Academic journal article Indian Journal of Psychiatry

Delirium: Predictors of Delay in Referral to Consultation Liaison Psychiatry Services

Academic journal article Indian Journal of Psychiatry

Delirium: Predictors of Delay in Referral to Consultation Liaison Psychiatry Services

Article excerpt

Byline: Sandeep. Grover, Natasha. Kate, Surendra. Mattoo, Subho. Chakrabarti, Savita. Malhotra, Ajit. Avasthi, Parmanand. Kulhara, Debasish. Basu

Objective: To evaluate the predictors of delay in psychiatry referral for patients with delirium. Materials and Methods: The consultation liaison psychiatry registry and case notes of 461 patients referred to psychiatry consultation liaison services and diagnosed as having delirium were reviewed. Data pertaining to sociodemographic variables, clinical variables, Delirium Rating Scale-Revised 98 version, etiologies associated with delirium were extracted. Results: Older age, presence of and higher severity of sleep disturbance, presence of and higher severity of motor retardation, presence of visuospatial disturbances, presence of fluctuation of symptoms, being admitted to medical ward/medical intensive care units, and absence of comorbid axis-1 psychiatry diagnoses were associated with longer duration of psychiatric referral after the onset of delirium. Of these only four variables (presence of sleep disturbance, presence of motor retardation, being admitted to medical ward intensive care units and absence of comorbid axis-1 psychiatry diagnoses) were associated with longer duration of psychiatric referral in the regression analysis. Conclusion: The variables associated with delay in psychiatry referral for delirium suggest that there is a need to improve the understanding of the physicians and surgeons about the signs and symptoms, risk factors, and prognostic factors of delirium.

Introduction

Delirium is the most common psychiatric diagnoses seen in patients referred to psychiatry consultation liaison (CL) services. [sup][1] Although highly prevalent, data suggest that 32-67% of patients with delirium in medical units go unrecognized. [sup][2],[3],[4] Delirium has also been shown to be independently associated with significant increases in the length of hospital stay, inpatient mortality, long-term mortality, cognitive decline, requirement for institutional care, functional decline, healthcare costs, distress to the patient and family. [sup][5],[6],[7],[8],[9],[10],[11],[12] Taking all these facts into consideration, it is very important to identify and manage delirium as early as possible to improve the morbidity, mortality, and reduce the associated distress in patients and caregivers.

In many cases, the physicians and surgeons fail to identify the patients with delirium in the early phase and this leads to delay in psychiatric referral. Studies suggest that mean duration of delirium at the time of psychiatry referrals is about 3-5.3 days with range varying from 1 to 40 days. [sup][11],[12],[13],[14],[15],[16] Any effort to reduce the impact of delirium should involve reduction in the lag period of psychiatric referrals.

However, only occasional studies have evaluated the predictors of delay in psychiatry referral for delirium. An earlier study from our center, which included 80 consecutive patients with delirium, showed that presence of delirium at the time of hospitalization, presence of sleep-wake disturbance, and surgical specialty of referral were significant predictors of delayed diagnosis. [sup][16] Considering the fact that the previous study included a smaller sample size, the present study aimed at evaluating the predictors of delay in psychiatry referral for patients with delirium in a large sample size.

Materials and Methods

Setting

The study was carried out at the Postgraduate Institute of Medical Education and Research, Chandigarh, a multispecialty teaching hospital in North India. The Department of Psychiatry provides CL psychiatric services for the entire hospital. A patient referred to CL psychiatry services is first seen by a junior resident (trainee psychiatrist) under the supervision of a senior resident (a qualified psychiatrist). Final diagnoses are made according to the International Statistical Classification of Diseases and Related Health Problems-10 [sup][17] after the case is reviewed by a consultant psychiatrist. …

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