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PAPERS: DAVID J. MEAGHER, MARIA MORAN, BANGARU RAJU, DYMPNA GIBBONS, SINEAD DONNELLY, JEAN SAUNDERS, and PAULA T. TRZEPACZ Phenomenology of delirium: Assessment of 100 adult cases using standardised measures The British Journal of Psychiatry 2007; 190: 135-141 [Abstract] [Full text] [PDF]

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Phenomenolgy of Delirium

Sarah M Maddicott, Dinah Bennett, Stephen Lawrie   (7 September 2007)

Phenomenolgy of Delirium 7 September 2007
Sarah M Maddicott, Locum Consultant Psychiatrist Royal Edinburgh Hospital, Dinah Bennett, Stephen Lawrie Send letter to journal: Re: Phenomenolgy of Delirium sarahmaddicott{at}hotmail.com Sarah M Maddicott, et al.	Letter to British Journal of Psychiatry 26th April 2007 Phenomenology of Delirium Meagher et al (2007) describe the phenomenology of delirium in 100 patients in an in-patient palliative care setting. Delirium is an under- researched area and we were interested in the findings gained from a large number of delirium cases using tools including the Delirium Rating Scale- Revised-’98 (DRS R98) and the Cognitive Test for Delirium. We have conducted a small study into the phenomenology of delirium in patients with liver disease. Consecutive, consenting admissions to a gastro-intestinal ward with primary intra-hepatic liver disease as diagnosed by the responsible physician, were screened for the presence of delirium using a combination of DSM-IV criteria and the DRS R98. Patients were seen by one of the researchers within 7 days of admission. In patients with delirium, the Motoric subtype was classified according to criteria described by Liptzin and Levkoff (1992). 78 out of a possible 145 subjects were screened (39 refused, 28 were missed and the remainder were excluded because of a language barrier, inability to consent or being considered too unwell to approach). Eleven of these patients met DSM IV criteria for delirium ; 9 of these fulfilled the criteria for hypoactive delirium and 2 could not be classified. However, using the suggested cut-off scores on the DRS-R of 15.25 on the severity scale and 17.75 on the total score, only 4 out of 11 of our subjects scored above this cut off. In our subject group, the mean severity score was 12.41 (SD 3.7) and the mean total score was 16.23 (SD 4.9). We therefore suggest that while the DRS-R is a useful tool to help describe and record symptoms of delirium it is less useful as a screening instrument for detecting hypoactive delirium. Research into the phenomenology of delirium can be difficult to carry out due to the variable presentations of delirium and its fluctuating course, the possibility of multiple aetiologies and the ethics of obtaining consent on patients with impaired cognition. We hope that despite this, there will be on-going interest and further advances in developing research methods and trying to clarify the nature and causes of delirium. References Meagher D, Moran M, Raju B and Gibbons D. (2007) Phenomenology of delirium. British Journal of Psychiatry, 190, 135 – 141. Liptzin B, Levkoff S.E. (1992) An empirical study of delirium subtypes. British Journal of Psychiatry, 161, 843 - 845 Declaration of interest ; None Authors; Dr Sarah Maddicott, Locum Consultant Psychiatrist, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh, UK. EH10 5HF Tel; 0131 537 6631 Fax; 0131 537 6112 Dr Dinah Bennett, Career Medical Officer, Parkview Unit, Macquarie Hospital, North Ryde, NSW 2112, Australia Dr Stephen Lawrie, Senior Clinical Research fellow, Edinburgh University Department of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF