Magazine article Clinical Psychiatry News

Symptoms of Pediatric Delirium Often Overlooked, Mistreated

Magazine article Clinical Psychiatry News

Symptoms of Pediatric Delirium Often Overlooked, Mistreated

Article excerpt

SANTA ANA PUEBLO, N.M. -- Pediatric delirium is rarely discussed in the medical literature and hardly ever diagnosed in practice, but Dr. Susan Beckwitt Turkel contends that children may be as vulnerable as elderly patients.

"I think when we say that children don't get delirium, it is because it is very rarely diagnosed by pediatricians, and most consultation-liaison psychiatrists don't bump into it," Dr. Turkel said at the annual meeting of the Academy of Psychosomatic Medicine.

Pediatric delirium "is probably very common, and when it does occur, it is typically mistreated," said Dr. Turkel, chief of neuropsychiatry and child adolescent psychiatry at Childrens Hospital Los Angeles.

She speculated that age-related changes in the cholinergic systems may put children and the elderly at risk for delirium. "It may have something to do with the development of the cholinergic system in the brain and then the decline of cholinergic system in the brain," she said.

Children present with many of the characteristic symptoms in the DSM-IV, but, because pediatricians think in a developmental context, they describe "behavioral regression," according to Dr. Turkel.

She suggested many children become delirious while running high fevers from common conditions such as ear infections that are treated at home.

At Childrens Hospital, a tertiary care referral center, she and a colleague reviewed 84 cases involving very sick children who were the subject of psychiatric-liaison consultations from 1991 through 1995 (J. Neuropsychiatry Clin. Neurosci. 2003; 15:431-5).

Delirium was identified in 45 males and 39 females, ranging in age from 6 months to 18 years. Their length of stay ranged from 1 to 255 days, with an average of 41 days.

Infection was the most common cause of delirium, but mortality was higher in children with organ failure, autoimmune diseases, or a recent transplant. Overall, the mortality rate was 20%.

All of the children had impaired attention and fluctuating symptoms, often described as "waxing and waning." Nearly all had impaired alertness, confusion, sleep disturbance, and impaired responsiveness. Exacerbation at night and disorientation also were common.

Apathy and agitation were documented in more than two-thirds of the children. …

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