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Hypoactive delirium

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https://www.readbyqxmd.com/read/28750419/pipamperone-and-delirium-a-preliminary-evaluation-of-its-effectiveness-in-the-management-of-delirium-and-its-subtypes
#1
Soenke Boettger, Silvana Knöpfel, Maria Schubert, David Garcia Nuñez, Michael Martin Plichta, Richard Klaghofer, Josef Jenewein
INTRODUCTION: Delirium has been recognised as an underdiagnosed and undermanaged syndrome with substantial prevalence rates and potentially deleterious consequences in the medically ill population. Despite its frequent administration in the management of delirium, the effectiveness of pipamperone has not yet been evaluated. METHODS: In this retrospective, descriptive cohort study of 192 patients, pipamperone as monotherapy and as an adjunct to haloperidol, haloperidol alone, or atypical antipsychotics were compared with respect to their effectiveness in the management of delirium and its subtypes over the course of 20 days...
July 27, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28710219/comparison-of-propofol-and-dexmedetomidine-infused-overnight-to-treat-hyperactive-and-mixed-icu-delirium-a-protocol-for-the-basel-prodex-clinical-trial
#2
Alexa Hollinger, Katrin Ledergerber, Stefanie von Felten, Raoul Sutter, Stephan Rüegg, Lukas Gantner, Sibylle Zimmermann, Andrea Blum, Luzius A Steiner, Stephan Marsch, Martin Siegemund
BACKGROUND/OBJECTIVES: Delirium is a neurobehavioural disturbance that frequently develops particularly in the intensive care unit (ICU) population. It was first described more than half a century ago, where it was already discovered as a state that might come along with serious complications such as prolonged ICU and hospital stay, reduced quality of life and increased mortality. However, in most cases, there is still lack of proof for causal relationship. Its presence frequently remains unrecognised due to suggested predominance of the hypoactive form...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28579352/clinical-features-associated-with-delirium-motor-subtypes-in-older-inpatients-results-of-a-multicenter-study
#3
Alessandro Morandi, Simona G Di Santo, Antonio Cherubini, Enrico Mossello, David Meagher, Andrea Mazzone, Angelo Bianchetti, Nicola Ferrara, Alberto Ferrari, Massimo Musicco, Marco Trabucchi, Giuseppe Bellelli
OBJECTIVE: To date motor subtypes of delirium have been evaluated in single-center studies with a limited examination of the relationship between predisposing factors and motor profile of delirium. We sought to report the prevalence and clinical profile of subtypes of delirium in a multicenter study. METHODS: This is a point prevalence study nested in the "Delirium Day 2015", which included 108 acute and 12 rehabilitation wards in Italy. Delirium was detected using the 4-AT and motor subtypes were measured with the Delirium Motor Subtype Scale (DMSS)...
May 4, 2017: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/28553757/motor-disturbances-in-elderly-medical-inpatients-and-their-relationship-to-delirium
#4
Dimitrios Adamis, Geraldine McCarthy, Edmond O'Mahony, David Meagher
Motor disturbances in delirious patients are common, but their relationship to cognition and severity of illness has not been studied. We examined motor subtypes in an older age inpatient population, their relationship to clinical variables including delirium, and their association with 1-year mortality in a prospective study, using the Confusion Assessment Method, Acute Physiology and Chronic Health Evaluation II, Montreal Cognitive Assessment (MoCA), Barthel Index, and Delirium Rating Scale-Revised 98 (DRS-R98)...
July 2017: Journal of Geriatric Psychiatry and Neurology
https://www.readbyqxmd.com/read/28546253/hypoactive-delirium
#5
Christian Hosker, David Ward
No abstract text is available yet for this article.
May 25, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28515935/methotrexate-encephalopathy-two-cases-in-adult-cancer-patients-who-recovered-with-pathophysiologically-based-therapy
#6
Shodeinde A Coker, David A Pastel, Melissa C Davis, Elizabeth M Bengtson, Camilo E Fadul, Lionel D Lewis
BACKGROUND/OBJECTIVES: Neurotoxicity is a serious and sometimes fatal adverse effect that can occur following methotrexate treatment. We describe two adult patients with hematological malignancies with methotrexate encephalopathy who recovered with dextromethorphan therapy. RESULTS: Case 1: A 24-year-old male with acute lymphoblastic leukemia developed the acute onset of bilateral facial weakness and slurred speech after his first treatment with high-dose intravenous methotrexate...
2017: SAGE open medical case reports
https://www.readbyqxmd.com/read/28506099/propofol-based-palliative-sedation-to-treat-antipsychotic-resistant-agitated-delirium
#7
Alfredo Covarrubias-Gómez, Maria López Collada-Estrada
Delirium is a common problem in terminally ill patients that is associated with significant distress and, hence, considered a palliative care emergency. The three subtypes of delirium are hyperactive, hypoactive, and mixed, depending on the level of psychomotor activity and arousal disturbance. When agitated delirium becomes refractory in the setting of imminent dying, the agitation may be so severe that palliative sedation (PS) is required. Palliative sedation involves the administration of sedative medications with the purpose of reducing level of consciousness for patients with refractory suffering in the setting of a terminal illness...
May 16, 2017: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/28402867/functional-connectivity-and-network-analysis-during-hypoactive-delirium-and-recovery-from-anesthesia
#8
Tianne Numan, Arjen J C Slooter, Arendina W van der Kooi, Annemieke M L Hoekman, Willem J L Suyker, Cornelis J Stam, Edwin van Dellen
OBJECTIVE: To gain insight in the underlying mechanism of reduced levels of consciousness due to hypoactive delirium versus recovery from anesthesia, we studied functional connectivity and network topology using electroencephalography (EEG). METHODS: EEG recordings were performed in age and sex-matched patients with hypoactive delirium (n=18), patients recovering from anesthesia (n=20), and non-delirious control patients (n=20), all after cardiac surgery. Functional and directed connectivity were studied with phase lag index and directed phase transfer entropy...
June 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/28320171/stroke-severity-predicts-poststroke-delirium-and-its-association-with-dementia-longitudinal-observation-from-a-low-income-setting
#9
Akin Ojagbemi, Mayowa Owolabi, Toyin Bello, Olusegun Baiyewu
OBJECTIVE: The effect of delirium on stroke outcome has not been quantified in sub-Saharan Africa. We investigated the prevalence of delirium occurring within one week of stroke in Nigerian survivors and its association with dementia and mortality at 3months. METHODS: Delirium was ascertained after repeated assessments within one week of stroke using the Confusion Assessment Method. Demographic and clinical characteristics, stroke severity, current and pre-morbid cognitive functioning were also assessed...
April 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28289812/the-icm-research-agenda-on-intensive-care-unit-acquired-weakness
#10
Nicola Latronico, Margaret Herridge, Ramona O Hopkins, Derek Angus, Nicholas Hart, Greet Hermans, Theodore Iwashyna, Yaseen Arabi, Giuseppe Citerio, E Wesley Ely, Jesse Hall, Sangeeta Mehta, Kathleen Puntillo, Johannes Van den Hoeven, Hannah Wunsch, Deborah Cook, Claudia Dos Santos, Gordon Rubenfeld, Jean-Louis Vincent, Greet Van den Berghe, Elie Azoulay, Dale M Needham
We present areas of uncertainty concerning intensive care unit-acquired weakness (ICUAW) and identify areas for future research. Age, pre-ICU functional and cognitive state, concurrent illness, frailty, and health trajectories impact outcomes and should be assessed to stratify patients. In the ICU, early assessment of limb and diaphragm muscle strength and function using nonvolitional tests may be useful, but comparison with established methods of global and specific muscle strength and physical function and determination of their reliability and normal values would be important to advance these techniques...
March 13, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28288026/delirium-and-mortality-in-critically-ill-children-epidemiology-and-outcomes-of-pediatric-delirium
#11
Chani Traube, Gabrielle Silver, Linda M Gerber, Savneet Kaur, Elizabeth A Mauer, Abigail Kerson, Christine Joyce, Bruce M Greenwald
OBJECTIVES: Delirium occurs frequently in adults and is an independent predictor of mortality. However, the epidemiology and outcomes of pediatric delirium are not well-characterized. The primary objectives of this study were to describe the frequency of delirium in critically ill children, its duration, associated risk factors, and effect on in-hospital outcomes, including mortality. Secondary objectives included determination of delirium subtype, and effect of delirium on duration of mechanical ventilation, and length of hospital stay...
May 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28262089/subsyndromal-delirium-in-the-intensive-care-setting-phenomenological-characteristics-and-discrimination-of-subsyndromal-delirium-versus-no-and-full-syndromal-delirium
#12
Soenke Boettger, David Garcia Nuñez, Rafael Meyer, André Richter, Maria Schubert, Josef Jenewein
OBJECTIVE: Similar to delirium, its subsyndromal form has been recognized as the cause of diverse adverse outcomes. Nonetheless, the nature of this subsyndromal delirium remains vastly understudied. Therefore, in the following, we evaluate the phenomenological characteristics of this syndrome versus no and full-syndromal delirium. METHOD: In this prospective cohort study, we evaluated the Delirium Rating Scale-Revised, 1998 (DRS-R-98) versus the Diagnostic and Statistical Manual of Mental Disorders, 4th ed...
March 6, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/28194812/detection-and-management-of-hyperactive-and-hypoactive-delirium-in-older-patients-during-hospitalization-a-retrospective-cohort-study-evaluating-daily-practice
#13
Eveline L van Velthuijsen, Sandra M G Zwakhalen, Wubbo J Mulder, Frans R J Verhey, Gertrudis I J M Kempen
OBJECTIVES: The objectives of the study are to study daily hospital practice regarding detection and management and to study hyperactive and hypoactive delirium of older patients during their hospitalization. METHODS: A retrospective cohort study evaluating care as usual for older hospitalized patients with delirium at Maastricht University Medical Center+, a university hospital in the Netherlands, was performed. Inclusion criteria were older hospitalized patients (65+ years), diagnosed with delirium between 1 January and 31 December 2014...
February 14, 2017: International Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/28148581/delirium-a-guide-for-the-general-physician
#14
Oliver M Todd, Elizabeth A Teale
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...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28077196/brief-assessment-of-delirium-subtypes-psychometric-evaluation-of-the-delirium-motor-subtype-scale-dmss-4-in-the-intensive-care-setting
#15
Soenke Boettger, David Garcia Nuñez, Rafael Meyer, Andre Richter, Maria Schubert, David Meagher, Josef Jenewein
OBJECTIVE: The management of and prognosis for delirium are affected by its subtype: hypoactive, hyperactive, mixed, and none. The DMSS-4, an abbreviated version of the Delirium Motor Symptom Scale, is a brief instrument for the assessment of delirium subtypes. However, it has not yet been evaluated in an intensive care setting. METHOD: We performed a prospective/descriptive cohort study in order to determine the internal consistency, reliability, and validity of the relevant items of the DMSS-4 versus the Delirium Rating Scale-Revised-98 (DRS-R-98) and the original DMSS in a surgical intensive care setting...
January 12, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/28074801/delirium-after-cardiac-surgery-a-pilot-study-from-a-single-tertiary-referral-center
#16
Ashok K Kumar, Aveek Jayant, V K Arya, Rohan Magoon, Ridhima Sharma
BACKGROUND: Advances in cardiac surgery has shifted paradigm of management to perioperative psychological illnesses. Delirium is a state of altered consciousness with easy distraction of thoughts. The pathophysiology of this complication is not clear, but identification of risk factors is important for positive postoperative outcomes. The goal of the present study was to prospectively identify the incidence, motoric subtypes, and risk factors associated with development of delirium in cardiac surgical patients admitted to postoperative cardiac intensive care, using a validated delirium monitoring instrument...
January 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/27974719/acetylcholinesterase-activity-measurement-and-clinical-features-of-delirium
#17
Thomas A Jackson, Hannah C Moorey, Bart Sheehan, Alasdair M J Maclullich, John R Gladman, Janet M Lord
AIMS: Cholinergic deficiency is commonly implicated in the pathophysiology of delirium. We aimed to investigate the relationship between directly measured serum acetylcholinesterase (AChE) activity and (1) clinical features of delirium and (2) outcomes among older hospital patients with delirium. METHODS: Hospitalised patients with delirium were recruited, and delirium motor subtype, severity and duration of delirium were measured. Serum AChE activity was measured using a colorimetric assay...
2017: Dementia and Geriatric Cognitive Disorders
https://www.readbyqxmd.com/read/27956448/delirium-a-guide-for-the-general-physician
#18
Oliver M Todd, Elizabeth A Teale
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...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27943245/variability-of-delirium-motor-subtype-scale-defined-delirium-motor-subtypes-in-elderly-adults-with-hip-fracture-a-longitudinal-study
#19
Rikie M Scholtens, Barbara C van Munster, Dimitrios Adamis, Annemarieke de Jonghe, David J Meagher, Sophia E J A de Rooij
OBJECTIVES: To examine changes in motor subtype profile in individuals with delirium. DESIGN: Observational, longitudinal study; substudy of a multicenter, randomized controlled trial. SETTING: Departments of surgery and orthopedics, Academic Medical Center and Tergooi Hospital, the Netherlands. PARTICIPANTS: Elderly adults acutely admitted for hip fracture surgery who developed delirium according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for 2 days or longer (n = 76, aged 86...
February 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27847677/the-use-of-moca-and-other-cognitive-tests-in-evaluation-of-cognitive-impairment-in-elderly-patients-undergoing-arthroplasty
#20
Jukka Puustinen, Liisa Luostarinen, Markku Luostarinen, Veijo Pulliainen, Heini Huhtala, Marjo Soini, Jaana Suhonen
OBJECTIVE: To examine the prevalence and effect of cognitive impairment on treatment outcomes in elderly patients undergoing arthroplasty and to describe the feasibility of cognitive tests. MATERIALS AND METHODS: The participants were 52 patients with a mean age of 78 years 11 months (SD: 3.3), waiting for primary arthroplasty. We translated Montreal Cognitive Assessment (MoCA) into Finnish and compared it with Mini-Mental State Examination (MMSE), Mini-Cog, and clock-drawing tests prior to and 3 months after the surgery...
December 2016: Geriatric Orthopaedic Surgery & Rehabilitation
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