreased risk of delirium in the elderly

    NARCIS (Netherlands)

    Manenschijn, L; van Rossum, E F C; Jetten, A M; de Rooij, S E; van Munster, B C

    2011-01-01

    Delirium is the most common mental disorder at older age in hospitals after acute admission. The pathogenesis of delirium is largely unknown. Hyperactivity of the hypothalamic-pituitary-adrenal axis, leading to increased cortisol levels, has been suggested to play a role in the development of deliri

  12. Serum S100B in elderly patients with and without delirium.

    NARCIS (Netherlands)

    Munster, B.C. van; Korevaar, J.C.; Korse, C.M.; Bonfrer, J.M.; Zwinderman, A.H.; Rooij, S.E. de

    2010-01-01

    Objective: Elevation of S100B has been shown after various neurologic diseases with cognitive dysfunction. The aim of this study was to compare the serum level of S100B of patients with and without delirium and investigate the possible associations with different subtypes of delirium. Methods: Acute

  13. Cortisol, interleukins and S100B in delirium in the elderly.

    NARCIS (Netherlands)

    Munster, B.C. van; Bisschop, P.H.; Zwinderman, A.H.; Korevaar, J.C.; Endert, E.; Wiersinga, W.J.; Oosten, H.E. van; Goslings, J.C.; Rooij, S.E. de

    2010-01-01

    In independent studies delirium was associated with higher levels of cortisol, interleukin(IL)s, and S100B. The aim of this study was to simultaneously compare cortisol, IL-6, IL-8, and S100B levels in patients aged 65 years and older admitted for hip fracture surgery with and without delirium. Cort

  14. Risk factors for delirium in acutely admitted elderly patients : a prospective cohort study

    NARCIS (Netherlands)

    Korevaar, Johanna C; van Munster, Barbara C; de Rooij, Sophia E

    2005-01-01

    BACKGROUND: Delirium is a neuropsychiatric syndrome frequently observed in elderly hospitalised patients and can be found in any medical condition. Due to the severe consequences, early recognition of delirium is important in order to start treatment in time. Despite the high incidence rate, the occ

  15. Incomplete functional recovery after delirium in elderly people: a prospective cohort study

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    Freter Susan H

    2005-03-01

    Full Text Available Abstract Background Delirium often has a poor outcome, but why some people have incomplete recovery is not well understood. Our objective was to identify factors associated with short-term (by discharge and long-term (by 6 month incomplete recovery of function following delirium. Methods In a prospective cohort study of elderly patients with delirium seen by geriatric medicine services, function was assessed at baseline, at hospital discharge and at six months. Results Of 77 patients, vital and functional status at 6 months was known for 71, of whom 21 (30% had died. Incomplete functional recovery, defined as ≥10 point decline in the Barthel Index, compared to pre-morbid status, was present in 27 (54% of the 50 survivors. Factors associated with death or loss of function at hospital discharge were frailty, absence of agitation (hypoactive delirium, a cardiac cause and poor recognition of delirium by the treating service. Frailty, causes other than medications, and poor recognition of delirium by the treating service were associated with death or poor functional recovery at 6 months. Conclusion Pre-existing frailty, cardiac cause of delirium, and poor early recognition by treating physicians are associated with worse outcomes. Many physicians view the adverse outcomes of delirium as intractable. While in some measure this might be true, more skilled care is a potential remedy within their grasp.

  16. The association between delirium and the apolipoprotein E epsilon4 allele in the elderly

    NARCIS (Netherlands)

    van Munster, Barbara C; Korevaar, Johanna C; de Rooij, Sophia E; Levi, Marcel; Zwinderman, Aeilko H

    2007-01-01

    OBJECTIVE: As not all patients with similar risk factors and eliciting conditions develop delirium; it may be hypothesized that genetic variation may play a role in the risk of delirium. On the basis of the relationship between dementia, respectively reduced cholinergic activity, and the APOE epsilo

  17. A pilot study of rivastigmine in the treatment of delirium after stroke : A safe alternative

    NARCIS (Netherlands)

    Oldenbeuving, Annemarie W.; de Kort, Paul L. M.; Jansen, Ben P. W.; Kappelle, Jaap; Roks, Gerwin

    2008-01-01

    Background: Delirium is a common disorder in the early phase of stroke. Given the presumed cholinergic deficiency in delirium, we tested treatment with the acetylcholinesterase inhibitor rivastigmine. Methods: This pilot study was performed within an epidemiological study. In 527 consecutive stroke

  18. Delirium after Cardiac Surgery in Older Patients : Predictors of occurrence and outcome

    NARCIS (Netherlands)

    R.J. Osse (Robert Jan)

    2013-01-01

    textabstractAs early as in Hippocrates’ medical writings, clinical pictures of patients experiencing delirium were described . The syndrome we currently refer to as delirium was originally based on two distinct syndromes. A syndrome called Phrenitis, in which patients showed cognitive disturbances,

  19. Serum S100B in elderly patients with and without delirium

    NARCIS (Netherlands)

    B.C. Munster; J.C. Korevaar; C.M. Korse; J.M. Bonfrer; A.H. Zwinderman; S.E. de Rooij

    2010-01-01

    Objective: Elevation of S100B has been shown after various neurologic diseases with cognitive dysfunction. The aim of this study was to compare the serum level of S100B of patients with and without delirium and investigate the possible associations with different subtypes of delirium. Methods: Acute

  20. Sleep and delirium in unsedated patients in the intensive care unit

    DEFF Research Database (Denmark)

    Boesen, H C; Andersen, J H; Bendtsen, A O

    2016-01-01

    BACKGROUND: Sleep deprivation and delirium are major problems in the ICU. We aimed to assess the sleep quality by polysomnography (PSG) in relation to delirium in mechanically ventilated non-sedated ICU patients. METHODS: Interpretation of 24-h PSG and clinical sleep assessment in 14 patients...

  1. Do patient characteristics influence nursing adherence to a guideline for preventing delirium?

    NARCIS (Netherlands)

    IJkema, R.; Langelaan, M.; Steeg, L. van de; Wagner, C.

    2014-01-01

    Purpose: The purpose of this study was to examine if the characteristics of patients influence nursing adherence to a quality improvement guideline. This guideline consists of delirium risk screening and preventive care, including the use of the Delirium Observation Screening Scale (DOSS). Design: A

  2. Beyond Grand Rounds: A Comprehensive and Sequential Intervention to Improve Identification of Delirium

    Science.gov (United States)

    Ramaswamy, Ravishankar; Dix, Edward F.; Drew, Janet E.; Diamond, James J.; Inouye, Sharon K.; Roehl, Barbara J. O.

    2011-01-01

    Purpose of the Study: Delirium is a widespread concern for hospitalized seniors, yet is often unrecognized. A comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium was tested. Design and Methods: A 2-day CSI program that consisted of progressive 4-part didactic series,…

  3. Delirium in Severely Ill Young Children in the Pediatric Intensive Care Unit (PICU)

    Science.gov (United States)

    Schieveld, Jan N. M.; Leentjens, Albert F. G.

    2005-01-01

    Delirium is a serious neuropsychiatric disorder frequently seen in severely ill adult and geriatric patients. The clinical picture in adults is well known, as are the negative prognostic implications of delirium on length of hospital stay, morbidity, and mortality (American Psychiatric Association, 1999); however, it is less appreciated that…

  4. [Summary of the Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'

    NARCIS (Netherlands)

    Weele, G.M. van der; Olde Rikkert, M.G.M.; Eizenga, W.H.; Assendelft, W.J.J.

    2003-01-01

    The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people' contains a number of key messages. These are: Consider the diagnosis of delirium in the case of changes in consciousness and attention, incoherent thinking or disorientation, if this picture developed over a

  5. Udvikling og behandling af delirium hos kritisk syge børn

    DEFF Research Database (Denmark)

    Winther-Olesen, Marie; Afshari, Arash

    2012-01-01

    Delirium is a common and often under-recognised neuropsychiatric disorder in paediatric critical care, secondary to a general medical condition. Paediatric delirium (PD) is associated with high morbidity and mortality and prolonged stay at the intensive care unit. This review introduces the reader...

  6. 38 CFR 21.42 - Deferral or extension of the basic period of eligibility.

    Science.gov (United States)

    2010-07-01

    ... alcohol-induced physical or mental disorders or both, such as habitual intoxication, withdrawal, delirium... alcohol dependency or chronic alcohol abuse; and (ii) Have been determined to prevent the affected veteran... of alcoholism, chronic alcoholism, alcohol dependency, or chronic alcohol abuse, in and of...

  7. Alcohol disrupts sleep homeostasis.

    Science.gov (United States)

    Thakkar, Mahesh M; Sharma, Rishi; Sahota, Pradeep

    2015-06-01

    Alcohol is a potent somnogen and one of the most commonly used "over the counter" sleep aids. In healthy non-alcoholics, acute alcohol decreases sleep latency, consolidates and increases the quality (delta power) and quantity of NREM sleep during the first half of the night. However, sleep is disrupted during the second half. Alcoholics, both during drinking periods and during abstinences, suffer from a multitude of sleep disruptions manifested by profound insomnia, excessive daytime sleepiness, and altered sleep architecture. Furthermore, subjective and objective indicators of sleep disturbances are predictors of relapse. Finally, within the USA, it is estimated that societal costs of alcohol-related sleep disorders exceeds $18 billion. Thus, although alcohol-associated sleep problems have significant economic and clinical consequences, very little is known about how and where alcohol acts to affect sleep. In this review, we have described our attempts to unravel the mechanism of alcohol-induced sleep disruptions. We have conducted a series of experiments using two different species, rats and mice, as animal models. We performed microdialysis, immunohistochemical, pharmacological, sleep deprivation and lesion studies which suggest that the sleep-promoting effects of alcohol may be mediated via alcohol's action on the mediators of sleep homeostasis: adenosine (AD) and the wake-promoting cholinergic neurons of the basal forebrain (BF). Alcohol, via its action on AD uptake, increases extracellular AD resulting in the inhibition of BF wake-promoting neurons. Since binge alcohol consumption is a highly prevalent pattern of alcohol consumption and disrupts sleep, we examined the effects of binge drinking on sleep-wakefulness. Our results suggest that disrupted sleep homeostasis may be the primary cause of sleep disruption observed following binge drinking. Finally, we have also shown that sleep disruptions observed during acute withdrawal, are caused due to impaired

  8. [Endogenous blood ethanol in alcoholic patients and healthy subjects with and without a family history of alcoholism].

    Science.gov (United States)

    Pron'ko, P S; Shishkin, S N; Kolesnikov, V B; Volynets, S I; Ostrovskiĭ, Iu M

    1987-01-01

    Levels of endogenous ethanol were studied in healthy males, 12-13-year-old boys (sons of alcoholics and normal fathers) and alcoholic patients (after discontinuation of all drugs). The results showed no significant differences between the groups. On the other hand endogenous ethanol concentrations were higher than normal in oligophrenic boys irrespective of whether their fathers were alcoholics or healthy subjects. In the abstinence period endogenic ethanol concentrations were the minimal in patients with delirium tremens and a severe abstinence syndrome, the dynamics of this parameter in the process of treatment being dependent on the severity of the abstinence syndrome and on the nature of treatment.

  9. Moving Beyond Metabolic Encephalopathy: An Update on Delirium Prevention, Workup, and Management.

    Science.gov (United States)

    Brown, Ethan G; Douglas, Vanja C

    2015-12-01

    Delirium is a condition that frequently complicates hospitalization and consists of an acute decline in orientation and attention, often accompanied by other cognitive changes. Delirium is tied to multiple detrimental outcomes both in the short and long term, including cognitive and functional decline, inpatient complications, and mortality. Postoperative, elderly medical, and critical care patients have been identified as populations at particular risk. In this review, the authors discuss current theories on pathophysiology, recommended workup, and evidence-based prevention and management of inpatient delirium. In general, instituting a system of active screening of at-risk populations and nonpharmacologic interventions for prevention and treatment seems to be the most effective method of addressing delirium. More research is needed to clarify the etiology of delirium and develop safe therapeutic options that address the underlying pathophysiology.

  10. Short-term cognitive effects after recovery from a delirium in a hospitalized elderly sample.

    Science.gov (United States)

    Mark, Ruth E; Muselaers, Noortje; Scholten, Hetty; van Boxtel, Anton; Eerenberg, Trudy

    2014-10-01

    The aim of this study was to examine early cognitive performance after a delirium in elderly general hospital patients. Patients were divided into a delirium (n = 47) and a control (n = 25) group. One week before discharge and after delirium had cleared in the first group, all patients completed a neuropsychological test battery (The Cambridge Cognitive Examination-Revised [CAMCOG-R]). Group differences in cognitive performance were analyzed adjusting for differences in baseline sociodemographic and clinical variables. Adjusting for group differences in baseline variables, the delirium group performed significantly worse than the control group on CAMCOG-R; its subdomains language, praxis, and executive functioning; and on Mini Mental State Examination derived from CAMCOG-R. The occurrence of delirium in hospital thus detrimentally affects early cognitive performance.

  11. Preoperative plasma leptin levels predict delirium in elderly patients after hip fracture surgery.

    Science.gov (United States)

    Chen, Xue-Wu; Shi, Jun-Wu; Yang, Ping-Shan; Wu, Zhu-Qi

    2014-07-01

    Leptin is considered to be a modulator of the immune response. Hypoleptinemia increases the risk for Alzheimer's disease and vascular dementia. The present study aimed to investigate the ability of plasma leptin level to predict delirium in elderly patients after hip fracture surgery. Postoperative delirium (pod) was evaluated using the Confusion Assessment Method. Prolonged postoperative delirium (ppod) was defined as delirium lasting more than 4 weeks. Plasma leptin levels of 186 elderly patients and 186 elderly controls were measured by an enzyme-linked immunosorbent assay. Plasma leptin level was substantially lower in patients than in controls (4.6±2.2ng/ml vs. 7.5±1.8ng/ml, Pdelirium and also prolonged delirium in elderly patients after hip fracture surgery.

  12. Detection and Management of Delirium in the Neonatal Unit: A Case Series.

    Science.gov (United States)

    Groves, Alan; Traube, Chani; Silver, Gabrielle

    2016-03-01

    Delirium is increasingly recognized as a common syndrome in critically ill children, but in our experience, it is rarely considered in the NICU. Delirium is independently associated with prolonged length of stay and adverse long-term outcomes in children. We report the cases of 3 infants cared for in our NICU at corrected gestational ages of 4, 11, and 17 weeks who presented with classic symptoms of delirium. All 3 children had complex medical problems and were receiving multiple analgesic and sedative medications. All 3 children exhibited agitation that was unresponsive to increasing doses of medications, and they all appeared to improve after treatment with quetiapine, allowing weaning of other medications. It is possible that with increased vigilance, delirium will be increasingly recognized in newborns, thus allowing tailored intervention. Further research is needed to investigate the prevalence and associated risk factors for developing delirium in the NICU and to explore possible treatment options.

  13. Phenomenological and neuropsychological profile across motor variants of delirium in a palliative care unit

    LENUS (Irish Health Repository)

    Leonard, Maeve

    2011-01-01

    Studies using composite measurement of cognition suggest that cognitive performance is similar across motor variants of delirium. The authors assessed neuropsychological and symptom profiles in 100 consecutive cases of DSM-IV delirium allocated to motor subtypes in a palliative-care unit: Hypoactive (N=33), Hyperactive (N=18), Mixed (N=26), and No-Alteration motor groups (N=23). The Mixed group had more severe delirium, with highest scores for DRS-R-98 sleep-wake cycle disturbance, hallucinations, delusions, and language abnormalities. Neither the total Cognitive Test for Delirium nor its five neuropsychological domains differed across Hyperactive, Mixed, and Hypoactive motor groups. Most patients (70%) with no motor alteration had DRS-R-98 scores in the mild or subsyndromal range even though they met DSM-IV criteria. Motor variants in delirium have similar cognitive profiles, but mixed cases differ in expression of several noncognitive features.

  14. 27 CFR 22.113 - Receipt of tax-free alcohol.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Receipt of tax-free alcohol. 22.113 Section 22.113 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS DISTRIBUTION AND USE OF TAX-FREE ALCOHOL Withdrawal...

  15. Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum?

    Science.gov (United States)

    Gore, Rachel L; Vardy, Emma R L C; O'Brien, John T

    2015-01-01

    Dementia with Lewy bodies (DLB) is recognised as the second most common form of dementia in older people. Delirium is a condition of acute brain dysfunction for which a pre-existing diagnosis of dementia is a risk factor. Conversely delirium is associated with an increased risk of developing dementia. The reasons for this bidirectional relationship are not well understood. Our aim was to review possible similarities in the clinical presentation and pathophysiology between delirium and DLB, and explore possible links between these diagnoses. A systematic search using Medline, Embase and Psychinfo was performed. References were scanned for relevant articles, supplemented by articles identified from reference lists and those known to the authors. 94 articles were selected for inclusion in the review. Delirium and DLB share a number of clinical similarities, including global impairment of cognition, fluctuations in attention and perceptual abnormalities. Delirium is a frequent presenting feature of DLB. In terms of pathophysiological mechanisms, cholinergic dysfunction and genetics may provide a common link. Neuroimaging studies suggest a brain vulnerability in delirium which may also occur in dementia. The basal ganglia, which play a key role in DLB, have also been implicated in delirium. The role of Cerebrospinal fluid (CSF) and serum biomarkers for both diagnoses is an interesting area although some results are conflicting and further work in this area is needed. Delirium and DLB share a number of features and we hypothesise that delirium may, in some cases, represent early or 'prodromal' DLB. Further research is needed to test the novel hypothesis that delirium may be an early marker for future DLB, which would aid early diagnosis of DLB and identify those at high risk.

  16. Modeling IRA Accumulation and Withdrawals

    OpenAIRE

    Sabelhaus, John

    2000-01-01

    Empirical analysis of IRA accumulation and withdrawal patterns is limited because information about IRA balances and flows is not available for a sample of taxpayers. This paper combines survey data on IRA balances with individual tax return data on IRA flows to study IRA accumulation and withdrawal patterns across cohorts. The analysis shows that IRA rules such as penalties for early withdrawals and minimum distribution requirements have predictable effects on IRA flows. The estimated propen...

  17. Serum anticholinergic activity and cerebral cholinergic dysfunction: An EEG study in frail elderly with and without delirium

    Directory of Open Access Journals (Sweden)

    Driessen Martin

    2008-09-01

    Full Text Available Abstract Background Delirium increases morbidity, mortality and healthcare costs especially in the elderly. Serum anticholinergic activity (SAA is a suggested biomarker for anticholinergic burden and delirium risk, but the association with cerebral cholinergic function remains unclear. To clarify this relationship, we prospectively assessed the correlation of SAA with quantitative electroencephalography (qEEG power, delirium occurrence, functional and cognitive measures in a cross-sectional sample of acutely hospitalized elderly (> 80 y with high dementia and delirium prevalence. Methods 61 consecutively admitted patients over 80 years underwent an extensive clinical and neuropsychological evaluation. SAA was determined by using radio receptor assay as developed by Tune, and standard as well as quantitative EEGs were obtained. Results 15 patients had dementia with additional delirium (DD according to expert consensus using DSM-IV criteria, 31 suffered from dementia without delirium (D, 15 were cognitively unimpaired (CU. SAA was clearly detectable in all patients but one (mean 10.9 ± 7.1 pmol/ml, but was not associated with expert-panel approved delirium diagnosis or cognitive functions. Delirium-associated EEG abnormalities included occipital slowing, peak power and alpha decrease, delta and theta power increase and slow wave ratio increase during active delirious states. EEG measures correlated significantly with cognitive performance and delirium severity, but not with SAA levels. Conclusion In elderly with acute disease, EEG parameters reliable indicate delirium, but SAA does not seem to reflect cerebral cholinergic function as measured by EEG and is not related to delirium diagnosis.

  18. Incidence and Cause of Delirium in Hospitalized Patients between the Ages of 18 and 56: A Retrospective Chart Review

    Directory of Open Access Journals (Sweden)

    Michelle T. Weckmann

    2014-01-01

    Full Text Available Background. Delirium is a common and devastating condition which has been well characterized in elderly cancer patients, but little is known about delirium in cancer patients under the age of 65. Aim. A pilot study to explore the incidence and potential causes of delirium in hospitalized advanced cancer patients at the age of 18–56 years. Design. A retrospective chart review using validated instruments was used to examine the charts of hematology-oncology admissions in a large academic institution. Data was collected as to the likelihood of delirium and potential precipitants. Results. Delirium incidence was 29% among advanced cancer patients. The associated precipitants of delirium were multifactorial, the most common being medications and infection. Delirium was more common in patients admitted for either acute symptom management or the presence of a lung malignancy. Patients with delirium demonstrated significantly increased total hospital cost and a borderline significant result for increased mortality compared to those without delirium. Conclusions. Delirium is common in hospitalized advanced cancer patients (age 18–56 years and the cause is typically multifactorial. Delirium results in a more complicated hospital course and likely increased mortality. Further research is needed to define strategies to prevent and treat this common and distressing condition.

  19. Response to anticoagulant drug withdrawal.

    Science.gov (United States)

    Mulligan, R

    1987-09-01

    This study evaluated 44 separate medication withdrawal periods in 17 subjects who were attending a hospital anticoagulation clinic for management of anticoagulation medication. The data suggest that when anticoagulant withdrawal is needed for particular dental procedures, a 2-day hold is an effective period of medication withdrawal. No thromboembolic events were observed after any of the withdrawal periods. Further, no posttreatment hemorrhagic episodes were observed when the anticoagulant medication was reinstituted after dental treatment. Prothrombin time blood levels should be determined in the immediate pretreatment period, however, because the prothrombin time can fluctuate even in the best maintained patients.

  20. Determining the need for team-based training in delirium management: A needs assessment of surgical healthcare professionals.

    Science.gov (United States)

    Sockalingam, Sanjeev; Tehrani, Hedieh; Kacikanis, Anna; Tan, Adrienne; Hawa, Raed; Anderson, Ruthie; Okrainec, Allan; Abbey, Susan

    2015-01-01

    The high incidence of delirium in surgical units is a serious quality concern, given its impact on morbidity and mortality. While successful delirium management depends upon interdisciplinary care, training needs for surgical teams have not been studied. A needs assessment of surgical units was conducted to determine perceived comfort in managing delirium, and interprofessional training needs for team-based care. We administered a survey to 106 General Surgery healthcare professionals (69% response rate) with a focus on attitudes towards delirium and team management. Although most respondents identified delirium as important to patient outcomes, only 61% of healthcare professionals indicated that a team-based approach was always observed in practice. Less than half had a clear understanding of their role in delirium care, while just over half observed team communication of delirium care plans during handover. This is the first observation of clear gaps in perceived team performance in a General Surgery setting.

  1. Influence of the endogenous opioid system on high alcohol consumption and genetic predisposition to alcoholism

    OpenAIRE

    Gianoulakis, Christina

    2001-01-01

    There is increasing evidence supporting a link between the endogenous opioid system and excessive alcohol consumption. Acute or light alcohol consumption stimulates the release of opioid peptides in brain regions that are associated with reward and reinforcement and that mediate, at least in part, the reinforcing effects of ethanol. However, chronic heavy alcohol consumption induces a central opioid deficiency, which may be perceived as opioid withdrawal and may promote alcohol consumption th...

  2. Application effects of Orem self-care theory in patients with stroke and alcohol withdrawal syndrome%Orem护理系统理论在脑卒中患者并发酒精戒断综合征的应用

    Institute of Scientific and Technical Information of China (English)

    郑美爱; 林容杏; 罗美菊

    2012-01-01

    目的 探讨Orem护理系统理论在脑卒中并酒精戒断综合征患者中的应用效果.方法 将50例脑卒中并酒精戒断综合征患者随机分为观察组和对照组,各25例,对照组采取常规的护理干预措施,观察组在此基础上应用Orem护理系统模式进行护理干预:ADL能力评分≤40分者,实施①环境及人身安全护理(如上床栏,必要时使用保护性约束或适当的镇静剂);②加强意识、思维、认知观察;③避免激惹因素.ADL能力评分60 ~41分者,行肢体功能训练指导,坐、卧姿势,进食等的指导,干预三周后比较两组患者的日常生活能力( ADL),并观察两组患者在住院期间护理并发症的发生率.结果 观察组ADL得分高于对照组t=4.254.而误吸、肺部感染、压疮较对照组发生率低,t检验值分别为2.257、2.038,2.085.结论 将Orem护理系统理论应用于脑卒中并酒精戒断综合症患者的护理,可调动患者及家属的积极性,提高患者的生活质量,实现患者的自我护理和康复.%Objective To investigate the effect of Orem self-care theory in patients with stroke and alcohol withdrawal syndrome.Methods 50 patients with stroke and alcohol withdrawal syndrome were randomly divided into observation group and control group(n=25),cases in the control group took regular nursing care interventions,while the observation group had additional Orem self-care model of nursing intervention on the basis of regular nursing care:For those with activities of daily living (ADL) ability score =40 points,the following implementation were conducted:①Environmental and personal safety care (such as bedrails,if necessary,the use of protective restraint or sedative):②Strengthening awareness,thinking,cognition observation; ③Avoiding the irritation factor.Those with ADL score of 60~41 points,took the limb function training guidance,sitting or lying posture,eating guidance,3 weeks later 2 groups were compared with ADL

  3. Delirium in the fast-track surgery setting

    DEFF Research Database (Denmark)

    Krenk, Lene; Rasmussen, Lars S; Kehlet, Henrik

    2012-01-01

    Postoperative delirium (PD) and postoperative cognitive dysfunction (POCD) are two separate syndromes of cognitive decline after major surgery, especially in the elderly. Pathogenesis is multifactorial with some common risk factors, and to reduce the risk, a multimodal approach is necessary....../knee arthroplasty (THA/TKA). The fast-track set-up seems to be associated with a lower frequency of PD and early POCD after THA/TKA. Thus, in a series of 225 patients ≥60 years, no cases of PD were seen and the incidence of POCD was reduced by more than 50% at 1 week postoperatively compared to previous studies...

  4. A Clinical Update on Delirium: From Early Recognition to Effective Management

    Directory of Open Access Journals (Sweden)

    Joaquim Cerejeira

    2011-01-01

    Full Text Available Delirium is a neuropsychiatric syndrome characterized by altered consciousness and attention with cognitive, emotional and behavioural symptoms. It is particularly frequent in elderly people with medical or surgical conditions and is associated with adverse outcomes. Predisposing factors render the subject more vulnerable to a congregation of precipitating factors which potentially affect brain function and induce an imbalance in all the major neurotransmitter systems. Early diagnosis of delirium is crucial to improve the prognosis of patients requiring the identification of subtle and fluctuating signs. Increased awareness of clinical staff, particularly nurses, and routine screening of cognitive function with standardized instruments, can be decisive to increase detection rates of delirium. General measures to prevent delirium include the implementation of protocols to systematically identify and minimize all risk factors present in a particular clinical setting. As soon as delirium is recognized, prompt removal of precipitating factors is warranted together with environmental changes and early mobilization of patients. Low doses of haloperidol or olanzapine can be used for brief periods, for the behavioural control of delirium. All of these measures are a part of the multicomponent strategy for prevention and treatment of delirium, in which the nursing care plays a vital role.

  5. Licensed Nurse and Nursing Assistant Recognition of Delirium in Nursing Home Residents With Dementia

    Science.gov (United States)

    Steis, Melinda R; Behrens, Liza; Colancecco, Elise M; Mogle, Jacqueline; Mulhall, Paula M; Hill, Nikki L; Fick, Donna M; Kolankowski, Ann M

    2016-01-01

    Many nursing home residents experience delirium. Nursing home personnel, especially nursing assistants, have the opportunity to become familiar with residents’ normal cognitive function and to recognize changes in a resident’s cognitive function over time. The purpose of this study was to determine the accuracy of delirium recognition by licensed nurses and nursing assistants from eight nursing homes over a 12-month period. Participants were asked to complete five case vignette assessments at three different time points (in 6-month intervals) to test their ability to identify different subtypes of delirium and delirium superimposed on dementia (DSD). A total of 760 case vignettes were completed across the different time points. Findings reveal that staff recognition of delirium was poor. The case vignette describing hyperactive DSD was correctly identified by the greatest number participants, and the case vignette describing hypoactive DSD was correctly identified by the least number of participants. Recognition of the case vignette describing hypoactive delirium improved over time. Nursing assistants performed similarly to the licensed nurses, indicating that all licensed nursing home staff require further education to correctly recognize delirium in older adults. PMID:28042285

  6. gamma-Hydroxybutyric acid (GHB) suppresses alcohol's motivational properties in alcohol-preferring rats.

    Science.gov (United States)

    Maccioni, Paola; Pes, Daniela; Fantini, Noemi; Carai, Mauro A M; Gessa, Gian Luigi; Colombo, Giancarlo

    2008-03-01

    gamma-Hydroxybutyric acid (GHB) reduces alcohol drinking, promotes abstinence from alcohol, suppresses craving for alcohol, and ameliorates alcohol withdrawal syndrome in alcoholics. At preclinical level, GHB suppresses alcohol withdrawal signs and alcohol intake in rats. The present study was designed to investigate whether GHB administration was capable of affecting alcohol's motivational properties (the possible animal correlate of human craving for alcohol) in selectively bred Sardinian alcohol-preferring rats. To this aim, rats were initially trained to lever press for alcohol (15%, vol/vol) under a procedure of operant, oral alcohol self-administration (fixed ratio 4 in 30-min daily sessions). Once responding for alcohol had stabilized, rats were divided into two groups and allocated to two independent experiments. Experiment 1 assessed the effect of GHB (0, 25, 50, and 100mg/kg, i.p.) on breakpoint for alcohol, defined as the lowest response requirement not achieved by each rat when exposed to a single-session progressive ratio schedule of reinforcement. Experiment 2 assessed the effect of GHB (0, 25, 50, and 100mg/kg, i.p.) on single-session extinction responding for alcohol (alcohol was absent and unreinforced responding was recorded). Breakpoint and extinction responding for alcohol are reliable indexes of alcohol's motivational strength. In Experiment 1, all doses of GHB reduced--by approximately 20% in comparison to saline-treated rats--breakpoint for alcohol. In Experiment 2, administration of 25, 50, and 100mg/kg GHB reduced--by approximately 25%, 40%, and 50%, respectively, in comparison to saline-treated rats--extinction responding for alcohol. Conversely, no dose of GHB altered breakpoint and extinction responding for sucrose (3%, wt/vol) in two independent subsets of Sardinian alcohol-preferring rats. Together, these data suggest that GHB administration specifically suppressed alcohol's motivational properties in Sardinian alcohol-preferring rats

  7. Alcoholism between Fiction and Reality.

    Science.gov (United States)

    Carota, Antonio; Calabrese, Pasquale

    2013-01-01

    Alcoholism has always been emphasized in literature, narratives, and theater as its prevalence and related disability are very high, is found throughout the world, and affects women and men of all ages and social classes. There is a tragic or romantic fascination in the deep sense of personal failure that drinking is able to relieve and in the uncontrollable inability to stop drinking. These aspects have been portrayed well by fictional alcoholics in movies and novels. It has become evident that biological traits together with a complex series of psychosocial factors (e.g. negative life events, depression, anxiety, and other psychiatric or personality disorders), which are also well represented in novels and movies, can lead to alcohol addiction. Behavioral (euphoria, disinhibiting behaviors, aggressiveness) and neurological changes (confusion, bradypsychism, slurred speech, ataxia, blackouts) related to alcohol intoxication are also well portrayed by fictional characters. Delirium tremens, epilepsy, alcohol dementia, and Wernicke-Korsakoff disease, however, find less representation in literature and on the stage and screen. The treatment of alcoholic dependence is very difficult (as often reported by fictional and real stories), but should never be considered hopeless. It should be initiated at any stage of the disease. The support offered by Alcoholics Anonymous has always had great appeal for the public. Fictional works can portray alcohol addiction superbly and show some dark sides of human nature (negative emotions and autodestructive thoughts and behaviors), and, at the same time, the severity and pervasiveness of mental illnesses. The psychiatric and psychosocial aspects of alcohol addiction in movies and novels could be an inspiring source for new psychological studies and rehabilitation programs.

  8. Afghanistan after NATO Withdrawal

    Directory of Open Access Journals (Sweden)

    Bojor Laviniu

    2015-06-01

    Full Text Available The conclusion of a conflict, called by some American analysts as “America’s Longest War”, after the withdrawal of the majority of NATO military forces, requires a careful analysis of the conditions and security environment that ISAF mission, International Security Afghan Forces, leaves as legacy to the Afghan military forces. The transfer of authority towards a strong government, recognized by most Afghan provinces, and benefiting from the support of national military forces able to cope with terrorist and insurgent threats on its own, are the minimum and necessary conditions leading the country towards a stable and secure environment and towards a sustainable development. Given these realities, any approach on the consequences of the transition towards self-sustainable governance becomes interesting and timely for any military political study. These are the prospects that we propose in our paper.

  9. Molecular basis of alcoholism.

    Science.gov (United States)

    Most, Dana; Ferguson, Laura; Harris, R Adron

    2014-01-01

    Acute alcohol intoxication causes cellular changes in the brain that last for hours, while chronic alcohol use induces widespread neuroadaptations in the nervous system that can last a lifetime. Chronic alcohol use and the progression into dependence involve the remodeling of synapses caused by changes in gene expression produced by alcohol. The progression of alcohol use, abuse, and dependence can be divided into stages, which include intoxication, withdrawal, and craving. Each stage is associated with specific changes in gene expression, cellular function, brain circuits, and ultimately behavior. What are the molecular mechanisms underlying the transition from recreational use (acute) to dependence (chronic)? What cellular adaptations result in drug memory retention, leading to the persistence of addictive behaviors, even after prolonged drug abstinence? Research into the neurobiology of alcoholism aims to answer these questions. This chapter will describe the molecular adaptations caused by alcohol use and dependence, and will outline key neurochemical participants in alcoholism at the molecular level, which are also potential targets for therapy.

  10. Incidence and risk factors of delirium in critically ill patients after non-cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    SHI Cheng-mei; WANG Dong-xin; CHEN Kai-sheng; GU Xiu-e

    2010-01-01

    Background Delirium is a common and deleterious complication in critically ill patients after surgery. The purpose of this study was to determine the incidence and risk factors of delirium in critically ill patients after non-cardiac surgery, and to investigate the relationship between the serum cortisol level and the occurrence of postoperative delirium. Methods In a prospective cohort study, 164 consecutive patients who were admitted to the surgical intensive care unit after non-cardiac surgery were enrolled. Baseline characteristics and perioperative variables were collected. Blood samples were obtained on the first postoperative day and serum cortisol concentrations were measured. Delirium was assessed using the Nursing Delirium Screening Scale until the seventh postoperative day or the disappearance of delirious symptoms.Results Postoperative delirium occurred in 44.5% of patients (73 of 164). The median time to first onset of delirium is 0 (range 0 to 5 days) and the median duration of delirium is 3 (1 to 13) days. Independent risk factors of postoperative delirium included increasing age (odds ratio (OR) 2.646, 95% confidence interval (CI) 1.431 to 4.890, P=0.002), a history of previous stroke (OR 4.499, 95%CI 1.228 to 16.481, P=0.023), high Acute Physiology and Chronic Health Evaluation Ⅱ score on surgical intensive care unite admission (OR 1.391, 95%CI 1.201 to 1.612, P<0.001), and high serum cortisol level on the 1 st postoperative day (OR 3.381, 95%CI 1.690 to 6.765, P=0.001). The development of delirium was linked to higher incidence of postoperative complications (28.8% vs. 7.7%, P<0.001), and longer duration of hospitalization (18 (7 to 74) days vs. 13 (3 to 48) days, P <0.001).Conclusions Delirium was a frequent complication in critically ill patients after non-cardiac surgery. High serum cortisol level was associated with increased incidence of postoperative delirium.

  11. Delirium in the geriatric unit: proton-pump inhibitors and other risk factors

    Directory of Open Access Journals (Sweden)

    Otremba I

    2016-04-01

    Full Text Available Iwona Otremba, Krzysztof Wilczyński, Jan SzewieczekDepartment of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, PolandBackground: Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies.Objective: Evaluate specific factors for development of delirium in a geriatric ward setting.Methods: Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men, admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed.Results: Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54–5.01; P=0.001, preexisting dementia (OR =2.29; CI =1.44–3.65; P<0.001, previous delirium incidents (OR =2.23; CI =1.47–3.38; P<0.001, previous fall incidents (OR =1.76; CI =1.17–2.64; P=0.006, and use of proton-pump inhibitors (OR =1.67; CI =1.11–2.53; P=0.014.Conclusion: Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting.Keywords: delirium

  12. New aspects of delirium in elderly patients with critical limb ischemia

    Directory of Open Access Journals (Sweden)

    van Eijsden WA

    2015-09-01

    Full Text Available Willem A van Eijsden,1 Jelle W Raats,1 Paul GH Mulder,2 Lijckle van der Laan1 1Department of Surgery, 2Amphia Academy, Amphia Hospital, Breda, the Netherlands Objective: The primary objective was to identify possible risk factors for delirium in patients with critical limb ischemia undergoing surgery. The secondary objective was to study the effect of delirium on complications, the length of hospital stay, health care costs, and mortality. Methods: All patients 65 years or older with critical limb ischemia undergoing surgery from February 2013 to July 2014 at Amphia Hospital, were included and followed up until December 31, 2014. Delirium was scored using the Delirium Observation Screening Scale (DOSS. Perioperative risk factors (age, comorbidity, factors of frailty, operation type, hemoglobulin, and transfusion were collected and analyzed using logistic regression. Secondary outcomes were the number of complications, total hospital stay, extra health care costs per delirium, and mortality within 3 months and 6 months of surgery Results: We included 92 patients with critical limb ischemia undergoing surgery. Twenty-nine (32% patients developed a delirium during admission, of whom 17 (59% developed delirium preoperatively. After multivariable analysis, only diabetes mellitus (odds ratio [OR] =6.23; 95% confidence interval [CI]: 1.11–52.2; P=0.035 and Short Nutritional Assessment Questionnaire for Residential Care (SNAQ-RC ≥3 (OR =5.55; 95% CI: 1.07–42.0; P=0.039 was significantly associated with the onset of delirium. Delirium was associated with longer hospital stay (P=0.001, increased health care costs, and higher mortality after 6 months (P<0.001. Conclusion: Delirium is a common adverse event in patients with critical limb ischemia undergoing surgery with devastating outcome in the long term. Most patients developed delirium preoperatively, which indicates the need for early recognition and preventive strategies in the preoperative

  13. Long-term subcutaneous infusion of midazolam for refractory delirium in terminal breast cancer.

    Science.gov (United States)

    Ramani, S; Karnad, A B

    1996-11-01

    We describe the case of a 56-year-old woman with terminal metastatic breast cancer who had delirium in the form of frightening hallucinations, paranoid delusions, and nightmares resulting in violent agitation. During this period, her bone pains from metastases were well controlled with narcotic analgesics, but her delirium proved refractory to standard doses of drugs such as lorazepam, diazepam, and haloperidol. We report the use of a subcutaneous infusion of midazolam at home and its effectiveness in control of her delirium after other drugs had failed.

  14. Is crystallised intelligence preserved in elderly patients with post-operative delirium?

    OpenAIRE

    Robertson, Jennie

    2008-01-01

    The current investigation examined whether crystallised intelligence (Gc) is preserved in delirium, where fluid cognitive skills (Gf) are known to be impaired. McGurn et al. (2004) suggest that Gc may be preserved in cases of mild to moderate dementia, whereas Gf is not. The present study hypothesised a similar pattern in post-operative delirium. Cognitive and delirium test batteries were administered to 37 patients over the age of 60, pre- and post-coronary artery bypass graft (CABG) and/or ...

  15. Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI.

    Science.gov (United States)

    Cavallari, Michele; Dai, Weiying; Guttmann, Charles R G; Meier, Dominik S; Ngo, Long H; Hshieh, Tammy T; Callahan, Amy E; Fong, Tamara G; Schmitt, Eva; Dickerson, Bradford C; Press, Daniel Z; Marcantonio, Edward R; Jones, Richard N; Inouye, Sharon K; Alsop, David C

    2016-04-01

    Despite the significant impact of postoperative delirium on surgical outcomes and the long-term prognosis of older patients, its neural basis has not yet been clarified. In this study we investigated the impact of premorbid brain microstructural integrity, as measured by diffusion tensor imaging before surgery, on postoperative delirium incidence and severity, as well as the relationship among presurgical cognitive performance, diffusion tensor imaging abnormalities and postoperative delirium. Presurgical diffusion tensor imaging scans of 136 older (≥70 years), dementia-free subjects from the prospective Successful Aging after Elective Surgery study were analysed blind to the clinical data and delirium status. Primary outcomes were postoperative delirium incidence and severity during the hospital stay, as assessed by the Confusion Assessment Method. We measured cognition before surgery using general cognitive performance, a composite score based on a battery of neuropsychological tests. We investigated the association between presurgical diffusion tensor imaging parameters of brain microstructural integrity (i.e. fractional anisotropy, axial, mean and radial diffusivity) with postoperative delirium incidence and severity. Analyses were adjusted for the following potential confounders: age, gender, vascular comorbidity status, and general cognitive performance. Postoperative delirium occurred in 29 of 136 subjects (21%) during hospitalization. Presurgical diffusion tensor imaging abnormalities of the cerebellum, cingulum, corpus callosum, internal capsule, thalamus, basal forebrain, occipital, parietal and temporal lobes, including the hippocampus, were associated with delirium incidence and severity, after controlling for age, gender and vascular comorbidities. After further controlling for general cognitive performance, diffusion tensor imaging abnormalities of the cerebellum, hippocampus, thalamus and basal forebrain still remained associated with delirium

  16. Validation of a consensus method for identifying delirium from hospital records.

    Directory of Open Access Journals (Sweden)

    Elvira Kuhn

    Full Text Available Delirium is increasingly considered to be an important determinant of trajectories of cognitive decline. Therefore, analyses of existing cohort studies measuring cognitive outcomes could benefit from methods to ascertain a retrospective delirium diagnosis. This study aimed to develop and validate such a method for delirium detection using routine medical records in UK and Ireland.A point prevalence study of delirium provided the reference-standard ratings for delirium diagnosis. Blinded to study results, clinical vignettes were compiled from participants' medical records in a standardised manner, describing any relevant delirium symptoms recorded in the whole case record for the period leading up to case-ascertainment. An expert panel rated each vignette as unlikely, possible, or probable delirium and disagreements were resolved by consensus.From 95 case records, 424 vignettes were abstracted by 5 trained clinicians. There were 29 delirium cases according to the reference standard. Median age of subjects was 76.6 years (interquartile range 54.6 to 82.5. Against the original study DSM-IV diagnosis, the chart abstraction method gave a positive likelihood ratio (LR of 7.8 (95% CI 5.7-12.0 and the negative LR of 0.45 (95% CI 0.40-0.47 for probable delirium (sensitivity 0.58 (95% CI 0.53-0.62; specificity 0.93 (95% CI 0.90-0.95; AUC 0.86 (95% CI 0.82-0.89. The method diagnosed possible delirium with positive LR 3.5 (95% CI 2.9-4.3 and negative LR 0.15 (95% CI 0.11-0.21 (sensitivity 0.89 (95% CI 0.85-0.91; specificity 0.75 (95% CI 0.71-0.79; AUC 0.86 (95% CI 0.80-0.89.This chart abstraction method can retrospectively diagnose delirium in hospitalised patients with good accuracy. This has potential for retrospectively identifying delirium in cohort studies where routine medical records are available. This example of record linkage between hospitalisations and epidemiological data may lead to further insights into the inter-relationship between acute

  17. Delirium en ancianos hospitalizados: Seguimiento de 18 meses Delirium in elderly inpatients: An 18 month follow-up

    OpenAIRE

    Fernando J. Vázquez; Javier Benchimol; Diego Giunta; Carlos Cafferata; Antonio Freixas; Marcelo Vallone; Diego Andresik; Javier Pollan; Ana Aprile; Jimena Lorenzo; Gabriel Waisman; Luis Camera

    2010-01-01

    El objetivo de este trabajo fue describir la prevalencia de síndrome confusional agudo en ancianos hospitalizados, la evolución durante la internación y a los 18 meses. Se evaluó en forma prospectiva a pacientes de 70 años de edad o mayores, internados en el Servicio de Clínica Médica de nuestro hospital, entre septiembre de 2005 y mayo de 2006. Se utilizó una versión validada en español del Confussion Assessment Method para diagnosticar delirium. A los 18 meses se evaluó el estado vital, lug...

  18. Prevalence of delirium among patients at a cancer ward: Clinical risk factors and prediction by bedside cognitive tests.

    Science.gov (United States)

    Grandahl, Mia Gall; Nielsen, Svend Erik; Koerner, Ejnar Alex; Schultz, Helga Holm; Arnfred, Sidse Marie

    2016-08-01

    Background Delirium is a frequent psychiatric complication to cancer, but rarely recognized by oncologists. Aims 1. To estimate the prevalence of delirium among inpatients admitted at an oncological cancer ward 2. To investigate whether simple clinical factors predict delirium 3. To examine the value of cognitive testing in the assessment of delirium. Methods On five different days, we interviewed and assessed patients admitted to a Danish cancer ward. The World Health Organization International Classification of Diseases Version 10, WHO ICD-10 Diagnostic System and the Confusion Assessment Method (CAM) were used for diagnostic categorization. Clinical information was gathered from medical records and all patients were tested with Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test. Results 81 cancer patients were assessed and 33% were diagnosed with delirium. All delirious participants were CAM positive. Poor performance on the cognitive tests was associated with delirium. Medical records describing CNS metastases, benzodiazepine or morphine treatment were associated with delirium. Conclusions Delirium is prevalent among cancer inpatients. The Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test can be used as screening tools for delirium among inpatients with cancer, but even in synergy, they lack specificity. Combining cognitive testing and attention to nurses' records might improve detection, yet further studies are needed to create a more detailed patient profile for the detection of delirium.

  19. Battery of behavioral tests in mice to study postoperative delirium.

    Science.gov (United States)

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R; Xie, Zhongcong

    2016-07-20

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium.

  20. Alcohol Alert

    Science.gov (United States)

    ... main content National Institute on Alcohol Abuse and Alcoholism (NIAAA) Main Menu Search Search form Search Alcohol & ... on a single aspect of alcohol abuse and alcoholism. Please click on the desired publication for full ...

  1. Huntington′s disease and alcohol abuse.

    Directory of Open Access Journals (Sweden)

    Mattoo S

    1999-01-01

    Full Text Available The dopamine, glutamate and GABA systems are known to mediate the effects of alcohol on the movement disorders, though their exact roles are not clear. Thus, use of alcohol has implications for pathogenesis as well as management of the movement disorders. These implications are discussed citing a patient who had a strong family history of Huntington′s disease and in whom movement disorder and behavioral problems were manifest under alcohol use and withdrawal, but not while being abstinent.

  2. Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review

    DEFF Research Database (Denmark)

    Bitsch, Martin; Foss, Nicolai; Kristensen, Billy Bjarne

    2004-01-01

    BACKGROUND: Postoperative delirium is a frequent and serious complication in elderly patients following operation for hip fracture, leading to an increased risk of complications. The pathophysiological mechanisms are unresolved, but probably multifactorial. The purpose of this review...... specifically discussed pathogenic factors or interventions against postoperative delirium following operation for hip fracture. RESULTS: 1,823 patients were included with an average incidence of delirium of 35%. We concentrated on pre-, intra-, and postoperative risk factors. Only advanced age and dementia met...... is to summarize current knowledge about the pathogenesis of postoperative delirium with a view to finding strategies for prevention and management. METHOD: We conducted an Internet search through the Medline database (1966-March 2003) and supplemented it with a manual search. We included 12 studies which...

  3. Alcoholism: genes and mechanisms.

    Science.gov (United States)

    Oroszi, Gabor; Goldman, David

    2004-12-01

    Alcoholism is a chronic relapsing/remitting disease that is frequently unrecognized and untreated, in part because of the partial efficacy of treatment. Only approximately one-third of patients remain abstinent and one-third have fully relapsed 1 year after withdrawal from alcohol, with treated patients doing substantially better than untreated [1]. The partial effectiveness of strategies for prevention and treatment, and variation in clinical course and side effects, represent a challenge and an opportunity to better understand the neurobiology of addiction. The strong heritability of alcoholism suggests the existence of inherited functional variants of genes that alter the metabolism of alcohol and variants of other genes that alter the neurobiologies of reward, executive cognitive function, anxiety/dysphoria, and neuronal plasticity. Each of these neurobiologies has been identified as a critical domain in the addictions. Functional alleles that alter alcoholism-related intermediate phenotypes include common alcohol dehydrogenase 1B and aldehyde dehydrogenase 2 variants that cause the aversive flushing reaction; catechol-O-methyltransferase (COMT) Val158Met leading to differences in three aspects of neurobiology: executive cognitive function, stress/anxiety response, and opioid function; opioid receptor micro1 (OPRM1) Asn40Asp, which may serve as a gatekeeper molecule in the action of naltrexone, a drug used in alcoholism treatment; and HTTLPR, which alters serotonin transporter function and appears to affect stress response and anxiety/dysphoria, which are factors relevant to initial vulnerability, the process of addiction, and relapse.

  4. Delirium as a contributing factor to "crescendo" pain: three case reports.

    Science.gov (United States)

    Coyle, N; Breitbart, W; Weaver, S; Portenoy, R

    1994-01-01

    Cancer patients occasionally experience periods of rapidly escalating pain--"crescendo" pain--that may present a challenge in assessment and management. Although these episodes are often associated with progressive neoplasm, any of a variety of other processes may be involved. Delirium is a potentially treatable and frequently unrecognized factor. We present three patients who illustrate this relationship between delirium and a crescendo pattern of cancer pain.

  5. Neuropathogenesis of delirium: review of current etiologic theories and common pathways.

    Science.gov (United States)

    Maldonado, José R

    2013-12-01

    Delirium is a neurobehavioral syndrome caused by dysregulation of neuronal activity secondary to systemic disturbances. Over time, a number of theories have been proposed in an attempt to explain the processes leading to the development of delirium. Each proposed theory has focused on a specific mechanism or pathologic process (e.g., dopamine excess or acetylcholine deficiency theories), observational and experiential evidence (e.g., sleep deprivation, aging), or empirical data (e.g., specific pharmacologic agents' association with postoperative delirium, intraoperative hypoxia). This article represents a review of published literature and summarizes the top seven proposed theories and their interrelation. This review includes the "neuroinflammatory," "neuronal aging," "oxidative stress," "neurotransmitter deficiency," "neuroendocrine," "diurnal dysregulation," and "network disconnectivity" hypotheses. Most of these theories are complementary, rather than competing, with many areas of intersection and reciprocal influence. The literature suggests that many factors or mechanisms included in these theories lead to a final common outcome associated with an alteration in neurotransmitter synthesis, function, and/or availability that mediates the complex behavioral and cognitive changes observed in delirium. In general, the most commonly described neurotransmitter changes associated with delirium include deficiencies in acetylcholine and/or melatonin availability; excess in dopamine, norepinephrine, and/or glutamate release; and variable alterations (e.g., either a decreased or increased activity, depending on delirium presentation and cause) in serotonin, histamine, and/or γ-aminobutyric acid. In the end, it is unlikely that any one of these theories is fully capable of explaining the etiology or phenomenologic manifestations of delirium but rather that two or more of these, if not all, act together to lead to the biochemical derangement and, ultimately, to the

  6. Cortisol, Interleukins and S100B in Delirium in the Elderly

    Science.gov (United States)

    van Munster, Barbara C.; Bisschop, Peter H.; Zwinderman, Aeilko H.; Korevaar, Johanna C.; Endert, Erik; Wiersinga, W. Joost; van Oosten, Hannah E.; Goslings, J. Carel; de Rooij, Sophia E. J. A.

    2010-01-01

    In independent studies delirium was associated with higher levels of cortisol, interleukin(IL)s, and S100B. The aim of this study was to simultaneously compare cortisol, IL-6, IL-8, and S100B levels in patients aged 65 years and older admitted for hip fracture surgery with and without delirium. Cortisol, IL-6, IL-8, and S100B were assayed in…

  7. Low hemoglobin level is associated with the development of delirium after hepatectomy for hepatocellular carcinoma patients.

    Directory of Open Access Journals (Sweden)

    Yao-Li Chen

    Full Text Available Hepatocellular carcinoma (HCC is one of the most common malignant tumors worldwide and liver resection is the only potential curative treatment option for those patients. Postoperative complications specific to elderly surgical patients such as delirium will be increasingly relevant in the coming decades. Herein, we aimed to investigate the risk factors for postoperative delirium in patients who have received hepatectomy for HCC.This is a single medical center observational study and the study subjects comprised 401 individuals who underwent liver resection for hepatocellular carcinoma during January 2009 to October 2013. Multivariate analysis was used to examine whether preoperative, intra-operative, or postoperative variables were associated with the development of delirium.Of the 401 patients who underwent hepatectomy, 34 developed postoperative delirium (8.4%. In the majority of those patients, symptoms and signs of the syndrome occurred on postoperative day 2 and the mean duration of symptoms was 3.61 ± 3.71 days. Multivariate analysis revealed that advanced age (>71 years [odds ratio (OR = 1.133, 95% confidence interval (CI: 1.071-1.200, p190 minutes (OR = 1.009, 95% CI: 1.000-1.017, p = 0.038, a decreased postoperative hemoglobin level (< 10.16 g/dL (OR = 0.777, 95% CI: 0.613-0.983, p = 0.036, and history of hypnotic drug use (OR = 3.074, 95% CI: 1.045-9.039, p = 0.041 were independent risk factors for the development of postoperative delirium after hepatectomy.Although the mechanism of postoperative delirium is not well understood, numbers of studies have shown that patients with postoperative delirium tend to have prolonged hospital stay, worse postoperative outcome and an increased risk of short- and long-term mortality. In this study, we found that advanced age, prolonged operative time, postoperative low hemoglobin level and history of hypnotic drug use are independent risk factors for postoperative delirium.

  8. Cerebrospinal fluid cortisol levels are higher in patients with delirium versus controls

    Directory of Open Access Journals (Sweden)

    White Timothy O

    2010-02-01

    Full Text Available Abstract Background High plasma cortisol levels can cause acute cognitive and neuropsychiatric dysfunction, and have been linked with delirium. CSF cortisol levels more closely reflect brain exposure to cortisol, but there are no studies of CSF cortisol levels in delirium. In this pilot study we acquired CSF specimens at the onset of spinal anaesthesia in patients undergoing hip fracture surgery, and compared CSF and plasma cortisol levels in delirium cases versus controls. Findings Delirium assessments were performed the evening before or on the morning of operation with a standard battery comprising cognitive tests, mental status assessments and the Confusion Assessment Method. CSF and plasma samples were obtained at the onset of the operation and cortisol levels measured. Twenty patients (15 female, 5 male aged 62 - 93 years were studied. Seven patients were diagnosed with delirium. The mean ages of cases (81.4 (SD 7.2 and controls (80.5 (SD 8.7 were not significantly different (p = 0.88. The median (interquartile range CSF cortisol levels were significantly higher in cases (63.9 (40.4-102.1 nmol/L than controls (31.4 (21.7-43.3 nmol/L; Mann-Whitney U, p = 0.029. The median (interquartile range of plasma cortisol was also significantly higher in cases (968.8 (886.2-1394.4 nmol/L, than controls (809.4 (544.0-986.4 nmol/L; Mann Whitney U, p = 0.036. Conclusions These findings support an association between higher CSF cortisol levels and delirium. This extends previous findings linking higher plasma cortisol and delirium, and suggests that more definitive studies of the relationship between cortisol levels and delirium are now required.

  9. Operant alcohol self-administration in dependent rats: focus on the vapor model.

    Science.gov (United States)

    Vendruscolo, Leandro F; Roberts, Amanda J

    2014-05-01

    Alcoholism (alcohol dependence) is characterized by a compulsion to seek and ingest alcohol (ethanol), loss of control over intake, and the emergence of a negative emotional state during withdrawal. Animal models are critical in promoting our knowledge of the neurobiological mechanisms underlying alcohol dependence. Here, we review the studies involving operant alcohol self-administration in rat models of alcohol dependence and withdrawal with the focus on the alcohol vapor model. In 1996, the first articles were published reporting that rats made dependent on alcohol by exposure to alcohol vapors displayed increased operant alcohol self-administration during acute withdrawal compared with nondependent rats (i.e., not exposed to alcohol vapors). Since then, it has been repeatedly demonstrated that this model reliably produces physical and motivational symptoms of alcohol dependence. The functional roles of various systems implicated in stress and reward, including opioids, dopamine, corticotropin-releasing factor (CRF), glucocorticoids, neuropeptide Y (NPY), γ-aminobutyric acid (GABA), norepinephrine, and cannabinoids, have been investigated in the context of alcohol dependence. The combination of models of alcohol withdrawal and dependence with operant self-administration constitutes an excellent tool to investigate the neurobiology of alcoholism. In fact, this work has helped lay the groundwork for several ongoing clinical trials for alcohol dependence. Advantages and limitations of this model are discussed, with an emphasis on what future directions of great importance could be.

  10. Alcohol, other Drugs, and Obesity: Plan-Of-The-Day-Notes, Volume 2

    Science.gov (United States)

    1993-08-11

    identified in urine. (b) was once an ingredient in Coca Cola . (c) is a depressant. (d) is used today to alleviate withdrawal from alcohol. ANS: b 57...alcoholism is caused by an individual’s "aller- gy" to alcohol -- that this person metabolizes alcohol different- ly than others. -- That it is caused

  11. Angka Kejadian Delirium dan Faktor Risiko di Intensive Care Unit Rumah Sakit Dr. Hasan Sadikin Bandung

    Directory of Open Access Journals (Sweden)

    Rakhman Adiwinata

    2016-04-01

    Full Text Available Delirium ditandai dengan perubahan status mental, tingkat kesadaran, serta perhatian yang akut dan fluktuatif. Keadaan ini merupakan kelainan yang serius berhubungan dengan pemanjangan lama perawatan di Intensive Care Unit (ICU, biaya yang lebih tinggi, memperlambat pemulihan fungsional, serta peningkatan morbiditas dan mortalitas. Tujuan penelitian adalah mengetahui angka kejadian delirium dan faktor risiko terjadinya delirium di ICU Rumah Sakit Dr. Hasan Sadikin (RSHS Bandung. Pengambilan sampel dilakukan selama tiga bulan (Januari–Maret 2015 di ICU RSHS Bandung. Metode penelitian ini deskriptif observasional secara kohort prospektif, menggunakan alat ukur Confusion Assessment Method-Intensive Care Unit (CAM-ICU, sebelumnya dilakukan penilaian dengan Richmond agitation-sedation scale (RASS pada pasien yang tersedasi. Hasil penelitian ini dari 105 pasien, 22 pasien dieksklusikan, dari 83 pasien didapatkan 31 pasien positif delirium, angka kejadian 37%. Faktor-faktor risiko pada pasien positif delirium terdiri atas geriatri 15 dari 31, pemakaian ventilator 12 dari 31, pemberian analgesik morfin 9 dari 31, sepsis atau infeksi 9 dari 31, kelainan jantung 8 dari 31, acute physiology and chronic health evaluation (APACHE II skor tinggi 8 dari 31, kelainan ginjal 7 dari 31 laboratorium abnormal 7 dari 31, pemberian sedasi midazolam 6 dari 31 kelainan endokrin 5 dari 31, pemberian analgesik fentanil 2 dari 31, dan strok 1 dari 31. Simpulan, angka kejadian delirium di ICU RSHS Bandung cukup tinggi sebesar 37% dengan faktor risiko terbesar adalah pasien geriatrik.

  12. Factors Associated with Post-Surgical Delirium in Patients Undergoing Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    Yadollah Jannati

    2014-09-01

    Full Text Available Objective: The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. Methods: This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression on SPSS software version 15. Results: We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. Conclusion: Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium.

  13. Identification and rates of delirium in elderly medical inpatients from diverse language groups.

    Science.gov (United States)

    Wand, Anne Pf; Thoo, William; Ting, Vicky; Baker, Janett; Sciuriaga, Hayley; Hunt, Glenn E

    2013-01-01

    A linguistically diverse cohort of 126 medical inpatients 65 y and over was recruited to determine rates of delirium after admission, associated outcomes, and staff detection of delirium. A clinical interview and cognitive and functional questionnaires were completed with the patient and their carer, and files were reviewed. The incidence of delirium at comprehensive assessment early after admission was 10.3% and the overall incidence 19.1% over the whole admission. Cognitive impairment was common (n = 80, 63.5%), including 61 patients (48.4%) who had dementia. Most patients (83%) with delirium had dementia. Staff recognized less than 21% of patients with delirium, 33% of patients with dementia, and 36% of cognitively impaired patients. There was no difference in outcomes between English and non-English speaking patients. Given the high prevalence and poor recognition of cognitive disorders in older people, routine cognitive screening should occur. Staff education should focus upon improving delirium detection and addressing the needs of cognitively impaired older inpatients.

  14. Disturbed Serotonergic Neurotransmission and Oxidative Stress in Elderly Patients with Delirium

    Directory of Open Access Journals (Sweden)

    Angelique Egberts

    2015-12-01

    Full Text Available Background: Oxidative stress and disturbances in serotonergic and dopaminergic neurotransmission may play a role in the pathophysiology of delirium. Aims: In this study, we investigated levels of amino acids, amino acid ratios and levels of homovanillic acid (HVA as indicators for oxidative stress and disturbances in neurotransmission. Methods: Plasma levels of amino acids, amino acid ratios and HVA were determined in acutely ill patients aged ≥65 years admitted to the wards of Internal Medicine and Geriatrics of the Erasmus University Medical Center and the ward of Geriatrics of the Havenziekenhuis, Rotterdam, The Netherlands. Differences in the biochemical parameters between patients with and without delirium were investigated by analysis of variance in models adjusted for age, gender and comorbidities. Results: Of the 86 patients included, 23 had delirium. In adjusted models, higher mean phenylalanine/tyrosine ratios (1.34 vs. 1.14, p = 0.028, lower mean tryptophan/large neutral amino acids ratios (4.90 vs. 6.12, p = 0.021 and lower mean arginine levels (34.8 vs. 45.2 µmol/l, p = 0.022 were found in patients with delirium when compared to those without. No differences were found in HVA levels between patients with and without delirium. Conclusion: The findings of this study suggest disturbed serotonergic neurotransmission and an increased status of oxidative stress in patients with delirium.

  15. Delirium – a common condition associated with negative outcome in the elderly

    Directory of Open Access Journals (Sweden)

    Vibeke Juliebø

    2012-11-01

    Full Text Available Delirium (“acute confusional state”, characterized by an acute decline in attention and cognition, is a common clinical syndrome in elderly patients. The prevalence of delirium increases with age, and is highest among hospitalized older patients. A systematic literature search of MEDLINE, EMBASE, and the Cochrane Library limited to the period 2000-2012 was conducted.The antecedent of delirium is often multifactorial, the development involving a complex interrelationship between a vulnerable patient with predisposing factors and exposure to precipitating events. Important predisposing factors include high age, cognitive impairment, comorbidity, sensory impairment, and low Body Mass Index (BMI. Infections, cardiovascular events, trauma/fracture, surgery, stroke, metabolic abnormalities, and dehydration, are all recognized as precipitating factors.Delirium is associated with negative outcomes like cognitive decline, increased morbidity and mortality, and should be prevented. Prevention and treatment of delirium is multifactorial and multidisiplinary, focusing on the treatment of factors precipitating and maintaining the delirium. No pharmacological treatment has so far demonstrated significant efficacy. The knowledge of risk factors and the underlying pathophysiological mechanisms involved remains scarce, and further research is warranted to explore the mechanisms and thereby develop targeted prevention and treatment strategies.

  16. Insulin-Like Growth Factor I and the Pathogenesis of Delirium: A Review of Current Evidence

    Directory of Open Access Journals (Sweden)

    Dimitrios Adamis

    2011-01-01

    Full Text Available Delirium is a frequent complication in medically ill elderly patients that is associated with serious adverse outcomes including increased mortality. Delirium risk is linked to older age, dementia, and illness that involves activation of inflammatory responses. IGF-I is increasingly postulated as a key link between environmental influences on body metabolism with a range of neuronal activities and has been described as the master regulator of the connection between brain and bodily well-being. The relationships between IGF-I and ageing, cognitive impairment and inflammatory illness further support a possible role in delirium pathogenesis. Five studies of IGF-I in delirium were identified by a systematic review. These conflicting findings, with three of the five studies indicating an association between IGF-1 and delirium occurrence, may relate to the considerable methodological differences in these studies. The relevance of IGF-I and related factors to delirium pathogenesis can be clarified by future studies which account for these issues and other confounding factors. Such work can inform therapeutic trials of IGF-I and/or growth hormone administration.

  17. The Prevention and Treatment of Delirium in Elderly Patients Following Hip Fracture Surgery.

    Science.gov (United States)

    Martocchia, Antonio; Curto, Martina; Comite, Fabrizia; Scaccianoce, Sergio; Girardi, Paolo; Ferracuti, Stefano; Nicoletti, Ferdinando; Falaschi, Paolo

    2015-01-01

    Osteoporotic hip fracture needs a specific approach and treatment, since elderly patients are at high risk for adverse outcomes after surgery. In particular, delirium often occurs in the peri-operative period, and it is associated with death, hospital-acquired complications, persistent cognitive impairments, poor functional recovery after surgery and increased healthcare costs. The pre-operative assessment of the risk factors for delirium improves the preventive measures. The delirium diagnostic tools should be included in the standard of orthogeriatric cure for hip fracture. Given the increasing complexity of the clinical pictures, we present a review of the available treatment options for delirium in patients with hip fracture. The metabolic pre-operative disorders and the management of co-morbid diseases are specific targets of treatment in order to optimize the outcomes after surgery. In particular, elderly patients with Alzheimer's disease are highly vulnerable to hip fracture and delirium, and they are severely frail with reduced physiologic reserves. An integrated approach combining environmental and pharmacological strategies is useful in the delirium treatment, with a close collaboration between the orthopedic and geriatric team.

  18. Combination of inhaled corticosteroid and bronchodilator-induced delirium in an elderly patient with lung disease.

    Science.gov (United States)

    Moss, Jason M; Kemp, Debra W; Brown, Jamie N

    2014-02-01

    Steroid psychosis has been well described with oral glucocorticoids, however, our search of the literature did not identify an association between delirium and the combination of inhaled glucocorticoids and long-acting beta-agonists. We describe the occurrence of delirium with the combination of an inhaled glucocorticoid and bronchodilator. An elderly male described confusion and hallucinations within 1 week after initiation of budesonide/formoterol for chronic obstructive pulmonary disease. The combination inhaler was discontinued with resolution of symptoms. Several weeks later, the patient was hospitalized and restarted on the combination inhaler. The patient was alert and oriented on admission, however, confusion and hallucinations progressed throughout his hospital stay. The combination inhaler was discontinued and his confusion and hallucinations resolved by discharge. The temporal relationship of these events and a probable Naranjo association allows for reasonable assumption that the use of the budesonide/formoterol combination inhaler caused or contributed to the occurrences of delirium in this elderly patient. The onset of delirium was likely due to the systemic absorption of the glucocorticoid from lung deposition, complicated in an individual with several predisposing risk factors for delirium. Health care providers should be aware of this potential adverse drug reaction when prescribing inhaled medications to older patients at risk for delirium.

  19. Observing nurses has improved my alcohol dependency care.

    Science.gov (United States)

    Jaques, Ellise

    2016-09-21

    My first placement in my first year of nursing training was on a gastrointestinal/hepatology ward. Alongside my mentor, I was caring for a patient who had been withdrawing from alcohol since admission to hospital the previous evening.

  20. Early-Onset Alcohol Dependence Increases the Acoustic Startle Reflex

    NARCIS (Netherlands)

    Schellekens, A.F.A.; Mulders, P.C.R.; Ellenbroek, B.A.; Jong, C.A.J. de; Buitelaar, J.K.; Cools, A.R.; Verkes, R.J.

    2012-01-01

    Background: Hyperreactivity and impaired sensory gating of the acoustic startle response in alcohol dependence has been suggested to reflect a residual effect of previous detoxifications, increasing the severity of subsequent withdrawal episodes. Previous studies on the acoustic startle only include

  1. 小组心理护理对酒依赖患者戒断症状和心理渴求的影响%Effect of group psychological care on the withdrawal symptoms and psychological craving of patients with alcohol dependence

    Institute of Scientific and Technical Information of China (English)

    徐秀玲

    2012-01-01

    Objective: To explore the effect of group psychological care on the withdrawal symptoms and psychological craving of patients with alcohol dependence. Methods: 48 patients with alcohol dependence were randomly divided into a study group and a control group ( 24 cases in each group ). The patients in both groups were given conventional treatment and nursing care and the patients in the study group were given extra group psychological care. AWS and AUQ were used to make an assessment of the patients respectively on admission and in the 4th week after admission. Results: The repeated survey variance analysis showed that the time factor had main effect on psychiatric symptoms, autonomic nerve symptoms and psychological craving scores ( P <0. 01 );the intervention factors had main effect on psychiatric symptoms and psychological craving scores ( P <0. 05 ,P <0. 01 );the intervention factors and time factor had interaction effect on psychiatric symptoms and psychological craving scores(P <0. 05,P <0.01 );the stepwise regression analysis found that the reduction value after alcohol withdrawal was influenced by psychiatric symptoms and psychological nursing intervention before the intervention ( P < 0. 01 );the reduction value of autonomic nerve symptoms was influenced by autonomic nerve symptoms and drinking time before the intervention ( P <0. 05 ,P <0. 01 );the reduction value of psychological craving was influenced by psychological craving,psychological nursing intervention and drinking time before the intervention ( P <0. 01 ). Conclusion: The group psychological care can markedly alleviate the withdrawal symptoms and psychological craving symptoms. And the symptoms before intervention and drinking time may affect the degree of improvement of withdrawal symptoms and psychological craving.%目的:探讨小组心理护理对酒依赖患者戒断症状和心理渴求的影响.方法:将48例酒依赖患者随机分为研究组和对照组各24例,均给予戒酒科常

  2. Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study

    Directory of Open Access Journals (Sweden)

    Arthur Kwizera

    2015-01-01

    Full Text Available Aim. Delirium is common among mechanically ventilated patients in the intensive care unit (ICU. There are little data regarding delirium among mechanically ventilated patients in Africa. We sought to determine the burden of delirium and associated factors in Uganda. Methods. We conducted a multicenter prospective study among mechanically ventilated patients in Uganda. Eligible patients were screened daily for delirium using the confusional assessment method (CAM-ICU. Comparisons were made using t-test, chi-squares, and Fisher’s exact test. Predictors were assessed using logistic regression. The level of statistical significance was set at P<0.05. Results. Of 160 patients, 81 (51% had delirium. Median time to onset of delirium was 3.7 days. At bivariate analysis, history of mental illness, sedation, multiorgan dysfunction, neurosurgery, tachypnea, low mean arterial pressure, oliguria, fevers, metabolic acidosis, respiratory acidosis, anaemia, physical restraints, marital status, and endotracheal tube use were significant predictors. At multivariable analysis, having a history of mental illness, sedation, respiratory acidosis, higher PEEP, endotracheal tubes, and anaemia predicted delirium. Conclusion. The prevalence of delirium in a young African population is lower than expected considering the high mortality. A history of mental illness, anaemia, sedation, endotracheal tube use, and respiratory acidosis were factors associated with delirium.

  3. Association between delirium superimposed on dementia and mortality in hospitalized older adults: A prospective cohort study

    Science.gov (United States)

    Curiati, Jose A. E.; Jacob-Filho, Wilson

    2017-01-01

    Background Hospitalized older adults with preexisting dementia have increased risk of having delirium, but little is known regarding the effect of delirium superimposed on dementia (DSD) on the outcomes of these patients. Our aim was to investigate the association between DSD and hospital mortality and 12-mo mortality in hospitalized older adults. Methods and findings This was a prospective cohort study completed in the geriatric ward of a university hospital in São Paulo, Brazil. We included 1,409 hospitalizations of acutely ill patients aged 60 y and over from January 2009 to June 2015. Main variables and measures included dementia and dementia severity (Informant Questionnaire on Cognitive Decline in the Elderly, Clinical Dementia Rating) and delirium (Confusion Assessment Method). Primary outcomes were time to death in the hospital and time to death in 12 mo (for the discharged sample). Comprehensive geriatric assessment was performed at admission, and additional clinical data were documented upon death or discharge. Cases were categorized into four groups (no delirium or dementia, dementia alone, delirium alone, and DSD). The no delirium/dementia group was defined as the referent category for comparisons, and multivariate analyses were performed using Cox proportional hazards models adjusted for possible confounders (sociodemographic information, medical history and physical examination data, functional and nutritional status, polypharmacy, and laboratory covariates). Overall, 61% were women and 39% had dementia, with a mean age of 80 y. Dementia alone was observed in 13% of the cases, with delirium alone in 21% and DSD in 26% of the cases. In-hospital mortality was 8% for patients without delirium or dementia, 12% for patients with dementia alone, 29% for patients with delirium alone, and 32% for DSD patients (Pearson Chi-square = 112, p < 0.001). DSD and delirium alone were independently associated with in-hospital mortality, with respective hazard ratios

  4. Delirium superimposed on Charles Bonnet syndrome: a case study.

    Science.gov (United States)

    Yeager, Jennifer J

    2013-01-01

    Older adults with visual impairment may experience visual hallucinations in the setting of normal cognition and absence of psychiatric illness. This phenomenon is referred to as Charles Bonnet syndrome. Information concerning Charles Bonnet syndrome predominantly comes from case studies. Reassuring the person experiencing the hallucinations they are not suffering from psychosis constitutes the mainstay of treatment. What follows is the case of a vision impaired, older adult male with known Charles Bonnet syndrome, who, following emergency surgery and associated delirium while in the intensive care unit, experiences an aggressive change in hallucinations. Nurses need to understand the pathology and characteristics of Charles Bonnet syndrome in order to distinguish it from other pathologies underlying hallucinations. This knowledge is necessary to provide safe, patient-centered care for older adults.

  5. Delirium after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Krenk, L; Rasmussen, L S; Hansen, T B

    2012-01-01

    BACKGROUND: /st>Postoperative delirium (PD) is a serious complication after major surgery in elderly patients. PD is well defined and characterized by reduced attention and disorientation. Multimodal optimization of perioperative care (the fast-track methodology) enhances recovery, and reduces......). Twenty-two patients received general anaesthesia, and the rest had spinal anaesthesia. No patients developed PD (95% confidence interval 0.0-1.6%). CONCLUSIONS: /st>A fast-track set-up with multimodal opioid-sparing analgesia was associated with lack of PD after elective THA and TKA in elderly patients....... cognitive dysfunction, we included 225 non-demented patients with a mean age of 70 yr undergoing either THA or TKA in a fast-track set-up. Anaesthesia and postoperative pain management were standardized with limited opioid use. Nursing staff were trained to look for symptoms of PD which was assessed during...

  6. Postinjection Delirium/Sedation Syndrome with Olanzapine Depot Injection

    Science.gov (United States)

    Sarangula, Sadhvi Mythili; Mythri, Starlin Vijay; Sanjay, Y.; Reddy, M. S.

    2016-01-01

    After 1 year of introduction of olanzapine long-acting injectable (LAI) in India, many psychiatrists believe that it is a very affordable, well-tolerated, and effective second generation long-acting antipsychotic depot compared to not well tolerated but cheap first generation antipsychotic depots and to other second generation depots which are costly. However, reports of its possible adverse events in clinical settings are not yet published. We report what probably might be the first case of postinjection delirium/sedation syndrome (PDSS) in India. Although the occurrence is uncommon, incorrect understanding of this event may hinder the future use of the potentially useful olanzapine LAI. We review the available literature on the proposed diagnostic guidelines, mechanism of this event, precautions, and management of PDSS. PMID:27570354

  7. Acute confusional state/delirium: An etiological and prognostic evaluation

    Directory of Open Access Journals (Sweden)

    Dheeraj Rai

    2014-01-01

    Full Text Available Introduction: Acute confusional state/delirium is a frequent cause of hospital admission, in the elderly. It is characterized by an acute fluctuating impairment of cognitive functions and inattention. Recognition and prompt treatment is crucial to decrease the morbidity and mortality associated with it. Materials and Methods: In this retrospective study, we determined the etiology and prognostic factors of an acute confusional state. A total of 52 patients of acute confusional state were clinically evaluated. All patients were also subjected to a battery blood biochemical examination, cerebrospinal fluid analysis and neuroimaging. Disability was assessed by using modified Barthel index (MBI. Patients were followed-up for 3 months. Results: The mean age of our cohort was 65.04 ± 10.6 years. 32 (61.5% patients were male. In 33 patients, we were able to identify possible precipitating cause of an acute confusional state. In the rest of the patients results of all the tests were normal. Leukocytosis and hyponatremia were frequent factors associated with delirium. The mean duration of the hospital stay was 10.73 ± 3.6 days (range 5-21 days. Patients with an abnormal work-up (possible precipitating cause had significantly lower mortality, less duration of hospital stay and less severe disability after 3 months. Age, underlying illness, serum creatinine, abnormal neuroimaging and MBI were identified as a significant prognostic indicator. 18 (34.6% of our patients died, of these in 10 patients we could not find a precipitating cause. Conclusion: Patients, in whom a cause was found out, had better prognosis in terms of lesser mortality and the duration of hospital stay.

  8. Evaluation for the withdrawal syndrome from gamma-hydroxybutyric acid (GHB), gamma-butyrolactone (GBL), and 1,4-butanediol (1,4-BD) in different rat lines.

    Science.gov (United States)

    Quang, Lawrence S; Colombo, Giancarlo; Lobina, Carla; Maccioni, Paola; Orru, Alessandro; Gessa, Gian Luigi; Maher, Timothy J; Carai, Mauro A M

    2006-08-01

    A severe and life-threatening gamma-hydroxybutyric acid (GHB) withdrawal syndrome, clinically similar to the alcohol withdrawal syndrome, is increasingly being reported in GHB addicts. We investigated for the occurrence of withdrawal in Wistar and Sprague-Dawley rats, and in the selectively bred lines of GHB-sensitive (GHB-S) and Sardinian alcohol-preferring (sP) rats, following chronic administration of GHB, gamma-butyrolactone (GBL), and/or 1,4-butanediol (1,4-BD). Using validated rodent alcohol withdrawal scoring scales, little to no spontaneous or pharmacologically precipitated withdrawal effects were observed in Wistar, Sprague-Dawley, or GHB-S rats. Conversely, sP rats displayed both spontaneous and precipitated audiogenic seizures following abrupt cessation of chronic GHB or 1,4-BD administration and following pharmacological challenge with the GABA(B) receptor-selective antagonist, SCH 50911, respectively.

  9. Alcohol Intolerance

    Science.gov (United States)

    ... beer-alcohol.aspx. Accessed Jan. 16, 2015. Alcohol angioedema and uticaria. American Academy of Allergy, Asthma & Immunology. http://www.aaaai.org/ask-the-expert/alcohol-angioedema-urticaria.aspx. Accessed Jan. 16, 2015. Alcohol and ...

  10. The diagnosis of delirium in an acute-care hospital in Moscow: what does the Pandora’s box contain?

    Science.gov (United States)

    Tkacheva, Olga N; Runikhina, Nadezda K; Vertkin, Arkadiy L; Voronina, Irina V; Sharashkina, Natalia V; Mkhitaryan, Elen A; Ostapenko, Valentina S; Prokhorovich, Elena A; Freud, Tamar; Press, Yan

    2017-01-01

    Background Delirium, a common problem among hospitalized elderly patients, is not usually diagnosed by doctors for various reasons. The primary aim of this study was to evaluate the effect of a short training course on the identification of delirium and the diagnostic rate of delirium among hospitalized patients aged ≥65 years. The secondary aim was to identify the risk factors for delirium. Methods A prospective study was conducted in an acute-care hospital in Moscow, Russia. Six doctors underwent a short training course on delirium. Data collected included assessment by the confusion assessment method for the intensive care units, sociodemographic data, functional state before hospitalization, comorbidity, and hospitalization indices (indication for hospitalization, stay in intensive care unit, results of laboratory tests, length of hospitalization, and in-hospital mortality). Results Delirium was diagnosed in 13 of 181 patients (7.2%) who underwent assessment. Cognitive impairment was diagnosed more among patients with delirium (30.0% vs 6.1%, P=0.029); Charlson comorbidity index was higher (3.6±2.4 vs 2.3±1.8, P=0.013); and Barthel index was lower (43.5±34.5 vs 94.1±17.0, P=0.000). The length of hospitalization was longer for patients with delirium at 13.9±7.3 vs 8.8±4.6 days (P=0.0001), and two of the 13 patients with delirium died during hospitalization compared with none of the 168 patients without delirium (P=0.0001). Conclusion Although the rate of delirium was relatively low compared with studies from the West, this study proves that an educational intervention among doctors can bring about a significant change in the diagnosis of the condition. PMID:28260868

  11. Delirium in awake patients with mechanical ventilation in intensive care unit

    Directory of Open Access Journals (Sweden)

    Ángela María Henao Castaño

    2015-01-01

    Full Text Available Objetivos: identificar la incidencia de delirium en pacientes despiertos que reciben profilaxis primaria durante la ventilación mecánica en la unidad de cuidados intensivos en la Clínica Palermo, Bogotá-Colombia. Metodología: estudio descriptivo transversal. Se exploró la relación del delirium con la enfermedad médica, la profilaxis primaria, la historia personal y asocia - ción con delirium. El tamaño de la muestra (n = 102 se calculó teniendo en cuenta la frecuencia de pacientes despiertos en ventilación mecánica con una estancia media hospitalaria de 7 días. Análisis estadísticos univariado, bivariado y multivariado. Resultados: el delirium se presentó en 8 de cada 102 pacientes (22 % se observaron diferencias significativas entre los que deliraron y los que no deliran por edad y Marshall. Relaciones significativas entre el delirium y el Apache II, Tiss 28, y Marshall no se han demostrado a través de la regresión logística. Conclusiones: la edad (más de 60 años es un factor predisponente para la presencia de delirium, así como los antecedentes de tabaquismo. La administración de medicamentos para la profilaxis primaria no mostró ninguna asociación con la ausencia de delirium en pacientes despiertos en ventilación mecánica en la UCI

  12. Delirium in the critically ill patient%ICU谵妄的研究进展

    Institute of Scientific and Technical Information of China (English)

    冯传江; 姚琴琴; 欧丹丹; 王雅楠; 李澜涛; 袁荆; 鲁卫华

    2016-01-01

    ICU delirium is defined as an acute cognitive dysfunction, the pathophysiology of delirium is still unclear. A variety of tools exist for the diagnosis of delirium, but only the DSM-Ⅴ, CAM-ICU, intensive care delirium screening checklist (ICDSC), nursing delirium screening scale (NU-DESC) and mini-mental state examination (MMSE) have been validated in the critically ill patients, and the CAM-ICU is the most common tool. Nonpharmacological and pharmacological interventions to prevent delirium as early as possible can reduce incidence rate. At present, there is no specific treatment of delirium, but dexmedetomidine can shorten time of duration.%ICU谵妄是一种急性的认知功能障碍,其发病机制仍不十分清楚。临床可通过精神疾病诊断与统计手册第五版(DSM-Ⅴ)、ICU 意识模糊评估法(CAM-ICU)、重症监护谵妄筛查量表(ICDSC)、护理谵妄筛查量表(NU-DESC)、简易智能精神状态检查量表(MMSE)等量表进行诊断,其中CAM-ICU临床应用比较广泛。及早进行预防,可减少ICU谵妄的发生率,其方法分为药物性和非药物性两类。目前临床尚无特异性治疗方法,输注右美托咪定镇静可减少患者的谵妄持续时间。

  13. The effects of melatonin versus placebo on delirium in hip fracture patients: study protocol of a randomised, placebo-controlled, double blind trial.

    NARCIS (Netherlands)

    Jonghe, A. de; Munster, B.C. van; Oosten, H.E. van; Goslings, J.C.; Kloen, P.; Rees, C. van; Wolvius, R.; Velde, R. van; Levi, M.M.; Korevaar, J.C.; Rooij, S.E. de

    2011-01-01

    BACKGROUND: With an ageing population, older persons become a larger part of the hospital population. The incidence of delirium is high in this group, and experiencing delirium has major short- and long-term sequelae, which makes prevention crucial. During delirium, a disruption of the sleep-wake cy

  14. The effect of an e-learning course on nursing staff's knowledge of delirium: A before-and-after study

    NARCIS (Netherlands)

    L. Van De Steeg (Lotte); R.I. Jkema (Roelie I); C. Wagner (Cordula); M. Langelaan (Maaike)

    2015-01-01

    textabstractBackground: Delirium is a common condition in hospitalized patients, associated with adverse outcomes such as longer hospital stay, functional decline and higher mortality, as well as higher rates of nursing home placement. Nurses often fail to recognize delirium in hospitalized patients

  15. The association of the dopamine transporter gene and the dopamine receptor 2 gene with delirium: a meta-analysis.

    NARCIS (Netherlands)

    Munster, B.C. van; Rooij, S.E.J.A. de; Yazdanpanah, M.; Tienari, P.J.; Pitkala, K.H.; Osse, R.J.; Adamis, D.; Smit, O.; Steen, M.S. van der; Houten, M. van; Rahkonen, T.; Sulkava, R.; Laurila, J.V.; Strandberg, T.E.; Tulen, J.H.M.; Zwang, L.; Macdonald, A.J.D.; Treloar, A.; Sijbrands, E.J.G.; Zwinderman, A.H.; Korevaar, J.C.

    2010-01-01

    Delirium is the most common neuropsychiatric syndrome in elderly ill patients. Previously, associations between delirium and the dopamine transporter gene (solute carrier family 6, member 3 (SLC6A3)) and dopamine receptor 2 gene (DRD2) were found. The aim of this study was to validate whether marker

  16. Preoperative protein profiles in cerebrospinal fluid in elderly hip fracture patients at risk for delirium : A proteomics and validation study

    NARCIS (Netherlands)

    Westhoff, Dunja; Witlox, Joost; van Aalst, Corneli; Scholtens, Rikie M.; de Rooij, Sophia E; van Munster, Barbara C; de Jonghe, Jos F M; Houdijk, Alexander P J; Eikelenboom, Piet; van Westerloo, David J; van de Beek, Diederik; van Gool, Willem A; Koenderman, Leo

    2015-01-01

    BACKGROUND: A neuroinflammatory response is suggested to play an important role in delirium, a common complication in older hospitalized patients. We examined whether hip fracture patients who develop postoperative delirium have a different proteome in cerebrospinal fluid (CSF) prior to surgery. MET

  17. Preoperative protein profiles in cerebrospinal fluid in elderly hip fracture patients at risk for delirium: A proteomics and validation study

    Directory of Open Access Journals (Sweden)

    Dunja Westhoff

    2015-12-01

    General significance: This study highlights the challenges and inconsistent findings in studies of delirium, a serious complication in older patients. We analysed proteins in CSF, the most proximal fluid to the brain. All patients were free from delirium at the time of sampling.

  18. The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'; response from a geriatric perspective

    NARCIS (Netherlands)

    Izaks, GJ

    2003-01-01

    Delirium in elderly people is a severe condition that requires vigorous medical attention. Therefore, the Dutch College of General Practitioners has duly chosen to develop a practice guideline 'Delirium in elderly people'. It is likely that many general practitioners are only partly familiar with de

  19. Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients

    NARCIS (Netherlands)

    Morandi, A; Pandharipande, P; Trabucchi, M; Rozzini, R; Mistraletti, G; Trompeo, A C; Gregoretti, C; Gattinoni, L; Ranieri, M V; Brochard, L; Annane, D; Putensen, C; Guenther, U; Fuentes, P; Tobar, E; Anzueto, A R; Esteban, A; Skrobik, Y; Salluh, J I F; Soares, M; Granja, C; Stubhaug, A; de Rooij, S E; Ely, E Wesley

    2008-01-01

    BACKGROUND: Delirium (acute brain dysfunction) is a potentially life threatening disturbance in brain function that frequently occurs in critically ill patients. While this area of brain dysfunction in critical care is rapidly advancing, striking limitations in use of terminology related to delirium

  20. Clinical characteristics of delirium Patients referred to consultation-liaison Psychiatry in general hosPi-tals%综合医院精神科会诊患者谵妄的临床特点

    Institute of Scientific and Technical Information of China (English)

    郑学宝; 王洪飞; 李金亮; 罗忠; 张开宇

    2014-01-01

    Objective:To explore the clinical characteristics of delirium patients referred to consultation-liaison psychiatry in general hospitals,as well as those in psychiatric hospitals. Method:The clinical data of 28 delirium patients referred to consultation-liaison psychiatry in general hospitals(consulation-liaison group) and 24 delirium patients in psychiatric hospitals(non-consulation-liaison group)admitted were included for a contrast analysis. They were all evaluated by the Chinese revision of confusion assessment method(CAM-CR). Results:Delirium patients in the consultation-liaison group were with elder age and complex etiology. Medi-cine diseases they suffering from were mainly in respiratory tract infections,brain stroke and cardiovascular dis-eases,while the surgical diseases were mainly in cerebral trauma,post-operation and fractures. Among them, multi-system diseases had the highest probability of causing delirium. The psychomotor retardation score in CAM-CR was significantly higher than the non-consultation-liaison group. However,delirium patients in non-consulation-liaison group were with younger age and simple etiology. Their diseases were mainly caused by with-drawing from psychoactive substances,senile dementia and improper application of antipsychotics. The total score,change in the level of consciousness,perceptual disturbance and psychomotor excitation scores in CAM-CR were all significantly higher than the consultation-liaison group. Conclusion:Elder age,complex etiology and symptoms,high misdiagnosis rate and poor prognosis are among the main features in delirium patients in general hospitals,the consultation liaison needs to be strengthened.%目的:探讨综合性医院精神科会诊中的谵妄与精神病专科医院中的谵妄的临床特点。方法:对综合性医院中精神科会诊中的28例谵妄患者(会诊组)与同期在精神病院的24例患者(非会诊组)的临床资料进行对照分析,并使用谵妄

  1. Topographic quantitative EEG amplitude in recovered alcoholics.

    Science.gov (United States)

    Pollock, V E; Schneider, L S; Zemansky, M F; Gleason, R P; Pawluczyk, S

    1992-05-01

    Topographic measures of electroencephalographic (EEG) amplitude were used to compare recovered alcoholics (n = 14) with sex- and age-matched control subjects. Delta, alpha, and beta activity did not distinguish the groups, but regional differences in theta distribution did. Recovered alcoholics showed more uniform distributions of theta amplitudes in bilateral anterior and posterior regions compared with controls. Because a minimum of 5 years had elapsed since the recovered alcoholic subjects fulfilled DSM-III-R criteria for alcohol abuse or dependence, it is unlikely these EEG theta differences reflect the effects of withdrawal.

  2. Reducing iatrogenic risks: ICU-acquired delirium and weakness--crossing the quality chasm.

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    Vasilevskis, Eduard E; Ely, E Wesley; Speroff, Theodore; Pun, Brenda T; Boehm, Leanne; Dittus, Robert S

    2010-11-01

    ICUs are experiencing an epidemic of patients with acute brain dysfunction (delirium) and weakness, both associated with increased mortality and long-term disability. These conditions are commonly acquired in the ICU and are often initiated or exacerbated by sedation and ventilation decisions and management. Despite > 10 years of evidence revealing the hazards of delirium, the quality chasm between current and ideal processes of care continues to exist. Monitoring of delirium and sedation levels remains inconsistent. In addition, sedation, ventilation, and physical therapy practices proven successful at reducing the frequency and severity of adverse outcomes are not routinely practiced. In this article, we advocate for the adoption and implementation of a standard bundle of ICU measures with great potential to reduce the burden of ICU-acquired delirium and weakness. Individual components of this bundle are evidence based and can help standardize communication, improve interdisciplinary care, reduce mortality, and improve cognitive and functional outcomes. We refer to this as the "ABCDE bundle," for awakening and breathing coordination, delirium monitoring, and exercise/early mobility. This evidence-based bundle of practices will build a bridge across the current quality chasm from the "front end" to the "back end" of critical care and toward improved cognitive and functional outcomes for ICU survivors.

  3. Biomarkers of Delirium in a Low-Risk Community-Acquired Pneumonia-Induced Sepsis.

    Science.gov (United States)

    Tomasi, Cristiane Damiani; Vuolo, Francieli; Generoso, Jaqueline; Soares, Márcio; Barichello, Tatiana; Quevedo, João; Ritter, Cristiane; Dal-Pizzol, Felipe

    2017-01-01

    There are different theories about the pathophysiology of sepsis-associated encephalopathy (SAE), and the majority of our knowledge was derived from critically ill patients. 7In less severe sepsis, it is probable that neuroinflammation can be a major aspect of SAE development. We hypothesized that in non-severe septic patients, blood biomarkers of inflammation, endothelial activation, coagulation, and brain function would be different when compared to patients with and without brain dysfunction. A total of 30 patients presenting with community-acquired pneumonia (CAP)-induced sepsis were included of which 10 (33 %) developed SAE. Eight medical patients admitted to the general ward, except due to sepsis or infection, which developed delirium were included as delirium, non-sepsis group. From all measured biomarkers, only brain-derived neurotrophic factor (BDNF), regulated upon activation normal T cell expressed, and presumably secreted (RANTES), and interleukin (IL)-10 where significantly different when compared to SAE and sepsis groups. In addition, SAE patients presented higher levels of BDNF, vascular cellular adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), platelet-derived growth factor (PDGF)-AB/BB and RANTES when compared to delirium patients. In conclusion, the profile of biomarkers differs between SAE, sepsis, and delirium patients, suggesting that pathways related to SAE are different from delirium and from sepsis itself.

  4. Sleep disorders and acute nocturnal delirium in the elderly: a comorbidity not to be overlooked.

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    Terzaghi, Michele; Sartori, Ivana; Rustioni, Valter; Manni, Raffaele

    2014-04-01

    Delirium is a disturbance of consciousness and cognition that results in a confusional state. It tends to fluctuate in intensity and is often observed in older patients. Sleep is a window of vulnerability for the occurrence of delirium and sleep disorders can play a role in its appearance. In particular, delirious episodes have been associated with obstructive sleep apnoea syndrome, which is reported to be frequent in the elderly. Hereby, we present a case-report documenting the sudden onset of a confusional state triggered by obstructive sleep apnoea-induced arousal, together with a review of the literature on the topic. We emphasise that, among the many pathogenic factors implicated in delirium, it is worth considering the possible link between nocturnal delirium and the occurrence of impaired arousals. Indeed, the complex confusional manifestations of delirium could be due, in part, to persistence of dysfunctional sleep activity resulting in an inability to sustain full arousal during behavioural wakefulness. Arousals can be triggered by sleep disturbances or other medical conditions. Clinicians should be aware that older patients may present disordered sleep patterns, and make investigation of sleep patterns and disorders potentially affecting sleep continuity a key part of their clinical workup, especially in the presence of cognitive comorbidities. Correct diagnosis and optimal treatment of sleep disorders and disrupted sleep can have a significant impact in the elderly, improving sleep quality and reducing the occurrence of abnormal sleep-related behaviours.

  5. Anticholinergic Drugs and Their Effects on Delirium and Mortality in the Elderly

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    M.J. Luukkanen

    2011-01-01

    Full Text Available Aim: To investigate the use of drugs with anticholinergic properties (DAPs and their associations with delirium and mortality among elderly patients with comorbidities. Methods: 425 patients (≧70 years of age in geriatric wards and nursing homes were assessed. The use of DAPs was retrieved from their medical records. Delirium was diagnosed according to the DSM-IV criteria. Results: Of the 341 patients (80.2% treated with multiple DAPs (≧2, 92 patients (27.0% suffered from delirium, whereas 14 of 84 patients (16.7% without DAP treatment had delirium (p = 0.050. In a logistic regression analysis with age, gender, and Charlson Comorbidity Index as covariates, DAP treatment did not predict delirium (odds ratio 1.67, 95% confidence interval 0.87–3.21. The 2-year mortality was 49.3% (n = 168 in DAP users and 35.7% (n = 30 in non-users, respectively (p = 0.026. In the Cox proportional hazard model adjusted for age, gender, and comorbidity, DAPs did not predict mortality (hazard ratio 1.12, 95% confidence interval 0.75–1.68. Conclusion: The use of DAPs is very frequent among frail inpatients with comorbidities, but their use has no independent prognostic significance.

  6. Sigma-1 receptor agonist fluvoxamine for delirium in intensive care units: report of five cases

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    Hashimoto Kenji

    2010-04-01

    Full Text Available Abstract Background Delirium is a highly prevalent disorder among older patients in intensive care units (ICUs. Although antipsychotic drugs are the medications most frequently used to treat this syndrome, these drugs are associated with a variety of adverse events, including sedation, extrapyramidal side effects, and cardiac arrhythmias. Drug treatment for delirium requires careful consideration of the balance between the effective management of symptoms and potential adverse effects. Methods We report on five Japanese men (an 84 year old (acute aortic dissociation: Stanford type A, a 55 year old (traumatic subarachnoid hemorrhage and brain contusion, a 76 year old (sepsis by pyelonephritis, an 85 year old (cerebral infarction, and an 86 year old (pulmonary emphysema and severe pneumonia in which the selective serotonin reuptake inhibitor and sigma-1 receptor agonist fluvoxamine was effective in ameliorating the delirium of the patients. Results Delirium Rating Scale (DRS scores in these five patients dramatically decreased after treatment with fluvoxamine. Conclusion Doctors should consider fluvoxamine as an alternative approach to treating delirium in ICU patients in order to avoid the risk of side effects and increased mortality from antipsychotic drugs.

  7. [Citicoline as component of the therapy of postoperative delirium in neurosurgical patients].

    Science.gov (United States)

    Popugaev, K A; Savin, I A; Sokolova, E Iu; Oshorov, A V; Kadashev, B A; Kalinin, P L; Kutin, M A

    2013-01-01

    Delirium is a clinical sign of acute cerebral dysfunction. It is characterized by consciousness alterations with attention impairment and mentally disorganization. Frequency of delirium is 40-80% in general intensive care and more in patients in neurointensive care unit. We tried to assess citicoline (Ceraxon, Nycomed) safety and efficacy in treatment of postoperative delirium in patients with tumors of chiasm-sellar area of brain. 12 patients were included in citicoline group and 8--in control group. In both group combined type of delirium was common: 83.3% and 75%, accordingly. Citicoline didn't influence on delirium duration. Median of duration of mechanical ventilation was 1.5 and 6 days; mean and standard deviation were 10.5 +/- 15.4 and 17.5 +/- 27.9 days. Median of length of stay in ICU was 7 and 9.5 days; mean and standard deviation were 25.4 +/- 33.1 and 14.9 +/- 15.1 days. These results show that citicoline didn't influence on duration of mechanical ventilation and length of stay in ICU. Outcomes were similar in both groups, but frequency of full functional state recovery in citicoline group was significantly higher: 5 (41.7%) to 2 (25%) in control group (p citicoline therapy is safe for patients with tumors of chiasm-sellar area and lead to increasing of frequency of full functional state recovery.

  8. Lorazepam withdrawal catatonia: a case report.

    Science.gov (United States)

    Sivakumar, Thanapal; Yadav, Anil; Sood, Mamta; Khandelwal, Sudhir K

    2013-12-01

    Catatonia is a rare manifestation of benzodiazepine withdrawal in elderly patients who have used it for a long time. We present a case of lorazepam withdrawal catatonia and highlight issues in diagnosis and management.

  9. 21 CFR 314.620 - Withdrawal procedures.

    Science.gov (United States)

    2010-04-01

    ... Efficacy Studies Are Not Ethical or Feasible § 314.620 Withdrawal procedures. (a) Reasons to withdraw... diligence; (3) Use after marketing demonstrates that postmarketing restrictions are inadequate to...

  10. Water withdrawals in Florida, 2012

    Science.gov (United States)

    Marella, Richard L.

    2015-09-01

    In 2012, the total amount of water withdrawn in Florida was estimated to be 14,237 million gallons per day (Mgal/d). Saline water accounted for 7,855 Mgal/d (55 percent), and freshwater accounted for 6,383 Mgal/d (45 percent). Groundwater accounted for 4,167 Mgal/d (65 percent) of freshwater withdrawals, and surface water accounted for the remaining 2,216 Mgal/d (35 percent). Surface water accounted for nearly all (99.9 percent) saline-water withdrawals. Freshwater withdrawals were greatest in Palm Beach County (682 Mgal/d), and saline-water withdrawals were greatest in Pasco County (1,822 Mgal/d). Fresh groundwater provided drinking water (through either public supply or private domestic wells) for 17.699 million residents (93 percent of Florida’s population), and fresh surface water provided drinking water for 1.375 million residents (7 percent). The statewide public-supply gross per capita water use for 2012 was estimated at 136 gallons per day.

  11. The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica

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    Rachel Gooden

    2014-12-01

    Full Text Available Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145 children were included, with emergence delirium occurring in 28 (19.3%. Emergence delirium episodes had a mean duration of 6.9±7.8 min, required pharmacologic intervention in 19 (67.8% children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7± 10.8 min for non-agitated children; p<0.001. Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2-8.6 and moderate and severe anxiety prior to induction (p <0.001, OR 5.6, 95% CI 2.3-13.0. Complications of emergence delirium included intravenous line removal (n = 1, and surgical site bleeding (n = 3. Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.

  12. A 3 year case study of alcohol related psychotic disorders at Hospital Seremban.

    Science.gov (United States)

    George, S; Chin, C N

    1998-09-01

    This paper reports the characteristics and psychopathology of alcohol dependents with alcohol induced psychotic disorder admitted to the Seremban Hospital. The method is that of a case study of all alcohol dependents with alcohol induced psychotic disorder admitted to the Psychiatric Ward, Hospital Seremban over 3 years (1993-1995). There were 34 subjects, 30 Indians, 3 Chinese and 1 Malay with a mean age of 43 years. 32 were men and predominantly of Social Class IV and V (91%). They had a mean duration of drinking of 14.2 years and had a mean weekly consumption of 69.5 units of alcohol. There was a family history of alcohol dependence in (44%). The majority (68%) consumed samsu with beer the second choice. Auditory hallucinations (26) and delusions (16) were common while visual hallucinations (3) and depression (2) were less frequent. Speech disorder occurred in 4 subjects. 2 developed delirium tremens and 1 died. Liver function test was normal in 55%. All except the death from delirium tremens responded to treatment with a combination of anxiolytics, thiamine and antipsychotics and were rapidly discharged. The mean stay was 7 days. However, (68%) did not return for follow up and only 4 were abstinent from alcohol at the time of follow up.

  13. Managing verbal agitation in people with dementia and delirium.

    Science.gov (United States)

    Inkley, Francesca; Goldberg, Sarah

    2016-03-01

    Patients with dementia and delirium in acute hospitals can exhibit verbal agitation, but there is no research on rate of occurrence or how ward staff manage such behaviour. This service evaluation aimed to measure rate of occurrence of verbal agitation in confused older inpatients and understand the management strategies used by staff. An agitation inventory was completed daily by the nursing team for all verbally agitated patients on eight older person wards over two weeks. Six semi-structured interviews were conducted with staff and three hours of non-participant observations were undertaken. A mean 6% (13/223) of patients were verbally agitated each day. Management strategies included trial and error, distraction and engagement, reassurance, communication and familiarity. Staff did not adopt a systematic approach to care planning due to lack of training and support on the ward, as well as scarce resources in terms of staff, space and activities. Research is needed to develop and evaluate interventions that support staff to care for these patients.

  14. Neurobiological Basis of Alcohol Addiction

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    Milagros Lisset León Regal

    2014-02-01

    Full Text Available Alcoholism is a serious social problem due to its impact on individual and collective health. In order to provide an update on the latest findings that explain the development and symptoms of alcohol addiction, the short and long term changes that this disorder causes in the central nervous system are shown in this paper. A total of 52 information sources were consulted, including 43 journal articles, 4 books and statistical reports. The main network managers were used. The interaction of ethanol with various structures of the neuronal membrane affects the cytoarchitecture and brain function associated with the reward system, motor processing, learning and memory, resulting in the development of alcohol dependence. In addition, ethanol-induced changes in excitation/inhibition explain the phenomena of alcohol tolerance and withdrawal.

  15. Review of non-convulsive status epilepticus and an illustrative case history manifesting as delirium.

    Science.gov (United States)

    Epstein, Daniel; Diu, Eric; Abeysekera, Tamara; Kam, Daniel; Chan, Yin

    2009-09-01

    Non-convulsive status epilepticus can result in significant morbidity and mortality. The condition can be difficult to recognise, and can mimic delirium due to other underlying pathologies. There are several clinical subtypes, although these can be difficult to distinguish by their clinical features alone. Electroencephalogram is the key diagnostic tool to making the diagnosis, but this investigation is a limited resource in many institutions. In this review, we present a case of non-convulsive status epilepticus, manifesting as delirium, and then proceed to a literature review on this important diagnosis.

  16. Shortening Anesthesia Duration does not Affect Severity of Withdrawal Syndrome in Patients Undergoing Ultra Rapid Opioid Detoxification

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    Shoaleh Shami

    2010-02-01

    Full Text Available Ultra rapid opioid detoxification (UROD is one of the new methods of detoxification. This method of detoxification involves putting patients under general anesthesia and actively giving them opioid antagonists. The objective of this study was to evaluate effects of anesthesia duration in UROD on severity of withdrawal syndrome. Sixty addicted patients seeking UROD procedure assigned randomly to one of the 2hr, 4hr or 6hr anesthesia duration groups. Premedication and anesthesia procedure (induction and maintenance were the same for three groups. Detoxification was done for all patients with 50 mg oral naltroxane (prior to induction and 20 mg intravenous naloxane (8 mg/bolus and 12 mg/infusion. Blood pressure, heart rate and respiratory rate were automatically measured and recorded every 5 minutes. The severity of withdrawal syndrome was measured and recorded every one hour during anesthesia, 2hours post-anesthesia, and 12 and 24 hours following the induction of anesthesia according to the Wang Scale modified by Lomier (WSMBL. Patients aged 20-58 in three groups. Three cases experienced delirium after detoxification that lasted 24 hours in one. Severity of withdrawal syndrome in patients of groups 2, 4 and 6 hour were 8.7, 7.4 and 5.1 respectively during anesthesia and 12.3, 11.1 and 13.9 after 18 hours of anesthesia. Results of this study showed that, in standard settings, UROD is a safe method for detoxification and has low complications. The withdrawal symptoms during and after anesthesia are low. Shortening the duration of anesthesia has no affect on severity of withdrawal syndrome during and after anesthesia.

  17. ICU探视制度对酒精戒断综合征患者临床症状和不良反应的影响%The impact of visiting policy on symptoms and complications in patients with Alcohol Withdrawal Syndrome in Intensive Care Unit

    Institute of Scientific and Technical Information of China (English)

    邓艳丽; 李梅华

    2016-01-01

    目的:调查半开放式和封闭式探视模式对酒精戒断综合征(AWS)患者临床症状和不良反应的影响。方法:45例AWS患者随机分为半开放式组(n=28)和封闭式组(n=17)。比较两组患者主要临床表现和不良反应。结果:半开放式组3d的谵妄CAM-ICU评分低于封闭式组(P0.05)。结论:半开放式探视有利于缓解AWS病情,降低不良反应的发生,而不增加医院感染率,可为探索未来ICU探视制度提供借鉴。%Objective: To investigate the different impact of half-open and restricted visiting policy on symptoms and complications in patients with alcohol withdrawal syndrome (AWS). Methods: Forty-ifve patients with AWS were divided into half-open group (n=28) and restricted group (n=17). Clinical symptoms and adverse reaction between two groups were compared. Results: CAM-ICU score on day 3 in half-open group was signiifcantly lower than restricted group (P<0.05), and AWS scale score, CAM-ICU score, SDS score and SAS score on day 7 in half-open group were also signiifcantly lower than restricted group (P<0.05). In half-open group, ICU stay, AWS duration, and usage of sedative drugs were signiifcantly lower compared to restricted group (P<0.05), while there was no difference of hospital acquired infection rate. The occurrence of injury and suicidal ideation in half-open group was signiifcanty lower compared to restricted group. Conclusions: Half-open visiting policy could improve the state of AWS, decrease the occurrence of accidents, but have no effect on hospital infection. It can be used as reference in terms of creating visiting policy in ICU in future.

  18. Slow Gait Speed and Rapid Renal Function Decline Are Risk Factors for Postoperative Delirium after Urological Surgery.

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    Tendo Sato

    Full Text Available The aim of this study was to identify risk factors associated with postoperative delirium in patients undergoing urological surgery.We prospectively evaluated pre- and postoperative risk factors for postoperative delirium in consecutive 215 patients who received urological surgery between August 2013 and November 2014. Preoperative factors included patient demographics, comorbidities, and frailty assessment. Frailty was measured by handgrip strength, fatigue scale of depression, fall risk assessment, and gait speed (the timed Get-up and Go test. Postoperative factors included types of anesthesia, surgical procedure, renal function and serum albumin decline, blood loss, surgery time, highest body temperature, and complications. Uni- and multivariate logistic regression analyses were performed to assess pre- and postoperative predictors for the development of postoperative delirium.Median age of this cohort was 67 years. Ten patients (4.7% experienced postoperative delirium. These patients were significantly older, had weak handgrip strength, a higher fall risk assessment score, slow gait speed, and greater renal function decline compared with patients without delirium. Multivariate analysis revealed slow gait speed (>13.0 s and rapid renal function decline (>30% were independent risk factors for postoperative delirium.Slow gait speed and rapid renal function decline after urological surgery are significant factors for postoperative delirium. These data will be helpful for perioperative patient management. This study was registered as a clinical trial: UMIN: R000018809.

  19. Delirium in elderly individuals with hip fracture: causes, incidence, prevalence, and risk factors Delirium em idosos com fratura de fêmur: causas, incidência, prevalência e fatores de risco

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    Maria Elizabet Furlaneto

    2006-02-01

    Full Text Available OBJECTIVES: To determine the incidence, prevalence, risk factors, and causes of delirium in elderly individuals with hip fractures, as well as the impact of delrium on mortality and length of hospital stay. PATIENTS: One hundred and three patients aged 65 and older with hip fractures were included consecutively between January 2001 and June 2002. METHOD: Delirium was diagnosed using the Confusion Assessment Method, applied within the first 24 hours after admission, and then daily. All patients underwent a global geriatric evaluation including clinical history, physical examination, laboratory tests, surgical risk evaluation, and functional and mental evaluations. Patients with delirium (cases were compared with patients without delirium (controls. RESULTS: Thirty (29.1% patients in this sample met the criteria for delirium, with a prevalence of 16.5% (17/103 and an incidence of 12.6% (13/103. Cognitive and functional deficits had a significant association with delirium, although only cognitive deficit was revealed to be an independent risk factor after analysis with the logistic regression model. The most frequent causes of delirium were drugs and infections. The hospital stay was significantly longer for patients with delirium compared with patients in the control group (26.27 versus 14.38 days, respectively. Mortality showed a tendency to higher levels in patients with delirium during their hospital stay, although with no statistical significance. CONCLUSIONS: Delirium is a frequent complication among hospitalized elderly individuals with hip fractures. It is associated with cognitive and functional deficits, and it is associated with increases the length of hospital stay and mortality.OBJETIVOS: Deteminar a incidência, prevalência, fatores de risco e causas de delirium em idosos com fratura de fêmur, e seu impacto sobre mortalidade e permanência hospitalar. MÉTODOS: Cento e três pacientes com 65 anos e mais com fratura de fêmur foram

  20. The Impact of Delirium Screening on Admission to General Hospital Using Stanford Proxy Test for Delirium SPTD [1]® , A Quality Improvement Project

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    Adel Zaraa

    2016-09-01

    Full Text Available In this Quality Improvement Project QIP, we hypothesized that implementing screening tool for detecting delirium at admission to general hospital will term a higher yield; thus early recognition and diagnosis will eventually lead to an early intervention and prevention. Method: We set to screen every patient admitted to a community general hospital. Exclusion criteria: Any congenital neurological malformation, a history of pervasive developmental disorder, or documented brain injury. For this purpose we used The Stanford Proxy Test for Delirium (S-PTD which is the first diagnostic test for delirium that combines criteria from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 and the International Classification of Diseases, 10th revision (ICD-10 2015. This test was generated in Stanford University 2015 by Jose R. Maldonado, MD et al. and discussed in the APM conference in November 2015, in New Orleans then in the APA meeting, 2016 Atlanta, USA. The test assesses the patient’s twelve different parameters. When set the positive cutoff score at 4 or more, the S-PTD had a sensitivity of 79%, specificity of 91%, positive predictive value of 70%, and negative predictive value of 94%. One of the big advantages of this tool is required 2 minutes to complete. Also, the nursing staff can easily administer it to their patient during their shift, which means measuring patients cognitive function in different times through the day [1]. Results: 19.55% of all admission suffered from delirium on admission, while the admitting officer clinically recognized 5.3% of all admission. Conclusion: using the SPTD [1] on admission yield 400% more positive result. It’s highly recommended to use screening tool as part of admission process.

  1. The diagnosis of delirium in an acute-care hospital in Moscow: what does the Pandora’s box contain?

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    Tkacheva ON

    2017-02-01

    Full Text Available Olga N Tkacheva,1 Nadezda K Runikhina,1 Arkadiy L Vertkin,2 Irina V Voronina,1 Natalia V Sharashkina,1 Elen A Mkhitaryan,1 Valentina S Ostapenko,1 Elena A Prokhorovich,2 Tamar Freud,3 Yan Press3–5 1Russian Gerontology Clinical Research Center, Pirogov Russian National Research Medical University of Ministry of Healthcare of the Russian Federation, 2Moscow State University of Medicine and Dentistry named after AI Evdokimov, Moscow, Russia; 3Department of Family Medicine, Faculty of Health Sciences, Sial Family Medicine and Primary Care Research Center, Ben-Gurion University of the Negev, 4Comprehensive Geriatric Assessment Unit, Clalit Health Care Services, Yassky Clinic, 5Community-Based Geriatric Unit, Division of Community Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel Background: Delirium, a common problem among hospitalized elderly patients, is not usually diagnosed by doctors for various reasons. The primary aim of this study was to evaluate the effect of a short training course on the identification of delirium and the diagnostic rate of delirium among hospitalized patients aged ≥65 years. The secondary aim was to identify the risk factors for delirium. Methods: A prospective study was conducted in an acute-care hospital in Moscow, Russia. Six doctors underwent a short training course on delirium. Data collected included assessment by the confusion assessment method for the intensive care units, sociodemographic data, functional state before hospitalization, comorbidity, and hospitalization indices (indication for hospitalization, stay in intensive care unit, results of laboratory tests, length of hospitalization, and in-hospital mortality. Results: Delirium was diagnosed in 13 of 181 patients (7.2% who underwent assessment. Cognitive impairment was diagnosed more among patients with delirium (30.0% vs 6.1%, P=0.029; Charlson comorbidity index was higher (3.6±2.4 vs 2.3±1.8, P=0.013; and Barthel index was lower (43

  2. The effects of dexmedetomidine on emergence delirium in pediatric under total intravenous anesthesia%右美托咪定对小儿全凭静脉麻醉苏醒期躁动的影响

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    石念军; 张维霞; 张昊; 于海涛; 张宁; 王绪彩

    2013-01-01

    目的 观察右美托咪定预防小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期躁动的作用.方法 将60例全凭静脉麻醉下行择期扁桃体腺样体切除术患儿,随机分为实验组(A组)与对照组(B组),诱导后分别持续静脉泵入右美托咪定每小时0.2 μg/kg和等容量的生理盐水至手术结束.记录患儿手术时间、停药至清醒时间、恢复室滞留时间、到达恢复室即刻改良Aldrete评分、进入恢复室后30 min内根据儿童麻醉后躁动评分(PAED)和改良加拿大东安大略儿童医院疼痛评分量表(m-CHEOPS),每5 min对患儿进行躁动和疼痛评分,所得最高值作为监测有效值.结果 实验组与对照组比较,停药至清醒时间、Aldrete评分及恢复室滞留时间的差异无统计学意义(P>0.05),PAED评分E组[(9.4±1.8)分]显著低于C组[(13.8±2.2)分,P<0.05],疼痛评分E组[(3.8±0.6)分]显著低于C组[(4.8±0.8)分,P<0.05].结论 右美托咪定可在一定程度上预防小儿扁桃体腺样体切除术全凭静脉麻醉苏醒期躁动的发生.%Objective To observe the effects of dexmedetomidine on emergence delirium in pediatric adenotonsillectomy under total intravenous anesthesia (TIVA).Methods 60 children undergoing adenotonsillectomy under TIVA were randomly divided into experimental group (group A) and control group (group B).Anesthesia was induced than dexmedetomidine was infused at the rate of 0.2 μg/kg.h in group E and sodium chloride was infused at the same volume in group C after induction.Record the time of operation,drug withdrawal to conscious,retention time of recovery room,and the modified Aldrete score of reaching recovery room,according to the Pediatric Anesthesia Emergence Delirium to mark the delirium of the patient in the future 30 minutes per 5 minutes,the highest score is used to effective value.and at the same time,mark the degree of pain according to the modified Children' s Hospital of Eastern Ontario Pain Scale

  3. High serum interleukin-6 level is associated with increased risk of delirium in elderly patients after noncardiac surgery:a prospective cohort study

    Institute of Scientific and Technical Information of China (English)

    LIU Pei; LI Ya-wei; WANG Xiao-shan; ZOU Xi; ZHANG Da-zhi; WANG Dong-xin; LI Shi-zhong

    2013-01-01

    Background The relationship between inflammation and delirium remains to be determined.The purposes of this study were to investigate the association between serum interleukin-6 levels and the occurrence of delirium in elderly patients after major noncardiac surgery.Methods A total of 338 elderly patients (60 years of age and over) undergoing major noncardiac surgery were enrolled.Blood samples were obtained before anesthesia and in the first postoperative morning and serum interleukin-6 concentrations were measured.Delirium was assessed twice daily by the confusion assessment method for the Intensive Care Unit during the first three postoperative days.Survival analyses were performed to assess the relationship between the serum IL-6 level and the occurrence of postoperative delirium.Results Postoperative delirium occurred in 14.8% (50 of 338) of patients.High serum interleukin-6 levelsafter surgery were significantly associated with increased risk of the occurrence of postoperative delirium (hazard ratio 1.514,95% confidence interval 1.155-1.985,P=0.003).Other independent predictors of delirium included increasing age,poor preoperative New York Heart Association classification,low preoperative Mini-Mental State Examination score,and high total postoperative Visual Analogue Scale pain score.Patients who developed delirium had a prolonged hospital stay after surgery.Conclusions Delirium is a frequent complication in elderly patients after noncardiac surgery.High serum interleukin-6 level after surgery is associated with increased risk of the occurrence of postoperative delirium.

  4. Adverse drug reactions of haloperidol used in critically ill children for the treatment of delirium

    NARCIS (Netherlands)

    Spaans, E.; Slooff, V.; Van Puijenbroek, E.; Jessurun, N.; De Hoog, M.; Tibboel, D.; De Wildt, S.

    2013-01-01

    BACKGROUND: As delirium in critically ill children is increasingly recognized, more children are treated with the antipsychotic drug haloperidol. However, little is known about its safety in this context. The objective of this study was to investigate the incidence and nature of adverse events assoc

  5. Beyond Urinary Tract Infections (UTIs) and Delirium: A Systematic Review of UTIs and Neuropsychiatric Disorders.

    Science.gov (United States)

    Chae, Jung Hee Jennifer; Miller, Brian J

    2015-11-01

    Urinary tract infections (UTIs) are among the most common bacterial infections. Although comorbid UTI in geriatric patients with delirium or dementia is well known, the prevalence and scope of the association with other neuropsychiatric disorders is unclear. We performed a systematic review of the association between UTIs and delirium, dementia, psychotic disorders, and mood disorders in hospitalized patients. We identified studies by searching PubMed, PsycInfo, and Web of Knowledge, and the reference lists of identified studies and review papers. Seventeen publications met the inclusion criteria. The primary findings were: (1) 88% of publications reported a positive association between UTIs and neuropsychiatric disorders; (2) 47% reported that the clinical course of a neuropsychiatric disorder may be precipitated or exacerbated by a UTI; (3) the mean weighted prevalence of UTIs in subjects was 19.4% for delirium, 11.2% for dementia, 21.7% for nonaffective psychotic disorders, and 17.8% for mood disorders. Our findings, which must be interpreted carefully given the heterogeneity among the studies, suggest that UTIs are highly comorbid in hospitalized patients and may precipitate or exacerbate some neuropsychiatric disorders. The association extends beyond geriatric patients with delirium, affects males and females, and includes adults with psychotic and mood disorders. These findings underscore the important interface between physical and mental health. Potential underlying mechanisms are also reviewed, including complex interactions between the immune system and the brain.

  6. Appreciative inquiry enhances cardiology nurses’ clinical decision making when using a clinical guideline on delirium

    DEFF Research Database (Denmark)

    Vedsegaard, Helle; Schrader, Anne-Marie; Rom, Gitte

    2016-01-01

    and axial coding drawing on the principles of grounded theory. The study shows that appreciative inquiry was meaningful to cardiology nurses in providing them with knowledge of using a guideline on delirium in clinical decision making, the main reasons being a) data on a current patient were included, b...

  7. Proteomic Profiling of Plasma and Serum in Elderly Patients With Delirium

    NARCIS (Netherlands)

    B.C. van Munster; M.J. van Breemen; P.D. Moerland; D. Speijer; S.E. de Rooij; C.J. Pfrommer; M. Levi; M.W. Hollmann; J.M. Aerts; A.H. Zwinderman; J.C. Korevaar

    2009-01-01

    The aim of this study was to compare plasma and serum protein profiles in elderly acute hip fracture patients with and without delirium. The spectra from surface-enhanced laser desorption ionization (SELDI) using time-of-flight (TOF) mass spectrometry of 16 patients without and 16 patients with deli

  8. Development of an abbreviated version of the delirium motor subtyping scale (DMSS-4)

    NARCIS (Netherlands)

    Meagher, D; Adamis, D; Leonard, M; Trzepacz, P; Grover, S; Jabbar, F; Meehan, K; O'Connor, M; Cronin, C; Reynolds, P; Fitzgerald, J; O'Regan, N; Timmons, S; Slor, C; de Jonghe, J; de Jonghe, A; van Munster, B C; de Rooij, S E; Maclullich, A

    2014-01-01

    BACKGROUND: Delirium is a common neuropsychiatric syndrome with considerable heterogeneity in clinical profile. Identification of clinical subtypes can allow for more targeted clinical and research efforts. We sought to develop a brief method for clinical subtyping in clinical and research settings.

  9. Long-Term Mental Health Problems after Delirium in the ICU

    NARCIS (Netherlands)

    Wolters, Annemiek E.; Peelen, Linda M.; Welling, Maartje C.; Kok, Lotte; De Lange, Dylan W.; Cremer, Olaf L.; Van Dijk, Diederik; Slooter, Arjen J C; Veldhuijzen, Dieuwke S.

    2016-01-01

    Objectives: To determine whether delirium during ICU stay is associated with long-term mental health problems defined as symptoms of anxiety, depression, and posttraumatic stress disorder.  Design: Prospective cohort study.  Setting: Survey study, 1 year after discharge from a medical-surgical ICU i

  10. Markers of cerebral damage during delirium in elderly patients with hip fracture

    NARCIS (Netherlands)

    van Munster, B.C.; Korse, C.M.; de Rooij, S.E.; Bonfrer, J.M.; Zwinderman, A.H.; Korevaar, J.C.

    2009-01-01

    ABSTRACT: BACKGROUND: S100B protein and Neuron Specific Enolase (NSE) can increase due to brain cell damage and/or increased permeability of the blood-brain-barrier. Elevation of these proteins has been shown after various neurological diseases with cognitive dysfunction. Delirium is characterized b

  11. Hazards of Hospitalization: Hospitalists and Geriatricians Educating Medical Students about Delirium and Falls in Geriatric Inpatients

    Science.gov (United States)

    Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert

    2008-01-01

    Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…

  12. Deconstructing Dementia and Delirium Hospital Practice: Using Cultural Historical Activity Theory to Inform Education Approaches

    Science.gov (United States)

    Teodorczuk, Andrew; Mukaetova-Ladinska, Elizabeta; Corbett, Sally; Welfare, Mark

    2015-01-01

    Older patients with dementia and delirium receive suboptimal hospital care. Policy calls for more effective education to address this though there is little consensus on what this entails. The purpose of this clarification study is to explore how practice gaps are constructed in relation to managing the confused hospitalised older patient. The…

  13. Protocol for assessing alcohol withdrawal syndrome by nursing professionals in emergency services: a pilot test Protocolo para evaluación del síndrome de abstinencia alcohólica por profesionales de enfermería en los servicios de emergencias: test piloto Protocolo para avaliação da síndrome de abstinência alcoólica por profissionais de enfermagem nos serviços de urgência: teste piloto

    Directory of Open Access Journals (Sweden)

    Margarita Antonia Villar Luis

    2008-03-01

    Full Text Available OBJECTIVES: This work speaks of a pilot test administered in four public services with emergency care (one at a hospital and three at community clinics in the city of Ribeirão Preto, São Paulo, to test an assessment protocol for Alcohol Withdrawal Syndrome. Involved were auxiliaries, technicians and soon-to-be-nurses. The object was to evaluate the protocol´s potential as a guide to nursing care, and to test whether it was adequate in terms of comprehension and applicability. METHODS: A protocol based on the Clinical Institute Withdrawal Assessment was constructed to be applied by nursing professionals in hospitals and community clinics, allowing for possible alterations based upon individual patients. Fifty-nine workers tested the protocol over four months. RESULTS: Sixty-eight patients (21 women and 47 men, with average age between 34 and 40 years, were interviewed. Alcohol was the predominant drug of use (90% on a daily average between both sexes. The protocol was designed to systematize health care. Among its purposes were: to facilitate care (42.4%; provide a script for faster orientation (30.5%; provide information giving professional updates (25.4%; provide explanations regarding the particular sickness (23.7. CONCLUSIONS: The experience was positive, identifying a lack of knowledge about Alcohol Withdrawal Syndrome. However, an interest to learn more on the subject became evident among workers.OBJETIVOS: Relatar la experiencia piloto en cuatro servicios públicos con servicios de emergencia (uno hospitalario y tres comunitarios en la ciudad de Ribeirão Preto- Sao Paulo, para probar un protocolo de evaluación del Síndrome de Abstinencia Alcohólica entre los auxiliares, técnicos y eventuales enfermeros, y evaluar el potencial del formulario como guía orientadora del cuidado de enfermería, asi como la adecuación del mismo en términos de comprensión y aplicabilidad. MÉTODOS: Se construyó, un protocolo para ser aplicado por

  14. Possibility to predict the development of secondary depression in primary alcoholics during abstinence

    Directory of Open Access Journals (Sweden)

    Mandić-Gajić Gordana

    2005-01-01

    Full Text Available Background/Aim. The relationship between alcoholism and depression is observed in clinical trials. The factors which could predict persistence of secondary depression after alcohol withdrawal are not enough explored on admission. The differences between depressed (DA and non-depressed (NDA alcoholics regarding the degrees of severity of withdrawal, severity of depression and the intensity of cognitive dysfunctions were explored on admission to investigate possibility of prediction of the development of secondary depression in alcoholics. Methods. A group of primary male alcoholics (n=86 was recruited during inpatient treatment. After 4 weeks alcoholics were divided in the DA group (n=43 and NDA (n=43 group according to the score on the Hamilton Depression Rating Scale (HAM-D. Clinical assessment of withdrawal, scoring on the Alcohol Dependency Severity Scale- ASD, and scoring on the Mini Mental Scale-MMSE were performed in all the participants on admission. The differences between the groups were tested by the Student's t-test. Results. The DA group showed the significantly higher severity of depression, higher levels of alcohol withdrawal symptoms and cognitive dysfunctions than the NDA group on admission. Conclusion. The specific group of depressive alcoholics was shown to be characterized by the higher severity of alcoholism and depression on admission, which could predict prolonged, secondary depression. Early detection and concurrent therapy of secondary depression could improve the treatment, and reduce the relapse of alcoholism.

  15. Confusion assessment method para analisar delirium em unidade de terapia intensiva: revisão de literatura Confusion assessment method to analyze delirium in intensive care unit: literature review

    Directory of Open Access Journals (Sweden)

    Satomi Mori

    2009-03-01

    Full Text Available O delirium é freqüentemente observado em pacientes internados em unidades de terapia intensiva e a sua ocorrência relaciona-se com o aumento da morbimortalidade, do período de internação, declínio funcional e custos elevados. O Confusion Assessment Method for Intensive Care Unit é um instrumento que facilita a identificação precoce e a ocorrência de delirium em pacientes intubados. Este trabalho tem como objetivo verificar aspectos já estudados sobre o delirium utilizando o Confusion Assessment Method for Intensive Care Unit. Foi realizada uma revisão narrativa nas bases de dados LILACS, MedLine, PubMed e CINAHL que compreendeu desde o ano de validação do Confusion Assessment Method for Intensive Care Unit (2001 até março de 2008. Os descritores utilizados nas bases de dados LILACS, MedLine, PubMed foram delirium e intensive care unit e na CINAHAL foram delirium e intensive care. Do total de 293 artigos encontrados foram selecionados 35. Em relação aos aspectos estudados constatou-se incidência variável dos tipos de delirium em diferentes tipos de unidades de terapia intensiva. Quanto a sensibilidade do Confusion Assessment Method for Intensive Care Unit este apresentou uma variação de 93 a 100% e a especificidade foi de 89 a 100% sendo considerado um instrumento valioso na detecção, caracterização e controle do delirium e suas repercussões. Além disso, sua utilização permite o controle mais eficaz dos pacientes graves que apresentam o distúrbio ou riscos para desenvolvê-lo.Delirium is frequently observed in intensive care unit patients and its occurrence is related to increased morbidity and mortality, length of stay, functional decline and high costs. The Confusion Assessment Method for Intensive Care Unit is a tool that facilitates early identification and occurrence of delirium among intubated patients. Objective: To verify the aspects of delirium studied by means of the Confusion Assessment Method for

  16. National Institute on Alcohol Abuse and Alcoholism

    Science.gov (United States)

    Skip to main content National Institute on Alcohol Abuse and Alcoholism (NIAAA) Main Menu Search Search form Search Alcohol & Your Health Overview of Alcohol Consumption Alcohol's Effects on the Body Alcohol Use ...

  17. Prevalence of delirium in hospitalized patients from an internal medicine service

    Directory of Open Access Journals (Sweden)

    Ana Carolina González Pezoa

    2015-12-01

    Full Text Available INTRODUCCIÓN El delirium es un síndrome neurocognitivo frecuente en pacientes hospitalizados, que se asocia en forma categórica e independiente a peores resultados globales en quienes lo presentan. A pesar de esto, suele ser subvalorado y no reconocido como un cuadro que requiere un manejo específico, independiente de la causa que lo origina. OBJETIVOS Determinar la tasa de prevalencia de delirium en los pacientes ingresados a un servicio de medicina y, secundariamente, el subdiagnóstico del cuadro por parte del médico tratante, residente o interno de medicina. MÉTODOS Estudio observacional descriptivo realizado en el Servicio de Medicina del Hospital Dr. Eduardo Pereira a los 125 pacientes ingresados entre el 12 de abril y 12 mayo de 2014. A través de la herramienta diagnóstica Confusion Assessment Method Instrument, se determinó la tasa de prevalencia del delirium y de casos subdiagnosticados. RESULTADOS Ciento dos pacientes cumplieron los criterios de inclusión. De éstos, 19 (18,6% pacientes fueron diagnosticados con delirium. En el grupo de pacientes diagnosticados, 13 (68,4% eran de sexo femenino. El subdiagnóstico se presentó en ocho pacientes (42,1%. CONCLUSIONES La prevalencia de delirium en este centro está dentro de lo esperable, según la literatura. Considerando la disponibilidad de herramientas para realizar su diagnóstico, es necesario instruir al equipo de salud para mejorar el reconocimiento y manejo de este cuadro dada su importancia pronóstica.

  18. Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit--five cases and a review

    DEFF Research Database (Denmark)

    Nielsen, R M; Olsen, K S; Lauritsen, Anne Øberg

    2014-01-01

    PURPOSE: Delirium in the intensive care unit (ICU) is conventionally treated pharmacologically but can progress into a protracted state refractory to medical treatment--a potentially life-threatening condition in itself. METHODS: We treated 5 cases of severe protracted delirium in our ICU...... with electroconvulsive therapy (ECT) after failure of conventional medical therapy. RESULTS: The delirious state of long standing agitation, anxiety, and discomfort was controlled in all patients. Electroconvulsive therapy was effective in controlling delirium in 4 patients. The last patient became calm, relieved...... of stress, and able to cooperate with the ventilator but remained in a state of posttraumatic amnesia after a head trauma. CONCLUSION: Although controversial, ECT is nevertheless recognized as an efficient and safe treatment for various psychiatric illnesses including delirium. Considering the significantly...

  19. Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomised controlled trial

    DEFF Research Database (Denmark)

    Tonnesen, H; Rosenberg, J; Nielsen, Hans Jørgen;

    1999-01-01

    liver disease admitted for elective colorectal surgery. INTERVENTIONS: Withdrawal from alcohol consumption for 1 month before operation (disulfiram controlled) compared with continuous drinking. MAIN OUTCOME MEASURES: Postoperative complications requiring treatment within the first month after surgery...

  20. A systematic review and meta-analysis of the association between the apolipoprotein E genotype and delirium.

    Science.gov (United States)

    Adamis, Dimitrios; Meagher, David; Williams, John; Mulligan, Owen; McCarthy, Geraldine

    2016-04-01

    The role of apolipoprotein E (APOE) in Alzheimer's disease and other dementias has been investigated intensively. However, the relationship between APOE and delirium has only recently been explored in studies that have included relatively small samples. A meta-analysis of the published pooled data is timely to explore the relationship between APOE and delirium and to inform further research in this topic. PubMed, EBSCOhost, Google Scholar, Scopus, all EBM Reviews (OVID) and the Cochrane Database of Systematic Reviews were searched with relevant keywords and from the references of relevant papers. Ten papers were found that examined the relationship between APOE and delirium. Data were extracted from eight of them and pooled for meta-analysis using random effects with R software. Data from 1762 participants, of whom 479 (27.2%) were diagnosed with delirium, showed low heterogeneity (Q=13.11, d.f.=7, P=0.07; I=44.86%). The possession of the APOE ε4 allele has a small (log odds ratio: 0.18, 95% confidence interval: 0.23-0.59), nonsignificant (P=0.38) effect on the presence of delirium. No publication bias was identified. The metapower of the pooled data was low (α=0.05, power=0.65). On analysing the studies to date, it seems that there is no association between APOE and the occurrence of delirium. We suggest that further studies are needed with greater number of patients to clarify any association as well as to examine for other patterns of association including relevance for subgroups of patients who develop delirium and for effects on the phenotype of delirium and the outcomes.

  1. Comparison of pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a protocol for a systematic review incorporating network meta-analyses

    OpenAIRE

    Burry, L.D.; Hutton, B.; Guenette, M.; Williamson, D; Mehta, S; Egerod, I.; Kanji, S; N.K. Adhikari; Moher, D.; C.M. Martin; Rose, L

    2016-01-01

    Background Delirium is characterized by acute changes in mental status including inattention, disorganized thinking, and altered level of consciousness, and is highly prevalent in critically ill adults. Delirium has adverse consequences for both patients and the healthcare system; however, at this time, no effective treatment exists. The identification of effective prevention strategies is therefore a clinical and research imperative. An important limitation of previous reviews of delirium pr...

  2. Associations between sedation, delirium and post-traumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit

    DEFF Research Database (Denmark)

    Svenningsen, Helle

    2013-01-01

    systematisk for delirium. En mindre del af patienterne er undersøgt i forhold til bl.a. posttraumatisk-stress¬syndrom (PTSD) efterfølgende. Studier om delirium viser at det er lidelsesfuldt for patienten, og at delirium øger risiko for død betydeligt, eller øger sygelighed efterfølgende fx i form af demens...

  3. Delirium and Sedation in the Intensive Care Unit (ICU): survey of behaviors and attitudes of 1,384 healthcare professionals

    Science.gov (United States)

    Patel, RP; Gambrell, M; Speroff, T; Scott, TA; Pun, BT; Okahashi, J; Strength, C; Pandharipande, P; Girard, TD; Burgess, H; Dittus, RS; Bernard, GR; Ely, EW

    2013-01-01

    Objective A 2001 survey found that most healthcare professionals considered ICU delirium as a serious problem, but only 16% used a validated delirium screening tool. Our objective was to assess beliefs and practices regarding ICU delirium and sedation management. Design and Setting Between October 2006 and May 2007, a survey was distributed to ICU practitioners in 41 North American hospitals, 7 international critical care meetings and courses, and the American Thoracic Society email database Study Participants A convenience sample of 1,384 health care professionals including 970 physicians, 322 nurses, 23 respiratory care practitioners, 26 pharmacists, 18 nurse practitioners and physicians’ assistants, and 25 others. Results A majority [59% (766/1300)] estimated that over 1 in 4 adult mechanically ventilated patients experience delirium. Over half [59% (774/1302)] screen for delirium, with 33% of those respondents (258/774) using a specific screening tool. A majority of respondents use a sedation protocol, but 29% (396/1355) still do not. A majority (76%, 990/1309) has a written policy on spontaneous awakening trials (SATs), but the minority of respondents (44%, 446/1019) practice SATs on more than half of ICU days. Conclusions Delirium is considered a serious problem by a majority of healthcare professionals, and the percent of practitioners using a specific screening tool has increased since the last published survey data. While most respondents have adopted specific sedation protocols and have an approved approach to stopping sedation daily, few report even modest compliance with daily cessation of sedation. PMID:19237884

  4. Advances in alcoholic liver disease: An update on alcoholic hepatitis.

    Science.gov (United States)

    Liang, Randy; Liu, Andy; Perumpail, Ryan B; Wong, Robert J; Ahmed, Aijaz

    2015-11-14

    Alcoholic hepatitis is a pro-inflammatory chronic liver disease that is associated with high short-term morbidity and mortality (25%-35% in one month) in the setting of chronic alcohol use. Histopathology is notable for micro- and macrovesicular steatosis, acute inflammation with neutrophil infiltration, hepatocellular necrosis, perivenular and perisinusoidal fibrosis, and Mallory hyaline bodies found in ballooned hepatocytes. Other findings include the characteristic eosinophilic fibrillar material (Mallory's hyaline bodies) found in ballooned hepatocytes. The presence of focal intense lobular infiltration of neutrophils is what typically distinguishes alcoholic hepatitis from other forms of hepatitis, in which the inflammatory infiltrate is primarily composed of mononuclear cells. Management consists of a multidisciplinary approach including alcohol cessation, fluid and electrolyte correction, treatment of alcohol withdrawal, and pharmacological therapy based on the severity of the disease. Pharmacological treatment for severe alcoholic hepatitis, as defined by Maddrey's discriminant factor ≥ 32, consists of either prednisolone or pentoxifylline for a period of four weeks. The body of evidence for corticosteroids has been greater than pentoxifylline, although there are higher risks of complications. Recently head-to-head trials between corticosteroids and pentoxifylline have been performed, which again suggests that corticosteroids should strongly be considered over pentoxifylline.

  5. 经皮穴位电刺激联合地西泮口服治疗创伤后酒精戒断综合征心理渴求的临床观察%Clinical observation of transcutaneous acupoint electrical stimulation combined diazepam oral in the treatment of posttraumatic psychological craving for alcohol withdrawal syndrome

    Institute of Scientific and Technical Information of China (English)

    王明明

    2015-01-01

    目的 研究经皮穴位电刺激联合地西泮口服治疗创伤后酒精戒断综合征患者在躯体戒断期心理渴求的临床疗效.方法 选择2011年1月-2014年1月收治的由于突发性创伤导致的四肢某部位骨折或关节、软组织损伤等需禁止或减少饮酒的患者120例作为研究对象,随机分为对照组和观察组各60例.对照组患者给予地西泮口服治疗,10 mg/次,2次/d;观察组在对照组的基础上给予经皮穴位电刺激治疗,30 min/次,2次/d;并由心理咨询师给予个性化的心理健康教育指导.于干预后第1、2周应用酒精戒断综合自评量表(alcohol withdrawal integrated self rating scale,AWSS)及焦虑自评量表(selg-rating anxiety scale, SAS)评价两组患者的临床治疗效果.计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用x2检验,P<0.05为差异有统计学意义.结果 观察组干预后第1、2周AWSS及SAS评分分别为(9.53±0.34)、(3.57±0.35)、(49.11 ±2.69)、(30.87±0.87)分,显著低于对照组的(14.09±0.17)、(7.21±0.30)、(68.34±2.17)、(49.88±0.56)分,差异均有统计学意义(均P<0.05).观察组对于饮酒"十分想"心理渴求率为3.33%,低于对照组的35.00%,差异有统计学意义(P<0.05).结论 经皮穴位电刺激联合地西泮口服治疗创伤后酒精戒断综合征患者,可显著减轻患者躯体戒断期的心理渴求,有效改善患者停止饮酒后发生的严重戒断反应,值得临床推广应用.

  6. Development of Delirium in the Intensive Care Unit in Patients after Endovascular Aortic Repair: A Retrospective Evaluation of the Prevalence and Risk Factors

    Directory of Open Access Journals (Sweden)

    Yohei Kawatani

    2015-01-01

    Full Text Available Delirium is an acute form of nervous system dysfunction often observed in patients in the intensive care unit. Endovascular aortic repair (EVAR is considered a minimally invasive surgical treatment for abdominal aortic aneurysm. Although the operation method is widely used, there are few investigations of the rate and risk factors of delirium development after the operation. In this study, we retrospectively examined the rate of delirium development in the intensive care unit (ICU after EVAR, as well as the associated preoperative risk factors and effects on the lengths of ICU and hospital stays. We examined the 81 consecutive patients who underwent elective EVAR between November 2013 and August 2014. The Intensive Care Delirium Screening Checklist was used to diagnose delirium. Twenty patients (24.7% were diagnosed with delirium in this study. The ICU and hospital length of stays of patients with delirium were 3.3 ± 2.4 days and 14.5 ± 11.9 days, respectively, the latter of which was significantly longer than that of patients without delirium (p= 0.019. Additionally, renal dysfunction, preoperative benzodiazepine use, and intraoperative transfusion were found to be risk factors for the development of delirium after elective EVAR.

  7. Membrane Tolerance to Ethanol is Rapidly Lost after Withdrawal: A Model for Studies of Membrane Adaptation

    Science.gov (United States)

    Taraschi, Theodore F.; Ellingson, John S.; Wu, Alice; Zimmerman, Robert; Rubin, Emanuel

    1986-06-01

    The structural properties of liver microsomes and erythrocytes obtained from rats that had been chronically administered ethanol were examined by electron spin resonance (ESR) following ethanol withdrawal for 1-10 days. Membranes obtained from control animals exhibited considerable molecular disordering upon the addition of ethanol in vitro (50-100 mM). Conversely, microsomal and erythrocyte membranes from alcoholic animals were resistant to this disordering by ethanol (membrane tolerance). These membrane properties were also apparent in lipid bilayers comprised of either total lipids or phospholipids isolated from the control and alcoholic animals. While several weeks of ethanol administration were required for both erythrocytes and microsomes to develop membrane tolerance, erythrocytes from alcoholic animals were disordered by ethanol in vitro after the animals had been withdrawn from ethanol for only 1 day. The same rapid loss of tolerance was observed in microsomes after 2 days of withdrawal. The same time course for the loss of tolerance was observed in lipid bilayers prepared from the total lipid and phospholipid extracts. No significant differences in the cholesterol/phospholipid ratio were observed between the microsomal or erythrocyte membranes isolated before and after withdrawal. Thus, alterations in the microsomal and erythrocyte phospholipids, and not cholesterol content, were responsible for conveying membrane tolerance. Membrane structural properties can be rapidly adjusted in a mammalian system in response to the withdrawal of the external membrane perturbant ethanol. The withdrawal model, which begins with established membrane tolerance and leads to rapid and complete loss of tolerance, provides a model to analyze the compositional changes responsible for this tolerance to disordering by ethanol.

  8. Czynniki ryzyka majaczenia alkoholowego u osób leczonych stacjonarnie w Polsce z powodu uzależnienia od alkoholu

    Directory of Open Access Journals (Sweden)

    Aneta Michalska

    2016-06-01

    Conclusions: Previous episodes of alcohol withdrawal syndrome are the risk factors of delirium tremens attributable to the severity of alcohol dependence. In our opinion, the other risk factors, such as loss of consciousness, suicide attempts in the past and harmful use of other psychoactive substances, are nonspecific to alcohol dependence.

  9. Test-Retest Reliability of a Serious Game for Delirium Screening in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Tiffany Tong

    2016-11-01

    Full Text Available Introduction: Cognitive screening in settings such as emergency departments (ED is frequently carried out using paper-and-pencil tests that require administration by trained staff. These assessments often compete with other clinical duties and thus may not be routinely administered in these busy settings. Literature has shown that the presence of cognitive impairments such as dementia and delirium are often missed in older ED patients. Failure to recognize delirium can have devastating consequences including increased mortality (Kakuma et al., 2003. Given the demands on emergency staff, an automated cognitive test to screen for delirium onset could be a valuable tool to support delirium prevention and management.In earlier research we examined the concurrent validity of a serious game, and carried out an initial assessment of its potential as a delirium screening tool (Tong et al., 2016. In this paper, we examine the test-retest reliability of the game, as it is an important criterion in a cognitive test for detecting risk of delirium onset.Objective: To demonstrate the test-retest reliability of the screening tool over time in a clinical sample of older emergency patients. A secondary objective is to assess whether there are practice effects that might make game performance unstable over repeated presentations.Materials and methods: Adults over the age of 70 were recruited from a hospital ED. Each patient played our serious game in an initial session soon after they arrived in the ED, and in follow up sessions conducted at eight-hour intervals (for each participant there were up to five follow up sessions, depending on how long the person stayed in the ED.Results: A total of 114 adults (61 females, 53 males between the ages of 70 and 104 years (M=81 years, SD=7 participated in our study after screening out delirious patients. We observed a test-retest reliability of the serious game (as assessed by correlation r-values between 0.5 and 0

  10. 27 CFR 19.534 - Withdrawals of spirits for use in production of nonbeverage wine and nonbeverage wine products.

    Science.gov (United States)

    2010-04-01

    ... use in production of nonbeverage wine and nonbeverage wine products. 19.534 Section 19.534 Alcohol... Withdrawals of spirits for use in production of nonbeverage wine and nonbeverage wine products. Spirits... bonded wine cellar for use in the production of nonbeverage wine and nonbeverage wine products. (Sec....

  11. [Treatment processes of pre-alcoholism and alcohol dependence targeted towards drinking reduction].

    Science.gov (United States)

    Yoshimura, Atsushi; Maesato, Hitoshi; Hisatomi, Nobuko; Higuchi, Susumu

    2013-02-01

    Since the 1990s, we have suggested the concept of pre-alcoholism which encompasses patients who have drunk a great deal of alcohol leading to alcohol related problems such as health issues, domestic violence, drunken driving and black-outs. Pre-alcoholism excludes alcohol-dependent patients who have experienced continuous drinking or withdrawal symptoms. We have treated many outpatients with pre-alcoholism for several years. Our regimen demands that the patients must be abstinent for half a year at the beginning of their treatment. After half a year they can choose whether they will continue to be abstinent or they will resume drinking with the aim of reducing their total alcohol consumption. The study clarified the character of pre-alcoholism by investigation of the patients' background and re-diagnosis of the patients based on the International Classification of Diseases, 10th Revision (ICD-10). A remarkable ratio of pre-alcoholic patients was diagnosed with alcohol dependence under ICD-10. We classified pre-alcoholic patients into two groups, one diagnosed as having ICD-10-classed alcohol dependence and the other which did not fulfill the ICD-10 diagnostic criteria of alcohol dependence, and examined the therapeutic processes of the two groups. It was shown that most pre-alcoholic patients could finally take required courses of treatment by themselves without regard to diagnosis under ICD-10, even if they chose any treatment and made alcohol related mistakes on the way. Our findings suggested that pre-alcoholic patients, a portion of whom may have exhibited mild alcohol dependence, could select drinking reduction as a primary goal of treatment after a certain period of abstinence.

  12. Alcohol Abuse

    Science.gov (United States)

    ... even small amounts of alcohol may hurt an unborn child)Drink alcohol while you are looking after ... shakes, being very suspicious), and can even include death. This is why you need your doctor’s care ...

  13. Behavioral measures of anxiety during opiate withdrawal.

    Science.gov (United States)

    Grasing, K; Wang, A; Schlussman, S

    1996-10-01

    Heightened anxiety is a major component of the withdrawal syndromes associated with ethanol and sedative hypnotic medications. Because of similarities between the opiate and sedative-hypnotic withdrawal syndromes as well as data implicating heightened noradrenergic tone with opiate withdrawal, we investigated changes in anxiety measures identified by plus-maze and social interaction testing during opiate withdrawal. Because Sprague Dawley rats had very low levels of entry into plus-maze open arms, further studies were conducted using the Long-Evans strain. Long-Evans rats received continuous infusions of morphine sulfate at 44 mg/kg per day delivered by osmotic pump over 7 days while control animals received inert implants. During the first 3 days of withdrawal, the number and time of entries into open and closed arms of a plus-maze was recorded. Both social and aggressive behaviors were scored durings pairings of groups of two socially naive animals. Body weight was significantly reduced in morphine-treated animals prior to and during withdrawal. Both the number of entries into open plus-maze arms and the time spent in open areas increased over the 3 days of testing. However, no difference in plus-maze activity was detected between morphine-treated and control subjects. On the third day of withdrawal, social interaction time was greater in pairs of withdrawn and control subjects compared to pairs of two control subjects. In conclusion, behavioral measures of anxiety are not increased during opiate withdrawal.

  14. 42 CFR 457.170 - Withdrawal process.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Withdrawal process. 457.170 Section 457.170 Public... Plans for Child Health Insurance Programs and Outreach Strategies § 457.170 Withdrawal process. (a... amendment, or any portion of a proposed State plan or plan amendment, at any time during the review...

  15. Alcohol Test

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    The recent alcohol tax increase poses a challenge to China’s white spirits makers Alcohol, rather than wine, is an in-dispensable component to Chinese table culture. The financial crisis has failed to affect white spirits sales, but an alcohol tax increase might.

  16. Alcohol Poisoning

    Science.gov (United States)

    ... t be awakened is at risk of dying. Alcohol poisoning is an emergency If you suspect that someone has alcohol poisoning — even if you don't see the ... immediately. Never assume the person will sleep off alcohol poisoning. Be prepared to provide information. If you ...

  17. Delirium followed by neuroleptic malignant syndrome in rehabilitation setting. Is it anger reaction before discharge?

    Science.gov (United States)

    Al Owesie, Rafat M; Robert, Asirvatham Alwin

    2013-01-01

    Delirium and neuroleptic malignant syndrome (NMS) are two uncommon syndromes that are often unrecognized or misdiagnosed by the primary physicians as functional psychiatric disorders. The infrequency and the heterogeneity of clinical manifestation, progression and outcome with which those diagnoses are encountered (particularly in chronic rehabilitation settings) make them formidable diagnostic challenge. In this report, we present a case in which there was a misdiagnosis of delirium and NMS as functional psychiatric disorders. This report demonstrates the fact that early recognition and intervention in such cases are essential to prevent the grave outcome and potential fatality. The authors believe that there is a key role for the consulting psychiatrist in this area in providing diagnostic clarity and advice regarding management and ongoing staff education.

  18. La lectura al web 2.0. Estudi de cas: els blogs en el 'Reto Delirium'

    Directory of Open Access Journals (Sweden)

    Sandra Sánchez García

    2013-06-01

    Full Text Available Aquest treball presenta els resultats de l'anàlisi d'un estudi de cas: els blogs que participaren en la campanya Reto Delirium, llançada per l'editorial SM al gener de 2011 amb l'objectiu de promoure i difondre el llibre de Lauren Oliver, Delirium. L'anàlisi del blocs participants, com a fenomen de comunicació social i com a eina de promoció lectora, s’ha realitzat seguint una metodologia exploratòria, analítica i quantitativa. La investigació s'ha centrat en un procés de comunicació virtual localitzat en espais concrets (els blogs i en un període temporal limitat, que ens ha permès determinar les capacitats i possibilitats d’aquest recurs de la web social per a la promoció de la lectura.

  19. MRI findings in patients with multiple lacunar infarcts manifesting hyperactive-type delirium

    Energy Technology Data Exchange (ETDEWEB)

    Arahata, Yutaka; Motegi, Yoshimasa; Furuse, Masahiro (Nakatsugawa Municipal General Hospital, Gifu (Japan)); Watanabe, Masaki; Takahashi, Akira

    1994-04-01

    MRI studies were carried out on 69 patients with multiple lacunar infarcts: 32 had hyperactive-type delirium and the other 37 were non-delirious controls. Between the two groups, there were no statistically significant differences in mean age and sex distribution. In the corona radiata and basal ganglia, the number of infarcts did not differ between the two groups. However, the extent of thalamic infarcts and periventricular hyperintensity (PVH), the maximal width of the third ventricle and Evans' ratio among the delirious patients were significantly larger than those in the controls. In conclusion, thalamic lesions and diffuse advanced PVH may have an intimate correlation in the development of hyperactive-type delirium in patients with multiple lacunar infarcts. (author).

  20. Diagnosing delirium in elderly Thai patients: Utilization of the CAM algorithm

    Directory of Open Access Journals (Sweden)

    Lerttrakarnnon Peerasak

    2011-07-01

    Full Text Available Abstract Background Delirium is a common illness among elderly hospitalized patients. However, under-recognition of the condition by non-psychiatrically trained personnel is prevalent. This study investigated the performance of family physicians when detecting delirum in elderly hospitalized Thai patients using the Thai version of the Confusion Assessment Method (CAM algorithm. Methods A Thai version of the CAM algorithm was developed, and three experienced Thai family physicians were trained in its use. The diagnosis of delirium was also carried out by four fully qualified psychiatrists using DSM-IV TR criteria, which can be considered the gold standard. Sixty-six elderly patients were assessed with MMSE Thai 2002, in order to evaluate whether they had dementia upon admission. Within three days of admission, each patient was interviewed separately by a psychiatrist using DSM-IV TR, and a family physician using the Thai version of the CAM algorithm, with both sets of interviewers diagnosing for delirium. Results The CAM algorithm tool, as used by family physicians, demonstrated a sensitivity of 91.9% and a specificity of 100.0%, with a PPV of 100.0% and an NPV of 90.6%. Interrater agreement between the family physicians and the psychiatrists was good (Cohen's Kappa = 0.91, p Conclusions Family physicians performed well when diagnosing delirium in elderly hospitalized Thai patients using the Thai version of the CAM algorithm, showing that this measurement tool is suitable for use by non-psychiatrically trained personnel, being short, quick, and easy to administer. However, proper training on use of the algorithm is required.

  1. Pain, Delirium and Physical Function in Skilled Nursing Home Patients with Dementia

    Science.gov (United States)

    Kolanowski, Ann; Mogle, Jacqueline; Fick, Donna M.; Hill, Nikki; Mulhall, Paula; Nadler, Jamie; Colancecco, Elise; Behrens, Liza

    2014-01-01

    Objective Skilled Nursing Facilities (SNFs) are major sites of post-acute care for patients with dementia. A recent Office of the Inspector General report indicated that outcomes in SNFs are sub-optimal due to poor-quality treatment, including the failure to provide needed care. Pain is frequently un-recognized and un-treated in patients with dementia. The aim of this exploratory study was to examine the effect daily pain has on delirium and physical function in patients with dementia in SNFs. The association of daily pain with discharge disposition was also examined. Design Secondary analysis of data from an on-going randomized clinical trial. Setting Eight SNFs located in central and northeast Pennsylvania. Participants One hundred and three SNF patients with adjudicated dementia and delirium diagnoses and a mean age of 86 (±6.8) years; most were female (66%) and Caucasian (98%). Measurements Measures of pain (Pain Assessment in Advanced Dementia), delirium (Confusion Assessment Method), and physical function (Barthel Index) were taken daily for 30 days or until discharge. Results On days when participants experienced greater than their average level of pain they also experienced more delirium symptoms (p < .001) and lower physical function (p < .001). Participants with higher levels of average daily pain were more likely to die (OR = 6.306, 95% CI: 1.914–20.771, p = .003) or be placed in a nursing home (OR= 4.77, 95% CI:1.7–13.2, p=.003) compared to returning to the community at 3-month follow-up. Conclusion Greater attention to pain in patients with dementia may be a potential solution to some of the quality problems and high costs of care in SNFs PMID:25239018

  2. 老年患者术后谵妄%Postoperative delirium in geriatric patients

    Institute of Scientific and Technical Information of China (English)

    刘金虎; 岳云

    2009-01-01

    谵妄是与意识障碍相联的广泛认知障碍,意识障碍是谵妄的基本特征.谵妄患者的临床表现有注意、记忆、定向、知觉障碍等.老年人术后发生谵妄的情况并不少见.术后谵妄是老年患者术后一种严重的并发症,如果认识不清且不能采取有效措施加以解决会延误诊治,严重者可导至患者死亡.有多种因素可能与其发生有关,包括年龄,术前合并症,药物,术中管理等.针对相关因素的综合预防措施是老年患者术后谵妄的最重要防治策略,其目的是镇静、控制精神状态、改善睡眠.%Delirium is a kind of severe postoperative complication occurred in geriatric patients. It may delay diagnosis and treatment and even lead to the death of patients if it is not recognized and solved in time by effective measures. Conscious disorder is the basic characteristic of delirium. Several factors, such as age, general health status, drug effects,intra-operative management, may be related to the occurrence of delirium. The most important preventive strategy on delirium is to take comprehensive measures according to various correlative factors. Its main purpose is to provide sedation, control spirit state and improve sleep.

  3. Assessment of role of perioperative melatonin in prevention and treatment of postoperative delirium after hip arthroplasty under spinal anesthesia in the elderly

    Directory of Open Access Journals (Sweden)

    Sultan Sherif

    2010-01-01

    Full Text Available Context: Little is known about the relationship between sedative drugs used preoperatively and postoperative delirium. Melatonin is a drug used to sedate patients preoperatively and is hypothesized by recent works to have a curative effect on postoperative delirium. Aims: The incidence of postoperative delirium will be tested if affected by three different sedative drugs including melatonin. Settings and Design: Controlled randomized double-blind study. Patients and Methods: Three-hundred patients aged>65 years scheduled for hip arthroplasty under spinal anesthesia were randomly distributed to one of the four groups. Group 1 (control received nothing for sedation. Group 2 (melatonin received 5 mg melatonin. Group 3 (midazolam received 7.5 mg midazolam. Group 4 (clonidine received 100 μg clonidine. These medications were given orally at sleep time at night of operation and another dose 90 min before operative time. Patients who developed postoperative delirium received 5 mg of melatonin 9 pm for three successive days in a trial to treat delirium. Statistical Analysis Used: Statistical analysis was done using the SPSS Software (version 13. Results: Total of 222 patients completed the study. Percentage of postoperative delirium in the control group was 32.65% (16/49 patients. The melatonin group showed a statistically significant decrease in the percentage of postoperative delirium to 9.43% (5/53 patients. Melatonin was successful in treating 58.06% of patients suffered postoperative delirium (36/62 patients with no difference between different groups. Conclusions: Postoperative delirium is affected with the drug used for preoperative sedation. Melatonin was successful in decreasing postoperative delirium when used preoperatively and in treating more than half of patients developed postoperative delirium when used for three postoperative nights.

  4. The current situation of treatment systems for alcoholism in Korea.

    Science.gov (United States)

    Kim, Jee Wook; Lee, Boung Chul; Kang, Tae-Cheon; Choi, Ihn-Geun

    2013-02-01

    Alcoholism is becoming one of the most serious issues in Korea. The purpose of this review article was to understand the present status of the treatment system for alcoholism in Korea compared to the United States and to suggest its developmental direction in Korea. Current modalities of alcoholism treatment in Korea including withdrawal treatment, pharmacotherapy, and psychosocial treatment are available according to Korean evidence-based treatment guidelines. Benzodiazepines and supportive care including vitamin and nutritional support are mainly used to treat alcohol withdrawal in Korea. Naltrexone and acamprosate are the drugs of first choice to treat chronic alcoholism. Psychosocial treatment methods such as individual psychotherapy, group psychotherapy, family therapy, cognitive behavior therapy, cue exposure therapy, 12-step facilitation therapy, self-help group therapy, and community-based treatment have been carried out to treat chronic alcoholism in Korea. However, current alcohol treatment system in Korea is not integrative compared to that in the United States. To establish the treatment system, it is important to set up an independent governmental administration on alcohol abuse, to secure experts on alcoholism, and to conduct outpatient alcoholism treatment programs and facilities in an open system including some form of continuing care.

  5. Alcoholic cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    Gonzalo; Guzzo-Merello; Marta; Cobo-Marcos; Maria; Gallego-Delgado; Pablo; Garcia-Pavia

    2014-01-01

    Alcohol is the most frequently consumed toxic substance in the world. Low to moderate daily intake of alcohol has been shown to have beneficial effects on the cardiovascular system. In contrast, exposure to high levels of alcohol for a long period could lead to progressive cardiac dysfunction and heart failure. Cardiac dysfunction associated with chronic and excessive alcohol intake is a specific cardiac disease known as alcoholic cardiomyopathy(ACM). In spite of its clinical importance, data on ACM and how alcohol damages the heart are limited. In this review, we evaluate available evidence linking excessive alcohol consumption with heart failure and dilated cardiomyopathy. Additionally, we discuss the clinical presentation, prognosis and treatment of ACM.

  6. Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists.

    Directory of Open Access Journals (Sweden)

    Alawi Luetz

    Full Text Available Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1 and 868 patients (part 2 were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%. In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524 and approved by the ethical committee.

  7. Postoperative delirium and myocardial infarction in elderly patients with hip fractures: the role of postoperative anemia

    Directory of Open Access Journals (Sweden)

    V. V. Kuz’Min

    2015-01-01

    Full Text Available Objective. To assess the impact of anemia on the incidence of myocardial infarction and delirium in the early postoperative period in patients with hip fractures who underwent total hip replacement. Materials and methods. A retrospective study of 303 patients with hip fractures who underwent total hip replacement was performed. Patients were divided into two groups according to the level of hemoglobin (Hb on the 2nd postoperative day: Group 1 (n = 116 with Hb levels above 100 g/L and Group 2 (n = 187 with Hb levels below 100 g/L. Results and conclusion. Transfusion in Group 1 was performed more often intraoperatively or in the early postoperative hours (67 vs. 35 patients; p <0.001. Hb levels on the 2nd day were significantly higher in Group 1 (108 [104; 117] vs. 87 [80; 92] g/L; p <0.001. Moderate and severe anemia in the early postoperative period was noted in 53.5% and 4.3% of the patients of Group 2, respectively. The incidence of myocardial infarction and delirium was higher in Group 2 than in Group 1 (6.4% vs. 0%; p = 0,013 and 7.5% vs 0.8%; p = 0.021, respectively. The study has shown that moderate and severe anemia in the early postoperative period is associated with an increase in the incidence of myocardial infarction and delirium.

  8. Reflexivity and exploring the meaning of delirium through media depictions: Methodological insights from a phenomenological study.

    Science.gov (United States)

    Day, Jenny; Higgins, Isabel

    2016-03-01

    In the course of a phenomenological study that explored the experiences of family members during their older loved one's delirium, a range of delirium experiences depicted in artistic, creative, and linguistic media were reviewed. The search for, and compilation of, media sources for reflection during data analysis is described in this paper. In doing so, the researcher reveals how attentiveness and openness to varied depictions of lived experiences, as well as a valuing attitude toward challenging subjective perspectives, can enhance researcher reflexivity and appreciation of interpretive meanings. Turning to media depictions of delirium offered alternative perspectives on the experience. It challenged the researcher's assumptions, enhanced phenomenological reflection, promoted critique of evolving interpretations, and suggested meanings that might not have otherwise been realized. The approach used is a potent, although often overlooked, way to differentiate the nature of phenomena shared through lived experience data. Media-based methods and their use in phenomenology continue to be explored. Illustrations of how to integrate media sources, as well as discussion about the benefits and alternatives to more common uses, are needed.

  9. Factors associated with sudden death of individuals requiring restraint for excited delirium.

    Science.gov (United States)

    Stratton, S J; Rogers, C; Brickett, K; Gruzinski, G

    2001-05-01

    The purpose of this article is to identify and rank factors associated with sudden death of individuals requiring restraint for excited delirium. Eighteen cases of such deaths witnessed by emergency medical service (EMS) personnel are reported. The 18 cases reported were restrained with the wrists and ankles bound and attached behind the back. This restraint technique was also used for all 196 surviving excited delirium victims encountered during the study period. Unique to these data is a description of the initial cardiopulmonary arrest rhythm in 72% of the sudden death cases. Associated with all sudden death cases was struggle by the victim with forced restraint and cessation of struggling with labored or agonal breathing immediately before cardiopulmonary arrest. Also associated was stimulant drug use (78%), chronic disease (56%), and obesity (56%). The primary cardiac arrest rhythm of ventricular tachycardia was found in 1 of 13 victims with confirmed initial cardiac rhythms, with none found in ventricular fibrillation. Our findings indicate that unexpected sudden death when excited delirium victims are restrained in the out-of-hospital setting is not infrequent and can be associated with multiple predictable but usually uncontrollable factors.

  10. 急性卒中后谵妄%Delirium after acute stroke

    Institute of Scientific and Technical Information of China (English)

    邹会达; 潘速跃

    2014-01-01

    Delirium is a common complication after acute stroke.It usually indicates the poor outcome,higher mortality,longer hospital stay and increased dementia risk of patients.Therefore,the early detection and intervention of delirium after acute stroke have an important significance.This article reviews the pathogenesis,risk factors,diagnosis,assessment,treatment and outcome of delirium after stroke.%谵妄是急性卒中的一种常见并发症,通常提示患者转归不良、病死率较高、住院时间较长以及痴呆风险增高.因此,急性卒中后谵妄的早期发现和干预具有重要意义.文章从卒中后谵妄的发病机制、危险因素、诊断评估、治疗和转归等方面进行了综述.

  11. [Acute gamma-butyrolactone poisoning with withdrawal syndrome].

    Science.gov (United States)

    Chwaluk, Paweł; Rejmak, Grazyna

    2011-01-01

    Gamma-butyrolactone (GBL) is a solvent that are part of many consumer products and in most countries can be legally purchased in the form of almost pure substance. After ingestion GBL is rapidly converted to gamma-hydroxybutyric acid (GHB). In recent years, GBL became a legal alternative to GHB, which is used widely since 1990s as a club drug and date rape drug. It is believed that abuse of GBL is not frequent in Europe, except for certain specific groups, mainly in urban centers in the west of the continent. We present a case of acute GBL poisoning with the withdrawal syndrome in 23-year-old man living in a rural area in eastern Poland. The patient was admitted to the Intensive Care Unit (ICU) because of coma of unknown origin. On admission erosions of the lips and mouth was seen. Ethyl alcohol was not present in blood sample, urine screening tests for drugs were negative. During his stay in the ICU patient required ventilatory support, was periodically agitated with muscular jerks and opisthotonos. The later medical history revealed that the patient from two years used GBL, which purchased as wheels cleaner. The tolerance developed, and the interruption of use of substance triggered symptoms of withdrawal. GBL abuse occurs in different social groups and is at risk for acute toxicity and the development of physical dependence.

  12. Alcohol and pregnancy

    Science.gov (United States)

    Drinking alcohol during pregnancy; Fetal alcohol syndrome - pregnancy; FAS - fetal alcohol syndrome ... When a pregnant woman drinks alcohol, the alcohol travels through her blood and into the baby's blood, tissues, and organs. Alcohol breaks down much more slowly in ...

  13. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care : a review

    NARCIS (Netherlands)

    de Lange, E.; Verhaak, P. F. M.; van der Meer, K.

    2013-01-01

    Objective The aim of this study is to provide an overview of prevalence, symptoms, risk factors and prognosis of delirium in primary care and institutionalized long-term care. Design The method used in this study is a systematic PubMed search and literature review. Results The prevalence of delirium

  14. Can an e-learning course improve nursing care for older people at risk of delirium: a stepped wedge cluster randomised trial.

    NARCIS (Netherlands)

    Steeg, L. van de; IJkema, R.; Langelaan, M.; Wagner, C.

    2014-01-01

    Background: Delirium occurs frequently in older hospitalised patients and is associated with several adverse outcomes. Ignorance among healthcare professionals and a failure to recognise patients suffering from delirium have been identified as the possible causes of poor care. The objective of the s

  15. The incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery

    Directory of Open Access Journals (Sweden)

    Wei WANG

    2011-06-01

    Full Text Available Objective To identify the incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery.Methods One hundred and twenty-five elderly patients who were admitted to the surgical intensive care unit(SICU after non-cardiac surgery were involved in the present study.Baseline and the perioperative variables of patients were collected.Postoperative delirium was diagnosed using the Confusion Assessment Method for Intensive Care Unit(CAM-ICU.Delirium assessment was performed once daily during the first five days after surgery.Results Postoperative evaluations of delirium were completed in 124 patients.Postoperative delirium occurred in 42 patients(33.87%,among them delirium occurred within the first 2 postoperative days in 92.86%(39/42(4.76% in the operative day,50.00% in the first postoperative day,and 38.10% in the second postoperative day,respectively.When compared with the non-delirious patients,the delirious patients had longer duration of ICU stay [39.75(21.00-65.63h vs 19.63(17.77-22.31h,P=0.000],higher incidence of postoperative complications [(38.1%(16/42 vs 13.4%(11/82,P=0.000],and higher mortality [11.9%(5/42 vs 1.2%(1/82,P=0.000].Multivariate logistic regression analysis demonstrated that the following risk factors predicted the occurrence of postoperative delirium: preoperative history of cerebral accident(OR=3.051,95%CI 1.032-8.370,high APACHE Ⅱ score at admission to the SICU(OR=1.664,95%CI 1.268-2.184,and high pain score at 24 hours after operation(OR=1.043,95%CI 1.021-1.086.Conclusions Delirium is a common complication after surgery.The prognosis is significantly worse in the delirious patients than in the non-delirious patients.Risk factors of postoperative delirium include history of preoperative cerebral accident,high APACHE Ⅱ score at admission to the SICU,and high pain score at 24 hours after operation.

  16. Impact of a multifaceted program to prevent postoperative delirium in the elderly: the CONFUCIUS stepped wedge protocol

    Directory of Open Access Journals (Sweden)

    Bonnefoy Marc

    2011-05-01

    Full Text Available Abstract Background Postoperative delirium is common in the elderly and is associated with a significant increase in mortality, complications, length of hospital stay and admission in long care facility. Although several interventions have proved their effectiveness to prevent it, the Cochrane advises an assessment of multifaceted intervention using rigorous methodology based on randomized study design. Our purpose is to present the methodology and expected results of the CONFUCIUS trial, which aims to measure the impact of a multifaceted program on the prevention of postoperative delirium in elderly. Method/Design Study design is a stepped wedge cluster randomized trial within 3 surgical wards of three French university hospitals. All patients aged 75 and older, and admitted for scheduled surgery will be included. The multifaceted program will be conducted by mobile geriatric team, including geriatric preoperative consultation, training of the surgical staff and implementation of the Hospital Elder Life Program, and morbidity and mortality conference related to delirium cases. The primary outcome is based on postoperative delirium rate within 7 days after surgery. This program is planned to be implemented along four successive time periods within all the surgical wards. Each one will be affected successively to the control arm and to the intervention arm of the trial and the order of program introduction within each surgical ward will be randomly assigned. Based on a 20% reduction of postoperative delirium rate (ICC = 0.25, α = 0.05, β = 0.1, three hundred sixty patients will be included i.e. thirty patients per service and per time period. Endpoints comparison between intervention and control arms of the trial will be performed by considering the cluster and time effects. Discussion Better prevention of delirium is expected from the multifaceted program, including a decrease of postoperative delirium, and its consequences (mortality

  17. How nurses understand and care for older people with delirium in the acute hospital: a Critical Discourse Analysis.

    Science.gov (United States)

    Schofield, Irene; Tolson, Debbie; Fleming, Valerie

    2012-06-01

    Delirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease-based classification systems and clinical guidelines. There is little systematic study of nurses' day-to-day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses' care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses' language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person-centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion.

  18. Delirium, in 405 articles of medical (non-surgical or ICU) inpatients: unproven speed of onset and recovery

    Science.gov (United States)

    Regal, Paul Jay

    2017-01-01

    Purpose There is agreement in the medical literature that delirium is of sudden or rapid onset. Although the speed of recovery cannot be used for initial diagnosis, recovery speed provides a test of diagnostic criteria. The aim of this study was to determine whether articles on delirium among medical inpatients proved sudden onset and rapid recovery. Methods The literature was searched for studies with at least 50 patients on medical or geriatric wards. Excluded were postoperative, critical care, and nursing home studies. Speed of onset was extracted as either the interval between symptom onset and diagnosis or between hospital admission and diagnosis of incident delirium. Mean or median days to recovery from delirium and the scale used to measure recovery were identified. Results Four-hundred and five articles were analyzed with 789,709 patients. The median article had 220 patients. Onset could only be extracted in 11 articles (2.7%): mean onset was 3.09±2.38 days. Median onset was 3.0 days, which conforms to Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Only 56 of 405 articles (13.8%) reported timing of recovery but mean or median recovery was available in 25 of 405 (6.2%): 6.56±4.80 days. Conclusion Medical delirium articles have failed to establish rapid onset and rapid recovery. PMID:28243074

  19. Validation and psychometric properties of the Delirium Motor Subtype Scale in elderly hip fracture patients (Dutch version).

    Science.gov (United States)

    Slor, Chantal J; Adamis, Dimitrios; Jansen, René W M M; Meagher, David J; Witlox, Joost; Houdijk, Alexander P J; de Jonghe, Jos F M

    2014-01-01

    The Delirium Motor Subtype Scale (DMSS) was developed to capture all the previous different approaches to delirium motor subtyping into one new instrument and emphasize disturbances of motor activity rather than associated psychomotoric symptoms. We investigated reliability and validity of the DMSS Dutch version. Elderly patients who had undergone hip fracture surgery received the DMSS and the Delirium Rating Scale Revised-98 (DRS-R-98). A diagnosis of delirium was defined according to the Confusion Assessment Method (CAM). Among 146 patients, 46 (32%) patients were diagnosed with delirium (mean age 86.3 years; SD 5.2). The internal consistency of the DMSS was acceptable (Cronbach's alpha=0.72). If an item was removed at random the internal consistency of the scale remained the same. Similarly the concurrent validity of DMSS was good (Cohen's kappa=0.73) while for each motor subtype the Cohen's kappa ranged from 0.58 to 0.85. The sensitivity and specificity of DMSS to detect each subtype ranged from 0.56 to 1 and from 0.88 to 0.98, respectively. This study suggests that the Dutch version of the DMSS is a reliable and valid instrument. The DMSS has scientific validity that could allow for greater precision in further research on motor subtypes.

  20. Progress of delirium in biomarkers%谵妄相关生物标志物研究进展

    Institute of Scientific and Technical Information of China (English)

    喇宏玲

    2015-01-01

    Delirium is an acute neural syndrome.The study on biomarkers for delirium can help us to explore the pathophysiologic mechanism,predict the occurrence of delirium,make a prompt diagnosis,and evaluate the severity and prognosis of delirium.This paper summarizes 6 aspects as genes,neurotransmitters,inflammatory factors,hormone,serum chemistry and end products of delirium.%谵妄是一种急性神经功能障碍综合征.对谵妄生物标志物进行研究,有助于探讨谵妄病理生理机制,预测其发生,及时明确诊断,评估严重程度和预后.本文从基因、神经递质、炎症因子、激素、生化因子、谵妄产物6个方面对谵妄的生物标志物研究进展作一综述.

  1. 2017-2022 Proposed Program - Withdrawal Areas

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This file represents the areas of the Outer Continental Shelf that have been withdrawn from disposition by leasing. The withdrawal of these areas prevents...

  2. Clonidina como droga adjuvante no tratamento da síndrome de abstinência alcoólica em unidade de terapia intensiva: relato de caso Clonidina como droga coadyuvante en el tratamiento de la síndrome de abstinencia alcohólica en unidad de terapia intensiva: relato de un caso Clonidine as adjuvant therapy for alcohol withdrawal syndrome in intensive care unit: case report

    Directory of Open Access Journals (Sweden)

    Leandro Gobbo Braz

    2003-12-01

    alta de la UTI. CONCLUSIONES: La droga escogida para el tratamiento del síndrome de abstinencia alcohólico es el benzodiazepínico. No obstante, en el presente relato, solamente el uso coadyuvante de clonidina consiguió proporcionar tratamiento adecuado al paciente.BACKGROUND AND OBJECTIVES: Sedation of patients with past history of alcohol and drug abuse in Intensive Care Units (ICU is a challenge due to the high incidence of sedative drugs tolerance and withdrawal syndromes. This report aimed at describing a case of a young patient admitted to the ICU who developed alcohol withdrawal syndrome and tolerance to sedatives, resolved only after clonidine administration. CASE REPORT: Male patient, 18 years old, alcohol, tobacco, cocaine and marijuana abuser, victim of firearm accident, who was admitted to the ICU in the first post-enterectomy day, after gastric content aspiration during tracheal re-intubation. Clinical evolution was: vasoactive drugs up to the 4th day; bilateral bronchopneumonia with pleural effusion and need for artificial ventilation up to the 15th day. Initial sedation scheme was the association of midazolam and fentanyl. As from the 4th day, patient presented with several psychomotor agitation episodes, even after the association of lorazepam in the 6th day. In the 9th day, patient received the largest doses but remained agitated. Dexmedetomidine was associated, which has decreased other drug doses in 35% and has improved agitation. In the 12th day, midazolam and dexmedetomidine were replaced by propofol infusion with worsening of agitation. In the 13th day, clonidine was associated to the sedation scheme with total resolution of agitation. Propofol was withdrawn in the 14th day, fentanyl was maintained and midazolam infusion was restarted, with doses 75% and 65% lower as compared to peak doses of such drugs. Patient was extubated in the 15th day and was discharged from ICU. CONCLUSIONS: Benzodiazepines should remain the drugs of choice for the

  3. Severe Relapsing Clozapine-Withdrawal Catatonia

    Directory of Open Access Journals (Sweden)

    Tarek Shahrour

    2015-01-01

    Full Text Available Catatonia as a clozapine-withdrawal syndrome has only been documented in the medical literature as case reports. We are reporting a case in which a 32-year-old man develops a catatonic state upon withdrawal of clozapine. The state was quite severe and needed ICU admission. The course was chronic and intermittent which we think was caused by the poor adherence to antipsychotics. The importance of identifying such cases early is underlined.

  4. Severe Relapsing Clozapine-Withdrawal Catatonia

    Science.gov (United States)

    Shahrour, Tarek; Siddiq, Muez; Ghalib, Saad

    2015-01-01

    Catatonia as a clozapine-withdrawal syndrome has only been documented in the medical literature as case reports. We are reporting a case in which a 32-year-old man develops a catatonic state upon withdrawal of clozapine. The state was quite severe and needed ICU admission. The course was chronic and intermittent which we think was caused by the poor adherence to antipsychotics. The importance of identifying such cases early is underlined. PMID:26788394

  5. 19 CFR 144.27 - Withdrawal from warehouse by transferee.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Withdrawal from warehouse by transferee. 144.27...; DEPARTMENT OF THE TREASURY (CONTINUED) WAREHOUSE AND REWAREHOUSE ENTRIES AND WITHDRAWALS Transfer of Right To Withdraw Merchandise from Warehouse § 144.27 Withdrawal from warehouse by transferee. At any time...

  6. 48 CFR 752.7024 - Withdrawal of students.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Withdrawal of students... Withdrawal of students. For use in contracts for participant training with an educational institution. Withdrawal of Students (APR 1984) (a) The Government may, at its option and at any time, withdraw any...

  7. 21 CFR 514.7 - Withdrawal of applications without prejudice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Withdrawal of applications without prejudice. 514... Withdrawal of applications without prejudice. The sponsor may withdraw his pending application from.... Such withdrawal may be made without prejudice to a future filing. Upon resubmission, the...

  8. Antiepileptic Drug Withdrawal in Dogs with Epilepsy.

    Science.gov (United States)

    Gesell, Felix Kaspar; Hoppe, Sonja; Löscher, Wolfgang; Tipold, Andrea

    2015-01-01

    Epilepsy is one of the most common neurological disorders in dogs and is treated by chronic administration of antiepileptic drugs (AEDs). In human beings with epilepsy, it is common clinical practice to consider drug withdrawal after a patient has been in remission (seizure free) for three or more years, but withdrawal is associated with the risk of relapse. In the present study, the consequences of AED withdrawal were studied in dogs with epilepsy. Therefore, 200 owners of dogs with idiopathic or presumed idiopathic epilepsy were contacted by telephone interview, 138 cases could be enrolled. In 11 cases, the therapy had been stopped after the dogs had become seizure free for a median time of 1 year. Reasons for AED withdrawal were appearance or fear of adverse side effects, financial aspects, and the idea that the medication could be unnecessary. Following AED withdrawal, four of these dogs remained seizure free, seven dogs suffered from seizure recurrence, of which only three dogs could regain seizure freedom after resuming AED therapy. Due to the restricted case number, an exact percentage of dogs with seizure recurrence after AED withdrawal cannot be given. However, the present study gives a hint that similar numbers as in human patients are found, and the data can help owners of epileptic dogs and the responsible clinician to decide when and why to stop antiepileptic medication.

  9. Antiepileptic drug withdrawal in dogs with epilepsy

    Directory of Open Access Journals (Sweden)

    Felix Kaspar Gesell

    2015-08-01

    Full Text Available Epilepsy is one of the most common neurological disorders in dogs and is treated by chronic administration of antiepileptic drugs (AEDs. In humans with epilepsy, it is common clinical practice to consider drug withdrawal after a patient has been in remission (seizure free for three or more years, but withdrawal is associated with the risk of relapse. In the present study, the consequences of AED withdrawal were studied in dogs with epilepsy. Therefore, 200 owners of dogs with idiopathic or presumed idiopathic epilepsy were contacted by telephone interview, 138 cases could be enrolled. In 11 cases the therapy had been stopped after the dogs had become seizure free for a median time of 1 year. Reasons for AED withdrawal were appearance or fear of adverse side effects, financial aspects and the idea that the medication could be unnecessary. Following AED withdrawal, 4 of these dogs remained seizure free, 7 dogs suffered from seizure recurrence, of which only 3 dogs could regain seizure freedom after resuming AED therapy. Due to the restricted case number, an exact percentage of dogs with seizure recurrence after AED withdrawal cannot be given. However, the present study gives a hint that similar numbers as in human patients are found, and the data can help owners of epileptic dogs and the responsible clinician to decide when and why to stop antiepileptic medication.

  10. Withdrawing Benzodiazepines in Patients With Anxiety Disorders.

    Science.gov (United States)

    Lader, Malcolm; Kyriacou, Andri

    2016-01-01

    The large class of CNS-depressant medications-the benzodiazepines-have been extensively used for over 50 years, anxiety disorders being one of the main indications. A substantial proportion (perhaps up to 20-30 %) of long-term users becomes physically dependent on them. Problems with their use became manifest, and dependence, withdrawal difficulties and abuse were documented by the 1980s. Many such users experience physical and psychological withdrawal symptoms on attempted cessation and may develop clinically troublesome syndromes even during slow tapering. Few studies have been conducted to establish the optimal withdrawal schedules. The usual management comprises slow withdrawal over weeks or months together with psychotherapy of various modalities. Pharmacological aids include antidepressants such as the SSRIs especially if depressive symptoms supervene. Other pharmacological agents such as the benzodiazepine antagonist, flumazenil, and the hormonal agent, melatonin, remain largely experimental. The purpose of this review is to analyse the evidence for the efficacy of the usual withdrawal regimes and the newer agents. It is concluded that little evidence exists outside the usual principles of drug withdrawal but there are some promising leads.

  11. Novel risk markers and long-term outcomes of delirium: The Successful Aging after Elective Surgery (SAGES) Study Design and Methods

    Science.gov (United States)

    Schmitt, Eva M.; Marcantonio, Edward R.; SM; Alsop, David C.; Jones, Richard N.; Rogers, Selwyn O.; Fong, Tamara G.; Metzger, Eran; Inouye, Sharon K.

    2012-01-01

    Objectives Delirium--a costly, life-threatening, and potentially preventable condition--is a common complication for older adults following major surgery. While the basic epidemiology of delirium after surgery has been defined, the contribution of delirium to long-term outcomes remains uncertain, and novel biomarkers from plasma and neuroimaging have yet to be examined. This program project was designed to contribute to our understanding of the complex multifactorial syndrome of delirium. Design Long-term prospective cohort study. Setting 3 academic medical centers (2 hospitals and 1 coordinating center). Participants Patients without recognized dementia (targeted cohort = 550 patients) age 70 and older scheduled to undergo elective major surgery are assessed at baseline prior to surgery, daily during their hospital stay, and for 18-36 months after discharge. Measurements The Successful Aging after Elective Surgery (SAGES) study is an innovative, interdisciplinary study that includes biomarkers, neuroimaging, cognitive reserve markers, and serial neuropsychological testing to examine the contribution of delirium to long-term cognitive and functional decline. The primary goal is to examine the contribution of delirium to long-term cognitive and functional decline. In addition, novel risk markers, for delirium are being examined, including plasma biomarkers (e.g., cytokines, proteomics), advanced neuroimaging markers (e.g., volumetric, white matter hyperintensity, noncontrast blood flow, and diffusion tensor measures) and cognitive reserve markers (e.g., education, occupation, lifetime activities). Conclusion Results from this study will contribute to a fuller understanding of the etiology and prognosis of delirium. Ultimately, we hope this project will provide the groundwork for future development of prevention and treatment strategies for delirium, designed to minimize the long-term negative impact of delirium in older adults. PMID:22999782

  12. A heuristic model of alcohol dependence.

    Directory of Open Access Journals (Sweden)

    Zhen Qi

    Full Text Available BACKGROUND: Substance dependence poses a critical health problem. Sadly, its neurobiological mechanisms are still unclear, and this lack of real understanding is reflected in insufficient treatment options. It has been hypothesized that alcohol effects are due to an imbalance between neuroexcitatory and neuroinhibitory amino acids. However, glutamate and GABA interact with other neurotransmitters, which form a complicated network whose functioning evades intuition and should be investigated systemically with methods of biomedical systems analysis. METHODS AND RESULTS: We present a heuristic model of neurotransmitters that combines a neurochemical interaction matrix at the biochemical level with a mobile describing the balances between pairs of neurotransmitters at the physiological and behavioral level. We investigate the effects of alcohol on the integrated neurotransmitter systems at both levels. The model simulation results are consistent with clinical and experimental observations. The model demonstrates that the drug diazepam for symptoms of alcohol withdrawal effectively reduces the imbalances between neurotransmitters. Moreover, the acetylcholine signal is suggested as a novel target for treatment of symptoms associated with alcohol withdrawal. CONCLUSIONS: Efficient means of integrating clinical symptoms across multiple levels are still scarce and difficult to establish. We present a heuristic model of systemic neurotransmitter functionality that permits the assessment of genetic, biochemical, and pharmacological perturbations. The model can serve as a tool to represent clinical and biological observations and explore various scenarios associated with alcohol dependence and its treatments. It also is very well suited for educational purposes.

  13. 老年人谵妄的识别与处理%Identification and treatment of delirium in elderly patients

    Institute of Scientific and Technical Information of China (English)

    王秋梅; 刘晓红

    2012-01-01

    谵妄是老年人中常见的问题,与不良预后有关,对老年人的健康影响较大.通过介绍谵妄的临床相关内容,包括概念、流行病学、诊断,尤其是谵妄的危险、促发因素及其预防和治疗,以引起临床医生的重视.%Delirium is a common disorder in aged people.Although it is in poor prognosis,delirium still has been under-recognized and inappropriately evaluated and treated.The clinical aspects of delirium on epidemiology,diagnosis,risk and precipitating factors,prevention and treatment were introduced in this paper.

  14. Intensive care delirium - effect on memories and health-related quality of life - a follow-up study

    DEFF Research Database (Denmark)

    Svenningsen, Helle; Tønnesen, Else K; Videbech, Poul

    2013-01-01

    delirium, memories and health-related quality needs further investigation. DESIGN: We used an observational multicentre design with telephone interviews. METHODS: Adult intensive care unit patients (n = 360) were consecutively recruited and interviewed using the intensive care unit-Memory Tool one week...... nondelirious patients up to six months postintensive care unit discharge. Delirium, memories and intensive care unit diaries with follow-up did not affect health-related quality of life and healthcare dependency. Memories of delusions might have an impact on patients assessed as nondelirious. CONCLUSIONS: More......AIMS AND OBJECTIVES: To investigate the effects of delirium in the intensive care unit on health-related quality of life, healthcare dependency and memory after discharge and to explore the association between health-related quality of life and memories, patient diaries and intensive care unit...

  15. Refeeding syndrome is uncommon in alcoholics admitted to a hospital detoxification unit.

    Science.gov (United States)

    Manning, S; Gilmour, M; Weatherall, M; Robinson, G M

    2014-05-01

    The refeeding syndrome is increasingly recognised. It is a serious change in electrolytes when nutrition is reintroduced to malnourished patients. Alcohol dependence is a risk factor for the refeeding syndrome. We report a prospective cohort study of 36 alcoholics hospitalised for withdrawal management. We found no evidence of refeeding syndrome in any patient after 3 days of hospitalisation, despite hypomagnesaemia, a risk factor for the refeeding syndrome being prevalent (44% of subjects). Low thiamine levels were infrequent affecting 3/29 (10%). We recommend that in alcoholics admitted for managed withdrawal, risk of refeeding syndrome appears to be low, and routine testing of repeat electrolytes appears unnecessary.

  16. Association of cognitive and noncognitive symptoms of delirium: A study from consultation-liaison psychiatry set-up

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2016-01-01

    Full Text Available Aims: This study aims to evaluate the cognitive functions of patients with delirium using Hindi Mental Status Examination (HMSE, to study the correlation of cognitive functions assessed by HMSE with noncognitive symptoms as assessed using Delirium Rating Scale-Revised 1998 (DRS-R-98 and to study the association of cognitive functions assessed using HMSE and DRS-R98. Methods: A total of 76 consecutive patients fulfilling the diagnosis of delirium were evaluated on DRS-R-98, HMSE, and Short Informant Questionnaire on Cognitive Decline in the Elderly (retrospective IQCODE. Results: The mean DRS-R-98 score 33.9 (standard deviation [SD] - 7.2 and the mean DRS-R-98 severity score was 25.9 (SD - 7.2. The mean score on HMSE was 19.3 (7.98. There were significant correlations of all the domains of HMSE with DRS-R-98 total score, DRS-R-98 severity score, DRS-R-98 cognitive subscale score, DRS-R-98 noncognitive domain subscale score, and DRS severity score without attention score. When the association of each item of DRS-R-98 and HMSE was evaluated, except for the items of delusions, lability of affect and motor retardation, there were significant negative association between all the items of DRS-R-98 and HMSE, indicating that higher severity of cognitive symptoms as assessed on HMSE is associated with higher severity of all the cognitive symptoms and most of the noncognitive symptoms as assessed by DRS-R-98. Conclusion: The present study suggests that attention deficits in patients with delirium influence the severity of cognitive and noncognitive symptoms of delirium. Further, the present study suggests an increase in the severity of cognitive symptoms in other domains is also associated with an increase in the severity of noncognitive symptoms of delirium.

  17. Delirium and high fever are associated with subacute motor deterioration in Parkinson disease: a nested case-control study.

    Directory of Open Access Journals (Sweden)

    Atsushi Umemura

    Full Text Available BACKGROUND: In Parkinson disease (PD, systemic inflammation caused by respiratory infections such as pneumonia frequently occurs, often resulting in delirium in the advanced stages of this disease. Delirium can lead to cognitive and functional decline, institutionalization, and mortality, especially in the elderly. Inflammation causes rapid worsening of PD motor symptoms and signs, sometimes irreversibly in some, but not all, patients. PURPOSE: To identify factors associated with subacute motor deterioration in PD patients with systemic inflammation. METHODS: The association of clinical factors with subacute motor deterioration was analyzed by a case-control study. Subacute motor deterioration was defined as sustained worsening by one or more modified Hoehn and Yahr (H-Y stages. Using multivariable logistic regression incorporating baseline characteristics (age, sex, PD duration, modified H-Y stage, dementia, and psychosis history and statistically selected possible predictors (peak body temperature, duration of leukocytosis, and presence of delirium, the odds ratios for these factors were estimated as relative risks. RESULTS: Of 80 PD patients with systemic inflammation, 26 with associated subacute motor deterioration were designated as cases and the remainder as controls. In the 26 cases, 6 months after its onset the motor deterioration had persisted in 19 patients and resolved in four (three were lost for follow-up. Multivariable logistic regression analysis showed that delirium and body temperature are significantly associated with motor deterioration after systemic inflammation (P = 0.001 for delirium and P = 0.026 for body temperature, the adjusted odds ratios being 15.89 (95% confidence interval [CI]: 3.23-78.14 and 2.78 (95% CI: 1.13-6.83, respectively. CONCLUSIONS: In patients with PD and systemic inflammation, delirium and high body temperature are strong risk factors for subsequent subacute motor deterioration and such deterioration

  18. The validity and reliability of the portuguese versions of three tools used to diagnose delirium in critically ill patients

    Directory of Open Access Journals (Sweden)

    Dimitri Gusmao-Flores

    2011-01-01

    Full Text Available OBJECTIVES: The objectives of this study are to compare the sensitivity and specificity of three diagnostic tools for delirium (the Intensive Care Delirium Screening Checklist, the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet in a mixed population of critically ill patients, and to validate the Brazilian Portuguese Confusion Assessment Method for Intensive Care Units. METHODS: The study was conducted in four intensive care units in Brazil. Patients were screened for delirium by a psychiatrist or neurologist using the Diagnostic and Statistical Manual of Mental Disorders. Patients were subsequently screened by an intensivist using Portuguese translations of the three tools. RESULTS: One hundred and nineteen patients were evaluated and 38.6% were diagnosed with delirium by the reference rater. The Confusion Assessment Method for Intensive Care Units had a sensitivity of 72.5% and a specificity of 96.2%; the Confusion Assessment Method for Intensive Care Units Flowsheet had a sensitivity of 72.5% and a specificity of 96.2%; the Intensive Care Delirium Screening Checklist had a sensitivity of 96.0% and a specificity of 72.4%. There was strong agreement between the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet (kappa coefficient = 0.96 CONCLUSION: All three instruments are effective diagnostic tools in critically ill intensive care unit patients. In addition, the Brazilian Portuguese version of the Confusion Assessment Method for Intensive Care Units is a valid and reliable instrument for the assessment of delirium among critically ill patients.

  19. Hypersensitivity to meta-chlorophenylpiperazine (mCPP) in migraine and drug withdrawal.

    Science.gov (United States)

    Kalkman, H O

    1997-01-01

    Administration of a bolus dose of mCPP, a 5-HT2C receptor agonist, to rats provokes endocrine and behavioural effects that are reminiscent of some of the symptoms of human depression. Rats exposed to chronic mild stress (which is also a key factor in the precipitation of human depression) were hypersensitive to mCPP, whilst chronic treatment with antidepressant serotonin re-uptake inhibitors suppressed the responsiveness to mCPP. Similarities also exist with respect to withdrawal reactions following chronic alcohol or benzodiazepine abuse. In humans, a bolus dose of mCPP can cause alcohol craving (in abstinent alcoholics) and migraine (in susceptible persons), suggesting that there is a 5-HT2C receptor hyperresponsiveness in these conditions also. It is hypothesized that chronic treatment with SSRI's can prevent migraine attacks and drug craving.

  20. The effects of melatonin versus placebo on delirium in hip fracture patients: study protocol of a randomised, placebo-controlled, double blind trial

    Directory of Open Access Journals (Sweden)

    van Velde Romuald

    2011-07-01

    Full Text Available Abstract Background With an ageing population, older persons become a larger part of the hospital population. The incidence of delirium is high in this group, and experiencing delirium has major short- and long-term sequelae, which makes prevention crucial. During delirium, a disruption of the sleep-wake cycle is frequently observed. Melatonin plays an important role in the regulation of the sleep-wake cycle, so this raised the hypothesis that alterations in the metabolism of melatonin might play an important role in the development of delirium. The aim of this article is to describe the design of a randomised, placebo controlled double-blind trial that is currently in progress and that investigates the effects of melatonin versus placebo on delirium in older, postoperative hip fracture patients. Methods/Design Acutely hospitalised patients aged 65 years or older admitted for surgical repair of hip fracture are randomised (n = 452 into a treatment or placebo group. Prophylactic treatment consists of orally administered melatonin (3 mg at 21:00 h on five consecutive days. The primary outcome is the occurrence of delirium, to be diagnosed according to the Confusion Assessment Method, within eight days after start of the study medication. Secondary outcomes are delirium severity, measured by the Delirium Rating Scale; duration of delirium; differences in subtypes of delirium; differences in total length of hospital stay; total dose of antipsychotics and/or benzodiazepine use during delirium; and in-hospital complications. In the twelve-month follow up visit, cognitive function is measured by a Mini-Mental state examination and the Informant Questionnaire on Cognitive Decline in the Elderly. Functional status is assessed with the Katz ADL index score (patient and family version and grip strength measurement. The outcomes of these assessments are compared to the outcomes that were obtained during admission. Discussion The proposed study will