Low anxiety disorder comorbidity rate in bipolar disorders in Han Chinese in Taiwan

Objectives

Studies report high comorbidity of lifetime anxiety disorders with bipolar disorders in Western patients, but it is unclear in Taiwan. The authors explored the comorbidity of anxiety disorders in different bipolar disorder subtypes in Han Chinese in Taiwan.

Methods

Three hundred twenty-five patients with bipolar disorder (bipolar I: 120; bipolar II: 205) disorder were recruited from two general medical outpatient services. They were evaluated and their diagnoses confirmed by a psychiatrist using the Chinese version of the Modified Schedule of Affective Disorder and Schizophrenia-Lifetime. The exclusion criteria were: any DSM-IV-TR Axis I diagnosis, other than bipolar disorder, being outside the 18-65-year-old age range, any other major and minor mental illnesses except anxiety disorder, any neurological disorders or organic mental disorders.

Results

Thirty-two (26.7%) of patients were comorbid with lifetime anxiety disorder and bipolar I, 80 (39.0%) with lifetime anxiety disorder and bipolar II, 7 (5.8%) were comorbid with two or more anxiety disorders and bipolar I, and 27 (13.2%) with two or more anxiety disorders and bipolar II.

Conclusion

That more than twice as many bipolar II than bipolar I patients reported two or more anxiety disorders implies that the complication is more prevalent in bipolar II patients.     

The relationship between abdominal fat, obesity, and common mental disorders: Results from the HUNT Study

Objective

While recent studies have suggested an association between obesity and common mental disorders, findings across different studies have varied and the nature of any relationship remains uncertain. The aim of this study was to examine the relationship between depression, anxiety, and two different measures of obesity in a large community-based sample.

Methods

The HUNT-2 study was used to conduct a cross-sectional study of 65,648 adults between 20 and 89 years of age. During a clinical examination, trained nurses took various anthropometric measurements allowing participants' body mass index (BMI) and waist-hip ratio (WHR) to be calculated. Anxiety and depressive symptoms were ascertained using the Hospital Anxiety and Depression Scale. Information regarding physical activity, level of social support, and medical comorbidity was also obtained.

Results

Elevated WHR was associated with increased prevalence of both anxiety and depression. After adjustment for BMI, physical activity, social isolation, and somatic diseases, WHR remained independently associated with depression in both males and females and with anxiety among males. Obesity, as defined by BMI, was associated with depression; however, this association was strongly attenuated by WHR. There was a negative association between BMI and anxiety in both genders.

Conclusion

Abdominal fat distribution (as measured by WHR) appears to be the key mediator in the relationship between obesity and depression. Increased BMI was not independently associated with depression and may provide some protection against anxiety. These findings are consistent with a hypothesis that links obesity and depression via metabolic disturbances involving the hypothalamic-pituitary-adrenocortical axis.     

Axis I comorbidity and psychopathologic correlates of autodestructive syndromes

Objective

Nonsuicidal deliberate self-harm and factitious disorders have been proposed as subtypes within the autodestructive behavior spectrum, basically differing in the issue of concealment. Aims are to determine Axis I diagnoses and psychopathologic correlates of open self-harmers and patients diagnosed with factitious disorders.

Methods

One hundred ninety-four psychosomatic medicine inpatients participated. Assessment included the structured World Health Organization Composite International Diagnostic Interview (computerized version) and self-report questionnaires for anxiety, depression, perceived stress, and personal coping resources.

Results

Thirty-seven patients identified with self-destructive behavior were matched with 37 patients without such behavior. Overt self-harmers (n = 18) were more frequently diagnosed with anxiety, depressive, substance abuse/dependence, or eating disorders and reported more stress than factitious disorder patients (n = 19) or those without self-destructive behavior. Patients with factitious disorder exhibited lower Axis I comorbidity and less psychopathology than patients without self-harm behavior.

Conclusions

Regarding psychopathologic assessment, contrary to open self-harmers, factitious disorder patients appear strikingly inconspicuous.     

Generalized hypervigilance in fibromyalgia patients: An experimental analysis with the emotional Stroop paradigm

Objective

In recent years, a good deal of serious research has been carried out on the hypothesized presence of generalized hypervigilance to sensory stimulation in fibromyalgia (FM). However, there are no studies which, following an operationalization of generalized hypervigilance as a propensity to attend to any task-irrelevant stimuli presented, make use of interference paradigms as the most appropriate experimental models for its analysis. The purpose of this study was to test the hypothesis of generalized hypervigilance in FM using the emotional modification of the Stroop task and to explore the possible mediating role of anxiety.

Methods

To this end, 25 women diagnosed with fibromyalgia and 25 matched controls were shown 32 stimulus words equally distributed in four categories: fibromyalgia symptoms, arousing-negative (A−), arousing-positive (A+), and neutral (N). These words had been selected on the basis of the results of an independent study. In addition to the emotional Stroop task, measures of trait and state anxiety were included.

Results

The results showed the possible presence of a generalized hypervigilance response in fibromyalgia patients based on significant slowness in the color-naming. This effect was mediated by the degree of perceived unpleasantness of the A−stimuli. However, the expected mediation effect of anxiety was not found.

Conclusions

These results suggest the presence of a generalized hypervigilance response in FM patients that is not mediated by anxiety. Implications for the correct functioning of controlled self-regulatory processes in fibromyalgia and similar pathologies are discussed.     

Mental disorders and cardiovascular disease among adults in the United States

Objective

Numerous population-based studies have found an association between major depression and CVD, though these studies did not assess anxiety disorders. Patient samples have shown associations between anxiety disorders and cardiovascular disease (CVD), but without consideration of depressive disorders. Therefore, it remains unclear whether: (a) both anxiety and depressive disorder are associated with CVD; (b) these associations are generalizable to adults in the community.

Materials and Methods

Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 43,093 civilian non-institutionalized participants aged 18 and older.

Results

CVD (total prevalence 3.3%) was associated with increased likelihood of any anxiety disorder (OR = 1.43, (1.20, 1.71)), after adjusting for depressive disorders, as well as Generalized Anxiety Disorder (OR = 1.48 (1.09, 2.01)), Panic disorder (OR = 1.46 (1.12, 1.91)), and specific phobia (OR = 1.29 (1.04, 1.59)). CVD was significantly associated with any mood disorder (OR = 1.34 (1.13, 1.58)) after adjusting for anxiety disorders, though neither the link with major depression, nor other specific mood disorders remained significant after adjustment.

Conclusions

Our findings suggest that anxiety disorders, mood disorders, and CVD are highly comorbid among adults in the United States, and demonstrate the importance of including anxiety disorder assessment in studies of mental and physical comorbidity. These results reveal how the lack of investigation into specific relationships between CVD and the range of mental disorders in population-based studies of risk factors for CVD may obscure important relationships.     

Anxiety disorders and suicidality in the National Comorbidity Survey-Replication

Objective

The current study sought to examine the unique associations between anxiety disorders and suicidality using a large nationally representative sample and controlling for a number of established risk factors for suicide.

Method

Data from the National Comorbidity Survey-Replication were used for analyses. Lifetime diagnostic history and demographics were obtained in this survey through a structured interview. Lifetime suicidal ideation and attempts were also assessed.

Results

Multivariate analyses covarying for psychiatric comorbidity and demographic variables found social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and panic disorder (PD) to be unique predictors of suicidal ideation, while only SAD, PTSD, and GAD were predictive of suicide attempts. Analyses by gender indicated that each of these four disorders were predictive of suicidal ideation or suicide attempts among women, while only PTSD and PD acted as risk factors among men.

Conclusions

Findings provide further evidence of the negative impact of anxiety disorders, suggest efforts should be made towards their early detection and treatment, and emphasize the importance of suicide risk assessment in treating individuals with anxiety disorders.     

Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents

Background

Recent literature has indicated that exposure to multiple traumatic events in adults is associated with high levels of posttraumatic stress disorder (PTSD), anxiety, and depression. Against the backdrop of stressful life events and childhood abuse and neglect, we investigated the cumulative effect of multiple trauma exposure on PTSD, anxiety, and depression in an adolescent sample.

Method

One thousand one hundred forty 10th-grade learners from 9 Cape Town (South Africa) schools completed questionnaires on stressful life experiences; trauma exposure; and symptoms of anxiety, depression, and PTSD. Our population of interest for this study was adolescents between the ages of 14 and 18 years who had been exposed to serious, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, qualifying traumatic events. The final sample size was thus 922.

Results

Rates of trauma exposure, PTSD, depression, and anxiety were high. Controlling for sex, stressful life experiences in the past year, and childhood adversity, we found an effect of cumulative trauma exposure effect on PTSD and depression, with an increase in the number of traumas linearly associated with an increase in symptoms of PTSD (F_(4,912) = 7.60, P < .001) and depression (F_(4,912) = 2.77, P < .05). We did not find a cumulative effect on anxiety.

Conclusion

Our findings indicate that adolescents exposed to multiple traumas are more likely to experience more severe symptoms of PTSD and depression than those who experience a single event, with this effect independent of childhood adversity and everyday stressful life experiences. Exposure to multiple trauma, however, does not seem to be associated with more severe anxiety symptoms.     

Commonalities and differences between the diagnostic groups: Current somatoform disorders, anxiety and/or depression, and musculoskeletal disorders

Objective

To identify the similarities and differences of risk factors and correlates of different groups of people fulfilling criteria for specified diagnostic groups according to current somatoform disorder (SDs) criteria, presence of anxiety and/or depression, and self-reported musculoskeletal disorders.

Methods

Participants of the Oslo-Lofoten general population cross-sectional study in 2000-2001 interviewed with the Composite International Diagnostic Interview (CIDI) somatoform section were examined by comparing similarities and differences in 8 groups identified by cross-tabulation of current SDs, anxiety and/or depression, and musculoskeletal disorders. The current SDs group was computed from the CIDI somatoform section raw data, anxiety and/or depression from the CIDI diagnostic algorithms and musculoskeletal disorders by questionnaire and self evaluation.

Results

In the 2001 sample of 1668 (875 women and 793 men) participants, the following eight disorder groups were identified: (i) current SDs, n=49 (75.5% women) (ii) musculoskeletal (functional somatic disorders), n=327; (53.5% women) (iii) anxiety and/or depression, n=148 (73.6% women); (iv) current SDs with anxiety and/or depression, n=38 (73.7% women); (v) current SDs with musculoskeletal, n=44 (72.7% women); (vi) current SDs with anxiety and/or depression and musculoskeletal, n=34 (76.5% women); (vii) musculoskeletal with anxiety and/or depression, n=101 (66.3% women); and (viii) no disorders, n=927 (43.3% women). Commonalities and differences between current SDs, anxiety and/or depression, and musculoskeletal disorders are apparent. Impairment of outcomes and risk factor load is high in current SDs with anxiety and/or depression and musculoskeletal.

Conclusion

The data in this article could help toward the needed DSM-V and ICD-11 diagnostic revision of the SDs category.     

Association of trauma exposure with psychiatric morbidity in military veterans who have served since September 11, 2001

Objective

This study examined the association of lifetime traumatic stress with psychiatric diagnostic status and symptom severity in veterans serving in the US military after 9/11/01.

Method

Data from 356 US military veterans were analyzed. Measures included a standardized clinical interview measure of psychiatric disorders, and paper-and-pencil assessments of trauma history, demographic variables, intellectual functioning, posttraumatic stress disorder (PTSD) symptoms, depression, alcohol misuse, and global distress.

Results

Ninety-four percent of respondents reported at least one traumatic stressor meeting DSM-IV criterion A for PTSD (i.e., life threatening event to which the person responded with fear, helplessness or horror), with a mean of four criterion A traumas. Seventy-one percent reported serving in a war-zone, with 50% reporting occurrence of an event meeting criterion A. The rate of current psychiatric disorder in this sample was: 30% PTSD, 20% major depressive disorder, 6% substance abuse or dependence and 10% for the presence of other Axis I psychiatric disorders. After accounting for demographic covariates and combat exposure, childhood physical assault and accident/disasters were most consistently associated with increased likelihood of PTSD. However, PTSD with no comorbid major depressive disorder or substance use disorder was predicted only by combat exposure and adult physical assault. Medical/unexpected-death trauma and adult physical assault were most consistently associated with more severe symptomatology.

Conclusions

Particular categories of trauma were differentially associated with the risk of psychiatric diagnosis and current symptom severity. These findings underscore the importance of conducting thorough assessment of multiple trauma exposures when evaluating recently post-deployed veterans.     

Family history of alcohol use disorders among adults with panic disorder in the community

Objective

Clinical studies suggest a familial association between panic disorder and alcohol use disorders but this relationship has not been examined in a representative community sample. The objective of this study is to examine the familial association between panic disorder and alcohol use disorders among adults in the community.

Method

Data were drawn from the NESARC, a nationally representative sample of over 43,000 adults in the United States. Rates of alcohol use disorders were examined using the family history method in first-degree relatives (FDRs) of adults with panic disorder. Analyses were adjusted for demographics, alcohol use disorders in the proband, and anxiety disorders in the FDRs.

Results

First-degree relatives of adults with panic disorder have significantly higher odds of alcohol use disorders, compared with FDRs of adults without panic disorder. These associations persist after adjusting for demographic characteristics, alcohol use disorders in the proband, and anxiety disorders in the FDR’s.

Conclusions

Consistent with findings from clinical studies, this is the first population-based study to show a familial link between panic disorder and alcohol use disorders. This association appears independent of the influence of comorbidity of alcohol use disorders and anxiety disorders, suggesting a potential familial and/or genetic pathway. Future longitudinal studies will be needed to further understand the mechanism of this observed association.     

Posttraumatic stress symptoms and postpartum depression in couples after childbirth: the role of partner support and attachment

Aim

The roles of partner attachment and perceptions of partner support were explored in relation to symptoms of posttraumatic stress and postpartum depression in couples within the first three postnatal months.

Methods

Participants (n = 372) were recruited within the first seven days postpartum, and completed questionnaire measures of trait anxiety, symptoms of acute posttraumatic stress, and perceptions of partner support. Postal questionnaires were completed at six weeks and three months, assessing attachment, perception of partner support, symptoms of posttraumatic stress, and postpartum depression. Two hundred and twelve couples completed all time-points.

Results

Results indicated that symptoms were significantly related within couples. Men's acute trauma symptoms predicted their partner's subsequent symptoms of posttraumatic stress. Less secure attachment and dissatisfaction with partner support were associated with higher levels of postpartum depression and posttraumatic stress.

Conclusions

Men's and women's responses following childbirth appear to be strongly interlinked; services should target both members of the dyad.     

Chronic childhood adversity and onset of psychopathology during three life stages: Childhood, adolescence and adulthood

Background

The aim is to report the individual and joint effects of a range of chronic childhood adversities on the first onset of a broad range of psychiatric disorders, and to evaluate their impact at different stages of the life course in a representative sample of the Mexican population.

Method

The data is from the Mexican National Comorbidity Survey (M-NCS), a stratified, multistage area probability sample of persons aged 18-65. The WHO World Mental Health Composite International Diagnostic Interview (WMH-CIDI) measured 12 childhood adversities, 20 psychiatric disorders and ages of onset. Discrete-time survival models were performed to estimate the odds of disorder onset.

Results

In bivariate models, all adversities (except economic adversity and parental death) were significant predictors of psychopathology; however in multivariate models which correct for the clustering of adversities, family dysfunction and abuse adversities were the strongest and most consistent predictors of all four classes of psychopathologies examined (mood, anxiety, substance use and externalizing), and for the most part, over all three life course stages (childhood, adolescence and adulthood). The effect of the number of adversities was nonlinear such that although the odds of disorder onset increased with increasing numbers of adversities, the odds increased at a decreasing rate.

Conclusions

Childhood family dysfunction and abuse is a strong predictor of the onset of psychopathology throughout the life course, consistent with evidence for the enduring effects of chronic stress on brain structures involved in many psychiatric disorders and with stress-sensitization models of psychopathology.     

The prevalence of dental anxiety across previous distressing experiences

Aims

To compare the prevalence of high dental anxiety across a variety of past distressing experiences with a previously reported Dutch sample.

Method

University students from the UK (N = 1024) completed an online survey containing; the Modified Dental Anxiety Scale, and the Level of Exposure-Dental Experiences Questionnaire (LOE-DEQ). Adjusted odds ratios (OR) were calculated to assess the association of self-reported distressing experiences and dental anxiety.

Results

The percentage of respondents with high dental anxiety (HDA) (total MDAS score ≥ 19) was 11.2%. Significant prevalence of HDA across several distressing experiences was shown in both UK and Dutch samples notably: extreme helplessness during dental treatment, lack of understanding of the dentist and extreme embarrassment during dental treatment. There were little or no effects of non-dental trauma, with the exception of sexual abuse in the UK sample.

Conclusions

Trauma from various past experiences may be implicated in an increased risk of high dental anxiety.     

Troubles du sommeil : caractéristiques sociodémographiques et comorbidités anxiodépressives. Étude (Baromètre santé INPES) chez 14 734 adultes en France

Aim

Several studies have identified a high prevalence of sleep disorders and insomnia in the French population; however these studies especially focused on sleep did not give enough details on the sociodemographic and occupational characteristics of subjects with sleep disorders. The aim of this study was to characterize adults complaining of sleep disorders in a vast population-based health demographics study (Baromètre Santé, Institut national pour l’éducation à la santé [INPES]).

Method

Fourteen thousand seven hundred and thirty-four adults aged from 18 to 65 years old were interviewed by telephone and “subjects with severe sleep disorders in the last 8 days” were isolated and compared with the others regarding sociodemographic and occupational aspects and with regard to psychiatric disorders. The sleep items were extracted from the Duke and WHOQOL (brief form) questionnaires. Depressive disorders were recognized based on the Composite International Diagnostic Interview (CIDI) Short-Form (CIDI-SF) and the ISD 10.

Results

Among the subjects, 12.5% were concerned. Women, young or subjects after 45, low income, employees and unemployed categories had significantly more sleep disorders. Sleep disorders in the last 8 days were also significantly linked to previous depressive episodes, anxiety disorders and history of suicide.

Conclusion

Assessing sleep disorders in the last 8 days seems to be a good method to identify severely affected subjects in general population surveys.     

Family psychiatric history, peritraumatic reactivity, and posttraumatic stress symptoms: A prospective study of police

Background

Family history of psychiatric and substance use disorders has been associated with posttraumatic stress disorder (PTSD) in cross-sectional studies.

Method

Using a prospective design, we examined the relationships of family history of psychiatric and substance use disorders to posttraumatic stress symptoms in 278 healthy police recruits. During academy training, recruits were interviewed on family and personal psychopathology, prior cumulative civilian trauma exposure, and completed self-report questionnaires on nonspecific symptoms of distress and alcohol use. Twelve months after commencement of active duty, participants completed questionnaires on critical incident exposure over the previous year, peritraumatic distress to the worst critical incident during this time, and posttraumatic stress symptoms.

Results

A path model indicated: (1) family loading for mood and anxiety disorders had an indirect effect on posttraumatic stress symptoms at 12 months that was mediated through peritraumatic distress to the officer’s self-identified worst critical incident, (2) family loading for substance use disorders also predicted posttraumatic stress symptoms at 12 months and this relationship was mediated through peritraumatic distress.

Conclusion

These findings support a model in which family histories of psychopathology and substance abuse are pre-existing vulnerability factors for experiencing greater peritraumatic distress to critical incident exposure which, in turn, increases the risk for development of symptoms of posttraumatic stress disorder. Replication in other first responders, military and civilians will be important to determine generalizability of these findings.     

Whether medically unexplained or not, three or more concurrent somatic symptoms predict psychopathology and service use in community populations

Objectives

To examine the frequency of somatic symptoms in a community population of various ethnic backgrounds and to identify correlates of these symptoms such as psychopathology, use of services, and personal distress.

Methods

Using a 14-symptom inventory with interviewer probes for somatic symptoms, we determined the presence of general physical symptoms (GPS) in a sample of 4864 white, Latino, and Asian US community respondents. Medically “edited” verbatim interview responses were used to decide whether or not physical symptoms would qualify as medically unexplained physical symptoms (MUPS). We then assessed the association between GPS and MUPS and psychiatric disorders, psychological distress, and use of services, in both unadjusted and multivariate regression analyses.

Results

One-third (33.6%) of the respondents reported at least one GPS and 11.1% reported at least one MUPS within the last year. 10.7% of respondents had three or more GPS and 1.5% had three or more MUPS. Three or more GPS and MUPS were positively associated with depressive, anxiety, and substance use disorders; service use; and psychological distress in unadjusted comparisons. In multivariate regressions, GPS persisted as a significant predictor, but there was no significant independent effect of MUPS, after controlling for GPS and other covariates.

Conclusions

Regardless of the presence or absence of medical explanations, physical symptoms are an important component of common mental disorders such as depression and anxiety and predict service use in community populations. These results suggest that three or more current GPS can be used to designate a “case” and that detailed probes and procedures aimed at determining whether or not physical symptoms are medically unexplained may not be necessary for classification purposes.     

Early retirement from work among employees with a diagnosis of personality disorder compared to anxiety and depressive disorders

Objective

Risk of retirement from work before statutory retirement age among employees with personality disorders is unknown.

Method

We used diagnoses of awarded medical rehabilitations and hospitalisations to select two clinical cohorts from a population of 151,618 employees: participants in rehabilitation (total N = 1942, 233 personality disorder, 419 anxiety disorder and 1290 depression cases) and hospitalised patients (N = 1333, 354, 126 and 853, respectively). Early retirement from work was tracked through national registers during a period of 5 years. Cox proportional hazard models were used to examine the association of diagnostic groups with risk of early retirement.

Results

In models adjusted for age, sex and socioeconomic position, the relative risk of early retirement for patients with personality disorders was 3.5-fold (95% CI 2.1 to 5.8) in the rehabilitation cohort and 2.3-fold (95% CI 1.6 to 3.5) in the hospital cohort compared with anxiety disorders. The corresponding hazard ratios of early retirement for personality disorders compared with depressive disorders were 1.1 (95% CI 0.8-1.5) and 1.7 (95% CI 1.4-2.1), respectively.

Conclusions

Personality disorders increase the risk of early retirement at least to an equal extent as depression and more than twice that of anxiety disorders.     

Childhood adversity and personality disorders: results from a nationally representative population-based study

Background

Although, a large population-based literature exists on the relationship between childhood adversity and Axis I mental disorders, research on the link between childhood adversity and Axis II personality disorders (PDs) relies mainly on clinical samples. The purpose of the current study was to examine the relationship between a range of childhood adversities and PDs in a nationally representative sample while adjusting for Axis I mental disorders.

Methods

Data were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 34,653; data collection 2004-2005); a nationally representative sample of the United States population aged 20 years and older.

Results

The results indicated that many types of childhood adversity were highly prevalent among individuals with PDs in the general population and childhood adversity was most consistently associated with schizotypal, antisocial, borderline, and narcissistic PDs. The most robust childhood adversity findings were for child abuse and neglect with cluster A and cluster B PDs after adjusting for all other types of childhood adversity, mood disorders, anxiety disorders, substance use disorders, other PD clusters, and sociodemographic variables (Odd Ratios ranging from 1.22 to 1.63). In these models, mood disorders, anxiety disorders, and substance use disorders also remained significantly associated with PD clusters (Odds Ratios ranging from 1.26 to 2.38).

Conclusions

Further research is necessary to understand whether such exposure has a causal role in the association with PDs. In addition to preventing child maltreatment, it is important to determine ways to prevent impairment among those exposed to adversity, as this may reduce the development of PDs.     

Dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder

Objective

To examine the relationship between dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder (BPD).

Method

30 BPD patients completed the Wessex Dissociation Scale (WDS), Childhood Trauma Questionnaire (CTQ), General Health Questionnaire (GHQ), and Schema Mode Questionnaire (SMQ).

Results

The ‘Angry and Impulsive Child’ and ‘Abandoned and Abused Child’ modes uniquely predicted dissociation scores. Childhood trauma did not predict dissociation scores.

Conclusions

Findings support the schema mode model of BPD [Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioners guide. London: Guilford Press] and its emphasis on the role of dissociation. Clinically they support the emphasis on the identification and integration of dysfunctional parts of the personality in working with individuals diagnosed with BPD.     

Delirium in children and adolescents: A systematic review of the literature

Objectives

The purpose of this study was to collate all works relating to delirium and probable delirium in children and adolescents published since 1980.

Methods

A systematic review of the literature in all languages published between 1980 and March 2009 was conducted.

Results

The literature is limited to small case series and case reports including a total of 217 children or adolescents with definite delirium and a further 136 children and adolescents with “probable delirium.” These articles, in addition to unsystematic reviews, overviews, editorials, journal commentaries, and pertinent book chapters, are discussed in relation to prevalence, predisposing and precipitating factors, phenomenology, residual psychopathology, mortality, management, and prevention of delirium in childhood and adolescence.

Conclusions

Delirium is an important but neglected disorder of childhood associated with significant morbidity and high mortality. Current clinical practice for management is based on slim empirical evidence.