Delirium Due to Medical Cause Is Often Misdiagnosed

By Tucker, Miriam E. | Clinical Psychiatry News, May 2012 | Go to article overview

Delirium Due to Medical Cause Is Often Misdiagnosed


Tucker, Miriam E., Clinical Psychiatry News


WASHINGTON - Delirium due to underlying medical conditions was misdiagnosed as a psychiatric disorder in a significant proportion of patients who were admitted to an inpatient geriatric psychiatric unit, a retrospective chart review found.

The analysis of charts from 112 consecutive patients admitted to Central Regional Hospital, Butler, N.C., with a diagnosis of a psychiatric disorder, showed that 27 (24%) were subsequently found to have delirium due to an underlying medical condition. All 27 also had prior psychiatric diagnoses.

"If a patient has a previous psychiatric history, physicians are not as scrupulous or as careful to screen them for underlying medical issues. They are more likely to send them to a psych unit ... The message is ... consider any behavioral manifestation as delirium until proven otherwise," Dr. Meera Balasubramaniam said in an interview.

Upon evaluation in the psychiatric unit, most of the patients were diagnosed with hyperactive delirium (23), with the other 4 having mixed delirium. Urinary tract infection was the most common medical etiology for the delirium (11), followed by medications (6), poor glycemic control (3), electrolyte disturbance (1), acute central nervous system events (1), and dehydration (1). The rest did not have a cause documented in the discharge summary, said Dr. Balasubramaniam, a psychiatry resident at Duke University, Durham, N.C.

Nearly half of the patients (12) had been referred from the emergency department, while another 11 had been sent from an inpatient medical unit. …

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