Diagnostic and treatment practices of delirium in a general hospital

Background: Despite the increase in research on delirium, it remains underdiagnosed and difficult to manage, and the outcome is poor especially in older people.

Aims: To identify the clinically diagnosed rates of delirium, the possible aetiologies, to describe treatment, number and type of psychotropic medication used and to investigate the reasons for referral to a liaison psychiatric team. Methods: Retrospective study of medical records of inpatients admitted to Sligo Regional Hospital during an 18-month period.

Results: One hundred and fifty-six files had a documentation of delirium (time prevalence 2 %). Mean age of the sample was 82 years (SD = 7.2), 66 (42 %) were male. Sixty-nine (44.2 %) of the total sample had a previous history of dementia, and 57 (36.5 %) had a previous history of delirium. In 67 (43.2 %) samples, the cause was infection, while in 4, no specific cause was identified. Ninety (58 %) were referred to the liaison service, but only in 26 (28.9 %), the reason for referral was ‘‘acute confusion’’ or ‘‘delirium’’. In a majority of referrals, the reason was an affective disorder more often depression. There were no significant differences between delirium subtypes and referrals (χ² = 3.868, df 3, p = 0.28). Examination of the amount of antipsychotics prescribed before, during and after delirium shows that there was a significant increase in use during the delirium (χ² = 17.512, df 8, p = 0.025) and decrease in z-hypnotics medication (zopiclone/zolpidem), (χ² = 20.114, df 4, p<0.001), while benzodiazepines and antidepressants remained the same.

Conclusions: Delirium is often misdiagnosed and unrecognized in hospital settings; however, when identified the pharmacological management is appropriate.