Academic journal article Indian Journal of Psychiatry

Indian Research on Acute Organic Brain Syndrome: Delirium

Academic journal article Indian Journal of Psychiatry

Indian Research on Acute Organic Brain Syndrome: Delirium

Article excerpt

Byline: Charles. Pinto

Delirium, though quite often referred to psychiatrists for management, does not find many takers for analysis, research and publications. Acute in onset, multiplicity of etiology and manifestations, high risk of mortality delirium is very rewarding in proper management and outcome. Delirium has a limited agenda on teaching programs, research protocols and therapeutic strategies. There is a dearth of Indian studies both in international and national scientific literature. This annotation is based on a Medline search for "delirium India" on Pubmed, which resulted in 54 articles. A search in Indian Journal of Psychiatry for "delirium'' resulted in 38 published articles, "delirium tremens" showed up only five articles. The articles are primarily from the Indian Journal of Psychiatry with cross reference to articles on Pubmed or Google search on Indian studies and a few international studies

Introduction

Delirium is an acute organic brain syndrome with increased morbidity and mortality. It is derived from Latin, meaning "off the track". Sutton described delirium tremens. Delirium is a complex neuropsychiatric syndrome presenting primarily with disturbances of cognition, perception and sensorium, alertness, sleep/wake cycle, and psychomotor behavior in the context of a medical etiology. The presentation can be quite variable among patients and even within a given patient because of its waxing and waning course. This variability and overlap with other psychiatric syndromes has led to substantial under recognition and under treatment in clinical settings. [sup][1] It is a transient cognitive impairment syndrome but an emergency as it has a favorable outcome if diagnosed and treated early. Delirium occurs in 30% of hospitalized patients and is associated with prolonged hospital stay and increased morbidity and mortality. Delirium is a disturbance of consciousness characterized by acute onset, rapid fluctuations in mental status and impaired cognitive functioning. The patient's ability to receive, process, store and recall information is strikingly impaired. The patient may be agitated or lethargic. The mnemonic for the differential diagnosis I WATCH DEATH (Infections, Withdrawal, Acute metabolic encephalopathy, Trauma, central nervous system (CNS) pathology, hypoxia, deficiencies, endocrine disorders, acute vascular insufficiency, toxins and drugs, heavy metals) points to the fact that delirium may be the symptom of a serious underlying life-threatening disorder. Childhood delirium has a different course and symptom profile than adult and geriatric delirium. [sup][2] Adult and geriatric delirium differs only in the severity of cognitive symptoms.

The annotations on Acute Organic Brain Syndrome Delirium are conveniently described as they have been published in the Indian Journal of Psychiatry as clinical studies/research/brief communication; case histories/reports; editorials, reviews, invited articles; Presidential addresses/orations and poster/paper presentations, viewpoint, symposia. The reference and relevance of delirium in the article is highlighted with the authors comments in italics

Clinical/Research Studies

Original research

A study by Pawar et al . on "Cognitive and emotional effects of renal transplantation" [sup][3] notes that Organic brain syndromes such as delirium and dementia are also common in these patients. However, their study revealed an 86.7% prevalence of depression in ESRD patients as compared to 56.7% in post renal transplant patients and an analysis of neurocognitive functions on LNNB did not reveal any significant impairment. Hence they found no delirium or dementia in their study.

Prasad et al . in their original research article "Clinical practice with antidementia and antipsychotic drugs: Audit from a geriatric clinic in India" [sup][4] found donepezil to be the most commonly prescribed antidementia drug and quetiapine to be the most commonly used antipsychotic in a tertiary care geriatric clinic, in a developing country. …

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