Motor Symptoms in 100 Patients With Delirium Versus Control Subjects: Comparison of Subtyping Methods

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
Psychosomatics (Impact Factor: 1.86). 07/2008; 49(4):300-8. DOI: 10.1176/appi.psy.49.4.300
Source: PubMed


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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    • "Many authors have tried to characterize delirium into hyperactive vs hypoactive motor subtypes, cortical vs subcortical, anterior vs. posterior cortical, right vs. left hemisphere, psychotic vs. non psychotic, acute vs. chronic subtypes [12]. However, among these various subtyping methods, motor subtyping has received highest attention and data suggest that these motor subtypes may differ regarding their relationships to non-motor symptoms, etiology, pathophysiology, detection rates, delirium treatment experience, episode duration and outcome [13]. This literature is however constrained by the fact that there is heterogeneity in the method used in different studies to define various motor subtypes [14]. "
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    ABSTRACT: To explore the frequency of different motor subtypes of delirium in children and adolescents and to study the relationship of motor subtypes with other symptoms, etiology and outcome of delirium. Forty-nine consecutive patients, aged 8-19 years, diagnosed as having delirium as per DSM-IV-TR were assessed on Delirium Rating Scale-Revised 98 (DRS-R-98), amended Delirium Motor Symptom Scale (DMSS), delirium etiology checklist and risk factors for delirium. Different motoric subtypes of delirium were compared with each other for symptoms of delirium as assessed by DRS-R-98, risk factors, etiology and outcome. More than half (53%) of patients were classified as having hyperactive delirium, this was followed by the mixed (26.5%) and the hypoactive (16%) subtype. When the different subtypes were compared with each other, the 3 motor subtypes did not differ from each other in terms of frequency and severity of other symptoms except for minor differences. Hallucinations are more common in patients with hyperactive and mixed subtype. There is no significant difference in the outcome of delirium across different subtypes. Unlike in adults, motoric subtypes of delirium in child and adolescents do not differ from each other with respect to other symptoms, risk factors and outcome.
    Full-text · Article · Oct 2013 · General hospital psychiatry
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    • "The majority of patients with delirium experience discernible alterations in their activity levels with loss of control of activity levels and/or activity that is inappropriate in its timing (e.g., daytime somnolence, nocturnal agitation) that suggest disruption of systems that regulate the temporal pattern of behaviour [23]. Recent work has highlighted altered motor functional performance (measured by the Trunk Control Test and the Tinetti Scale) as a relatively specific marker of emerging and resolving delirium and that distinguishes the delirious state from dementia without delirium [39]. "
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    ABSTRACT: Delirium is a serious neuropsychiatric syndrome of acute onset that occurs in approximately one in five general hospital patients and is associated with serious adverse outcomes that include loss of adaptive function, persistent cognitive problems and increased mortality. Recent studies indicate a three-domain model for delirium that includes generalised cognitive impairment, disturbed executive cognition, and disruption of behaviours that are under circadian control such as sleep-wake cycle and motor activity levels. As a consequence, attention has focused upon the possible role of the circadian timing system (CTS) in the pathophysiology of delirium. We explored this possibility by reviewing evidence that (1) many symptoms that occur in delirium are influenced by circadian rhythms, (2) many features of recognised circadian rhythm disorders are similar to characteristic features of delirium, (3) common risk factors for delirium are known to disrupt circadian systems, (4) physiological disturbances of circadian systems have been noted in delirious patients, and (5) positive effects in the treatment of delirium have been demonstrated for melatonin and related agents that influence the circadian timing system. A programme of future studies that can help to clarify the relevance of circadian integrity to delirium is described. Such work can provide a better understanding of the pathophysiology of delirium while also identifying opportunities for more targeted therapeutic efforts.
    Full-text · Article · Jul 2013 · Medical Hypotheses
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    • "El DRS---R-98 identificó los casos de delírium más hipoactivos, en contraste con el DMC. Se encontraron trastornos motores en el 92 al 100% de los casos. Se propone replantear la clasificación de subtipos Meagher et al. 50 (2008) Pacientes con cáncer y delírium admitidos a un centro de cuidados paliativos ("
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    ABSTRACT: Delirium in palliative care patients is common and its diagnosis and treatment is a major challenge. Our objective was to perform a literature analysis in two phases on the recent scientific evidence (2007-2012) on the diagnosis and treatment of delirium in adults receiving palliative care. In phase1 (descriptive studies and narrative reviews) 133relevant articles were identified: 73addressed the issue of delirium secondarily, and 60articles as the main topic. However, only 4prospective observational studies in which delirium was central were identified. Of 135articles analysed in phase2 (clinical trials or descriptive studies on treatment of delirium in palliative care patients), only 3 were about prevention or treatment: 2retrospective studies and one clinical trial on multicomponent prevention in cancer patients. Much of the recent literature is related to reviews on studies conducted more than a decade ago and on patients different to those receiving palliative care. In conclusion, recent scientific evidence on delirium in palliative care is limited and suboptimal. Prospective studies are urgently needed that focus specifically on this highly vulnerable population.
    Full-text · Article · Jul 2013
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