Motor symptoms in 100 patients with delirium versus control subjects: Comparison of subtyping methods
ABSTRACT Different motor presentations of delirium may represent clinically meaningful subtypes.
Authors sought to evaluate delirium phenomena.
They used three non-validated delirium psychomotor subtype schemas, applied to a palliative-care population. Their unique items were merged to comprise a 30-item Delirium Motor Checklist (DMC) used to collect data, rate each schema, and determine subtype frequencies in 100 consecutive DSM-IV delirium patients and 52 medically-matched control subjects without delirium. The Delirium Rating Scale-Revised-98 (DRS-R98) assessed delirium severity, and subtype categorization using its two motor items was compared with the scale that used the psychomotor schema.
In delirium, motor disturbance was present in 100% by DMC versus 92% by DRS-R98 motor items; the DMC motor items also significantly distinguished delirium from control subjects. Motor subtype classification (hyperactive, hypoactive, mixed, and none) varied among the four methods, with low concordance across all four methods and 76% concordance for pairwise comparisons. The DRS-R-98 identified the most hypoactive delirium cases.
Motor disturbances are common in delirium, although whether they represent clinical subtypes is confounded by methodological issues. New motor subtyping methods are needed that are validated in other medical populations, use matched control subjects, and have higher sensitivity and specificity for pure motor features.
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ABSTRACT: Delirium often presents difficult diagnostic and classification challenges in palliative care settings.Journal of Pain and Symptom Management 05/2014; DOI:10.1016/j.jpainsymman.2014.03.012 · 2.74 Impact Factor
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ABSTRACT: To find out the prevalence of catatonic symptoms as per the Bush Francis Catatonia rating Scale (BFCRS) in patients with delirium and to evaluate the prevalence of catatonia as defined by Bush Francis Catatonia Screening instrument (BFCSI) and DSM-5 criteria in patients with delirium. Two hundred five consecutive subjects were assessed on delirium rating scale-revised 98 version, amended Delirium motor symptom scale and BFCRS. On BFCRS, two-fifth (N=80; 39%) of the study participants had 2 or more catatonic symptoms. When the diagnosis of catatonic syndrome was considered, 32% and 12.7% were observed to have catatonia as per BFCSI and proposed DSM-5 criteria respectively. Delirium with catatonic syndrome was more common in female gender and in those who had onset of delirium prior to hospitalization. Amongst the delirium subtypes, hypoactive delirium was more commonly associated with catatonic syndrome. Present study suggests that substantial number of patients with delirium have catatonic symptoms and a significant proportion have catatonic syndrome. This high prevalence makes the concurrent diagnosis of delirium and catatonia plausible. The association of catatonia with specific motor subtype of delirium could encourage the expansion or even modification of the existing subtypes of delirium.Psychiatry and Clinical Neurosciences 02/2014; 68(8). DOI:10.1111/pcn.12168 · 2.04 Impact Factor
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ABSTRACT: Background and Objectives: To compare the safety and efficacy of haloperidol and risperidone in the treatment of delirium and its subtypes Methods: We collected sociodemographic data and medical variables in addition to systematically rating all patients with delirium with the Memorial Delirium Assessment Scale (MDAS), Karnofsky Performance Status Scale (KPS) and abbreviated Udvalg for Kliniske Undersogelser (UKU) at baseline (T1), 2-3 days (T2) and 4-7 days (T3) and created an IRB-approved delirium database. For this secondary analysis we extracted all data containing haloperidol (HAL) and risperidone (RIS). Results: We were able to retrieve 32 patients treated with haloperidol (HAL) and risperidone (RIS) each. Both samples did not significantly differ in respect to age, cancer diagnoses or etiologies. The MDAS scores at baseline were higher in HAL treated subjects (20.2) compared to RIS treated subjects (17.7). The treatment results between HAL and RIS were not significantly different: Over the course of treatment MDAS scores improved from 20.2 to 8.3 (HAL) and 17.7 to 7.5 in (RIS), delirium resolution rates were 68.8% (HAL) and 84.4% (RIS). In hypoactive delirium the MDAS scores improved from 18.5 to 9.3 (HAL) and from 15.3 to 6.6 (RIS), delirium resolution rates were 64.3% (HAL) and 91.3% (RIS). In hyperactive delirium the MDAS scores improved from 22.5 to 6.6 (HAL) and 20.1 to 8.4 (RIS), delirium resolution rates were 72.2% (HAL) and 75% (RIS). There were no significant differences in KPS scores at all observation times. Treatment with HAL caused more EPS. Conclusions: Both haloperidol and risperidone may be equally effective in the treatment of delirium and its subtypes. Treatment with haloperidol resulted in more side effects.European Journal of Psychiatry 06/2011; 25(2):59-67. DOI:10.4321/S0213-61632011000200001 · 0.46 Impact Factor