Horrifying images of spiders and snakes. Voices that tempt the listener into harm's way. These frightening hallucinations can be highly distressing symptoms of delirium, a condition frequently seen in psychiatric patients.
U of C Heritage researcher Dr. Scott Patten hopes information from the first in-depth study tracking the incidence of delirium in this at-risk group will help caregivers understand why it happens and help them prevent its propagation.
Delirium is a state of mental confusion and sometimes, nightmarish illusions, physical restlessness, and incoherence that can result from adverse drug reactions. "Delirium sometimes develops when the dosage of a medication is too high, or from a complicated interaction between two medications," Dr. Patten explains.
Psychiatric patients, the very ill, post-operative patients, the elderly, and alcoholics are all prone to the condition. People who are mentally retarded, or who have suffered previous head injuries or dementia, are also at greater risk. "Delirium is an important condition because its effects can be dangerous to patients and those around them. It's associated with high mortality as a result of associated physical problems, and it's a risk factor for suicide," says Dr. Patten. "For example, a delirious patient might try to jump out of a hospital window attempting to escape a hallucination that seems real."
Dr. Patten's 13-month study, supported by the Health Research Fund, was conducted in the four psychiatric units at the old Calgary General Hospital. The goals of the study were to identify risk factors for delirium and to track the incidence of the condition. It's thought that early intervention, medication changes and shortened hospital stays may prevent or lower occurrences of delirium. A set of three psychiatric tests which identify delirium were administered to 422 newly-admitted patients to eliminate anyone from the study who was already delirious. Patient progress was followed on a daily basis through chart reviews, repeat administration of the three tests, and interviews with the clinical staff who cared for the patients.
Twelve cases of delirium were identified-an incidence rate of 2%. This small number limited researchers' ability to conduct a detailed evaluation of risk factors for the condition. Risk factors may include sex, age, and medication exposure.
Study data was collected through face-to-face interviews with patients and staff. This very accurate data was then used to confirm that electronic data routinely gathered at most hospitals was accurate enough to be used to track delirium, something that had not been previously shown. "The information we gathered provides us with a benchmark which can be used for ongoing tracking of delirium. If a particular psychiatric unit has a high rate of delirium it could mean a reexamination of its admission policies or that certain patients have serious undetected physical illnesses, or that inappropriate drug treatment is being used."
As a direct result of Dr. Patten's research findings, the Department of Psychiatry in the Calgary Health Region may soon adopt electronic methods to track delirium in psychiatric inpatients.
Dr. Scott Patten is an AHFMR Population Health Investigator and an Assistant Professor in the Department of Community Health Sciences and Psychiatry at the U of C. The Health Research Fund is administered by the Heritage Foundation on behalf of Alberta Health. Dr. Patten receives additional support from the National Health Research and Development Program.
Heritage Brain WorksThe pioneering work of AHFMR-funded basic researchers has been instrumental in helping scientists unravel the incredibly complex workings of the brain. Gaining a better understanding of mysterious and devastating mental conditions such as delirium and schizophrenia are at the heart of the work of U of C's Dr. Brian MacVicar and Dr. Quentin Pittman.As a cell biologist and Heritage Medical Scientist, Dr. MacVicar has been working to uncover clues to the organic nature of schizophrenia. With his expertise in the electrophysiology of nerve cells he hopes to reveal the biological base for the disorder to help people with the disease to better manage their illness. As a member of the Neuroscience Research Group and a Heritage Medical Scientist, Dr. Pittman has gained national recognition for his advances in the understanding of how neurotransmitters in the brain control blood pressure, fever, immune responses, and other key events in the body. |
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Disseminating Research | Fall Prevention | Tracking Delirium
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