Differences in the Course of Alcohol Withdrawal in Women and Men: A Polish Sample

A retrospective study compared the course of alcohol withdrawal, including delirium tremens, in women and men hospitalized in the Nowowiejski Hospital in Warsaw from 1973 to 1987. Medical records pertaining to 1179 patients were analyzed; 13.8% of these patients were women and 86.2% were men. The study showed that women began intensive alcohol drinking later than men ( p < 0.0001), but the period between the onset of alcohol abuse and the first occurrence of alcohol withdrawal was shorter in women than in men ( p < 0.0001). In the period of heavy drinking before hospitalization, women consumed significantly less alcohol then men ( p < 0.0001); moreover, women drank nonbeverage alcohol less frequently than men ( p < 0.05). Women were hospitalized substantially longer than men ( p < 0.0001), whereas the duration of alcohol withdrawal symptoms at the time of hospitalization was comparable in both groups. Withdrawal seizures were significantly more frequent among men than among women ( p < 0.001). Significant differences in the patients'somatic conditions were not noted between the groups, with the exception of anemia and decreased potassium concentration, which were more frequently observed in women (both p < 0.0001), and of increased concentration of ALT and hypoproteinemia, which were more frequent in men (respectively, p < 0.05 and p < 0.01). Co-existing personality disorders, depressive disorders, and anxiety disorders—as well as abuse of benzodiazepines and barbiturates—were more frequently observed in women ( p < 0.0001). The period between the first hospitalization due to alcohol withdrawal and the time of death was significantly shorter in men than in women ( p < 0.05). The results point to differences in the conditions and the course of alcohol dependence and alcohol withdrawal between women and men.     

Identifying patients at risk for,and treatment of major psychiatric complications of cancer

A critically important aspect of supportive care in cancer is the prompt recognition and effective treatment of psychiatric complications. Psychiatric disorders such as depression, anxiety and delirium occur in a signifcant percentage of cancer patients, particularly as disease advances and as cancer treatments become more aggressive. This paper reviews factors that can be utilized to identify patients who are at increased risk for developing psychiatric complications, such as those with advanced disease, certain cancer treatments, uncontrolled physical symptoms, functional limitations, lack of social support, and past history of psychiatric disorder. Methods of diagnostic assessment and strategies for managing depression, anxiety, delirium and suicidal ideation are also reviewed.Presented as an invited lecture at the 6th International Symposium: Supportive Care in Cancer, New Orleans, La., USA, 2–5 March 1994     

Über die beziehungen zwischen halluzinationen im alkoholdelir and testpsychologisch objektivierbaren persönlichkeitsvariablen

Zusammenfassung Bei 83 Patienten, die sich wegen Delirium tremens bei chronischem Alkoholismus in der Psychiatrischen Universitätsklinik Würzburg zur stationären Behandlung befanden, wurde der Zusammenhang zwischen Auftreten und Qualität von Halluzinationen im Delir mit Persönlichkeitsmerkmalen im postdeliranten Statium untersucht. Die Persönlichkeitsmerkmale wurden in 13 Variablen kognitiver Leistungen und in 12 Variablen der Emotionalät t and der Motivation erfaßt. Es wurden der Status am Beginn des postdeliranten Stadiums auf diesen Variablen und ihre Veränderungen bei einer Kontrolle in der 4. Woche in die Berechnung einbezogen. Zwischen jener Patientengruppe, bei der Halluzinationen im Delir festgestellt wurden waren, and den Patienten, bei denen sich kein Hinweis auf Halluzinationen ergeben hatte, war weder im Ausgangszustand noch in den Veranderungen der Personlichkeitsvariablen im postdeliranten Stadium ein statistisch bedeutsamer Unterschied nachzuweisen. Hier gilt es allerdings zu beachten, daß der Anted der Patienten ohne Halluzinationen verhältnismäßig gering war. Deutliche Beziehungen ergaben sich dagegen zwischen der Gestaltung der Halluzinationen and den Persönlichkeitsvariblen: Patienten, die polymorph halluziniert hatten, wiesen geringere Leistungsdefizite und im affektiven Bereich deutlichere Zeichen der Ängstlichkeit auf als jene, die monomorph halluziniert hatten. Letztere hoben sich in der Affektivität durch Zeichen eher gehemmter Depressivität von ersteren ab. Die Restitution der kognitiven Fähigkeiten nahm bei den polymorph Halluzinierenden einen günstigeren Verlauf. Die wenigen Korrelationen, die sich zwischen Sinnesmodalitäten der Halluzinationen und Persönlichkeitsvariablen ergeben hatten, waren unter die Differenzierung zwischen poly und monomorpher Halluzination unterzuordnen.Die Untersuchung fand mit treundlicher Unterstützung des verstorbenen Direktors der Psychiatrischen Universitätsklinik Würzburg, Prof. Dr. Otto Schrappe, dessen die Autoren hier dankbar gedenken, start. Herr Schrappe gestattete die Datenerhebung in seiner Klinik, und er stand den Autoren his zur Fertigstellung des Manuskripts mit wertvollen Ratschlägen zur Seite.     

Probable Delirium and Associated Patient Characteristics in Long-Term Care and Complex Continuing Care: A Population-Based Observational Study

ObjectivesTo estimate the prevalence of probable delirium in long-term care (LTC) and complex continuing care (CCC) settings and to describe the resident characteristics associated with probable delirium.DesignPopulation-based cross-sectional study using routinely collected administrative health data.Setting and ParticipantsAll LTC and CCC residents in Ontario, Canada, assessed with the Resident Assessment Instrument–Minimum Dataset (RAI-MDS) assessment between July 1, 2016, and December 31, 2016 (LTC n=86,454, CCC n=10,217).MethodsProbable delirium was identified via the delirium Clinical Assessment Protocol on the RAI-MDS assessment, which is triggered when individuals display at least 1 of 6 delirium symptoms that are of recent onset and different from their usual functioning. RAI-MDS assessments were linked to demographic and health services utilization databases to ascertain resident demographics and health status. Multivariable logistic regression was used to identify characteristics associated with probable delirium, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) reported.ResultsDelirium was probable in 3.6% of LTC residents and 16.5% of CCC patients. LTC patients displayed fewer delirium symptoms than CCC patients. The most common delirium symptom in LTC was periods of lethargy (44.6% of delirium cases); in CCC, it was mental function varying over the course of the day (63.5% of delirium cases). The odds of probable delirium varied across individual demographics and health characteristics, with increased health instability having the strongest association with the outcome in both care settings (LTC: OR 30.4, 95% CI 26.2-35.3; CCC: OR 21.0, 95% CI 16.7-26.5 for high vs low instability).Conclusions and ImplicationsThere were differences in the presentation and burden of delirium symptoms between LTC and CCC, potentially reflecting differences in delirium severity or symptom identification. Several risk factors for probable delirium in LTC and CCC were identified that may be amenable to interventions to prevent this highly distressing condition.     

谵妄护理压力量表的汉化及信效度评价

目的 对谵妄护理压力量表（Strain of Care for Delirium Index,SCDI）进行汉化及信效度评价。方法 获得源量表开发者的授权后,采用Brislin法进行翻译、回译,并进行跨文化调适。调查337名具有谵妄患者护理经历的护士,采用临界比值法和相关系数法进行量表项目分析;探索性因子分析和验证性因子分析评价量表的效度;采用Cronbach α系数、重测信度评价量表的信度。结果 （1）中文版SCDI包含4个维度,20个条目。各条目与总分之间的相关系数为0.334～0.693（均P<0.05）,临界值为4.933～14.952（均P<0.05）。（2）探索性因子分析共提取出四个公因子,累计方差贡献率 63.638%,每个条目的因子负荷量为0.487～0.866（均＞0.45）;验证性因子分析显示,〖XC小五号.EPS;P〗/df为2.275、CFI为0.942、GFI为0.907、AGFI为0.875、RMSEA为0.062、RMR为0.021、IFI为0.943、TLI为0.929,模型的适配度良好。（3）总量表的Cronbach α系数是0.894,四个维度的 Cronbach α系数在 0.744～0.920之间;总量表的重测信度为0.898,四个维度的重测信度在 0.706～0.806之间。结论 中文版SCDI具有良好的信效度,可用于量化评估我国护理人员的谵妄护理压力。     

Prevalence of Delirium in End-of-Life Palliative Care Patients: An Observational Study

ObjectivesThe aim of this study was to assess the prevalence of delirium, using the Assessment Test for Delirium and Cognitive Impairment (4AT) in end-of-life palliative care patients.Subjects and MethodsThis retrospective cross-sectional study was conducted on end-of-life patients in a hospice or at home. All patients were evaluated with the 4AT for the presence of delirium.ResultsOf the 461 patients analyzed, 76 (16.5%) were inpatients and 83.5% (385) outpatients. The median age was 79.5 (72–86) years, and 51.0% were female. According to the 4AT score, 126 patients (27.3%) had delirium (A4T ≥4) at admission, 28 (36.8%) were inpatients, and 98 (25.5%) outpatients. Around 33.8% of the cancer inpatients had delirium, while 20.6% of the cancer outpatients had delirium. The prevalence of delirium varied according to the setting, clinical condition, and life expectancy. In addition, 55.0% (11) actively dying inpatients, within 3 days, had delirium, and 56.7% (17) outpatients had delirium; while among those with life expectancy longer than 4 days, 30.4% (17) inpatients and 22.8% (81) outpatients were with delirium.ConclusionsOur study confirms that delirium is common in cancer and noncancer palliative care patients. Further research on delirium in end-of-life palliative care patients should consider the complexity of palliative care of this population as well as of the characteristics of the settings.     

重症监护室患者谵妄发生情况及其影响因素分析

目的：探讨分析重症监护室患者谵妄发生情况及其影响因素。方法选择2009年3月-2013年2月于昆明医科大学第一附属医院重症监护室收治的503例患者的临床资料,根据患者在重症监护室期间是否发生谵妄将所有患者分为谵妄组（85例）和对照组（418例）,比较两组患者的临床资料,采用单因素分析,Logistic多因素回归分析重症监护室患者谵妄发生情况及其影响因素。结果503例患者中16.90%（85/503）的患者发生谵妄,谵妄组与对照组在年龄、糖尿病、低血压或心源性休克、缺氧、电解质紊乱、睡眠障碍、使用咪唑安定、感染、射血分数〈40%、机械通气情况的比较差异有统计学意义（P〈0.05）。低血压或心源性休克（β=1.830,OR =6.290）、缺氧（β=1.778,OR =5.918）、电解质紊乱（β=1.462,OR =4.315）、睡眠障碍（β=1.475,OR =4.371）、使用咪唑安定（β=1.746,OR =5.732）、感染（β=1.759,OR =5.807）、机械通气（β=1.822,OR =6.184）是重症监护室患者发生谵妄的独立危险因素。结论低血压或心源性休克、缺氧、电解质紊乱、睡眠障碍、使用咪唑安定、感染、机械通气是重症监护室患者发生谵妄的独立危险因素,对于合并有上述临床特征的患者,应及时实施针对性的措施以降低患者发生谵妄的风险。