Subsyndromal delirium in the intensive care setting: Phenomenological characteristics and discrimination of subsyndromal delirium versus no and full-syndromal delirium

2017 ◽  
Vol 16 (1) ◽  
pp. 3-13 ◽  
Author(s):  
Soenke Boettger ◽  
David Garcia Nuñez ◽  
Rafael Meyer ◽  
André Richter ◽  
Maria Schubert ◽  
...  
Keyword(s):  
Intensive Care ◽  
Care Setting ◽  
Rating Scale ◽  
Adverse Outcomes ◽  
Cognitive Domain ◽  
Intensive Care Setting ◽  
Text Revision ◽  
Subsyndromal Delirium ◽  
Diagnostic And Statistical Manual ◽  
Dsm Iv

ABSTRACTObjective:Similar to delirium, its subsyndromal form has been recognized as the cause of diverse adverse outcomes. Nonetheless, the nature of this subsyndromal delirium remains vastly understudied. Therefore, in the following, we evaluate the phenomenological characteristics of this syndrome versus no and full-syndromal delirium.Method:In this prospective cohort study, we evaluated the Delirium Rating Scale–Revised, 1998 (DRS–R–98) versus the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM–IV–TR) diagnostic criteria and examined the diagnosis of delirium with respect to phenomenological distinctions in the intensive care setting.Results:Out of 289 patients, 36 with subsyndromal delirium versus 86 with full-syndromal and 167 without delirium were identified. Agreement with respect to the DSM–IV–TR diagnosis of delirium was perfect. The most common subtype in those with subsyndromal delirium was hypoactive, in contrast to mixed subtype in those with full-syndromal delirium versus no motor alterations in those without delirium. By presence and severity of delirium symptoms, subsyndromal delirium was intermediate. The ability of the DRS–R–98 items to discriminate between either form of delirium was substantial. Between subsyndromal and no delirium, the cognitive domain and sleep–wake cycle were more impaired and allowed a distinction with no delirium. Further, between full- and subsyndromal delirium, the prevalence and severity of individual DRS–R–98 items were greater. Although the differences between these two forms of delirium was substantial, the items were not very specific, indicating that the phenomenology of subsyndromal delirium is closer to full-syndromal delirium.Significance of results:Phenomenologically, subsyndromal delirium was found to be distinct from and intermediate between no delirium and full-syndromal delirium. Moreover, the greater proximity to full-syndromal delirium indicated that subsyndromal delirium represents an identifiable subform of full-syndromal delirium.

Delirium in the intensive care setting dependent on the Richmond Agitation and Sedation Scale (RASS): Inattention and visuo-spatial impairment as potential screening domains

2019 ◽  
Vol 18 (2) ◽  
pp. 148-157
Author(s):  
Soenke Boettger ◽  
Rafael Meyer ◽  
André Richter ◽  
Alain Rudiger ◽  
Maria Schubert ◽  
...  
Keyword(s):  
Intensive Care ◽  
Care Setting ◽  
Rating Scale ◽  
Psychomotor Retardation ◽  
Cognitive Domain ◽  
Specific Marker ◽  
Correct Identification ◽  
Intensive Care Setting ◽  
Sedation Scale ◽  
The Impact

AbstractObjectiveIn the intensive care setting, delirium is a common occurrence; however, the impact of the level of alertness has never been evaluated. Therefore, this study aimed to assess the delirium characteristics in the drowsy, as well as the alert and calm patient.MethodIn this prospective cohort study, 225 intensive care patients with Richmond Agitation and Sedation Scale (RASS) scores of −1 — drowsy and 0 — alert and calm were evaluated with the Delirium Rating Scale-Revised-1998 (DRS-R-98) and the Diagnostic and Statistical Manual 4th edition text revision (DSM-IV-TR)-determined diagnosis of delirium.ResultsIn total, 85 drowsy and 140 alert and calm patients were included. Crucial items for the correct identification of delirium were sleep–wake cycle disturbances, language abnormalities, thought process alterations, psychomotor retardation, disorientation, inattention, short- and long-term memory, as well as visuo-spatial impairment, and the temporal onset. Conversely, perceptual disturbances, delusions, affective lability, psychomotor agitation, or fluctuations were items, which identified delirium less correctly. Further, the severities of inattentiveness and visuo-spatial impairment were indicative of delirium in both alert- or calmness and drowsiness.Significance of resultsThe impairment in the cognitive domain, psychomotor retardation, and sleep–wake cycle disturbances correctly identified delirium irrespective of the level alertness. Further, inattentiveness and — to a lesser degree — visuo-spatial impairment could represent a specific marker for delirium in the intensive care setting meriting further evaluation.

Brief assessment of delirium subtypes: Psychometric evaluation of the Delirium Motor Subtype Scale (DMSS)–4 in the intensive care setting

2017 ◽  
Vol 15 (5) ◽  
pp. 535-543 ◽  
Author(s):  
Soenke Boettger ◽  
David Garcia Nuñez ◽  
Rafael Meyer ◽  
Andre Richter ◽  
Maria Schubert ◽  
...  
Keyword(s):  
Intensive Care ◽  
Internal Consistency ◽  
Concurrent Validity ◽  
Care Setting ◽  
Rating Scale ◽  
Motor Symptom ◽  
Intensive Care Setting ◽  
Symptom Scale ◽  
Surgical Intensive Care ◽  
Brief Assessment

ABSTRACTObjective:The management of and prognosis for delirium are affected by its subtype: hypoactive, hyperactive, mixed, and none. The DMSS–4, an abbreviated version of the Delirium Motor Symptom Scale, is a brief instrument for the assessment of delirium subtypes. However, it has not yet been evaluated in an intensive care setting.Method:We performed a prospective/descriptive cohort study in order to determine the internal consistency, reliability, and validity of the relevant items of the DMSS–4 versus the Delirium Rating Scale–Revised-98 (DRS–R-98) and the original DMSS in a surgical intensive care setting.Results:A total of 289 elderly, predominantly male patients were screened for delirium, and 122 were included in our sample. The internal consistency of the DMSS–4 items was excellent (Cronbach's α = 0.92), and between the DMSS–4 and DRS–R-98 the overall concurrent validity was substantial (Cramer's V = 0.67). Within individual motor subtypes, concurrent validity remained at least substantial (Cohen's κ = 0.65–0.81) and sensitivity high (69.8 to 82.2%), in contrast to those of the no-motor subtype, with less validity and sensitivity (κ = 0.28, 22%). Similarly, total concurrent validity between the DMSS–4 and the original DMSS reached perfection (Cramer's V = 0.83), as did agreement between the subtypes (κ = 0.83–0.92), while sensitivity remained high (88.2–100%). Only in those with delirium with no-motor subtype was agreement moderate (κ = 0.56) and sensitivity lower (67%). Specificity was high across all subtypes (91.2–99.1%). The DMSS–4 yielded very sensitive ratings, particularly for hypoactive and hyperactive motor symptoms, and interrater agreement was excellent (Fleiss's κ = 0.83).Significance of Results:We found the DMSS–4 to be a most reliable and valid brief assessment of delirium in characterizing the subtypes of delirium in an intensive care setting, with increased sensitivity to hypoactive and hyperactive motor alterations.

Delirium in the intensive care setting: A reevaluation of the validity of the CAM–ICU and ICDSC versus the DSM–IV–TR in determining a diagnosis of delirium as part of the daily clinical routine

2017 ◽  
Vol 15 (6) ◽  
pp. 675-683 ◽  
Author(s):  
Soenke Boettger ◽  
David Garcia Nuñez ◽  
Rafael Meyer ◽  
André Richter ◽  
Susana Franco Fernandez ◽  
...  
Keyword(s):  
Intensive Care ◽  
Psychometric Properties ◽  
Concurrent Validity ◽  
Care Setting ◽  
High Specificity ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Intensive Care Setting ◽  
Clinical Routine ◽  
Dsm Iv

ABSTRACTBackground:In the intensive care setting, delirium is a common occurrence that comes with subsequent adversities. Therefore, several instruments have been developed to screen for and detect delirium. Their validity and psychometric properties, however, remain controversial.Method:In this prospective cohort study, the Confusion Assessment Method for the Intensive Care Unit (CAM–ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) were evaluated versus the DSM–IV–TR in the diagnosis of delirium with respect to their validity and psychometric properties.Results:Out of some 289 patients, 210 with matching CAM–ICU, ICDSC, and DSM–IV–TR diagnoses were included. Between the scales, the prevalence of delirium ranged from 23.3% with the CAM–ICU, to 30.5% with the ICDSC, to 43.8% with the DSM–IV–TR criteria. The CAM–ICU showed only moderate concurrent validity (Cohen's κ = 0.44) and sensitivity (50%), but high specificity (95%). The ICDSC also reached moderate agreement (Cohen's κ = 0.60) and sensitivity (63%) while being very specific (95%). Between the CAM–ICU and the ICDSC, the concurrent validity was again only moderate (Cohen's κ = 0.56); however, the ICDSC yielded higher sensitivity and specificity (78 and 83%, respectively).Significance of Results:In the daily clinical routine, neither the CAM–ICU nor the ICDSC, common tools used in screening and detecting delirium in the intensive care setting, reached sufficient concurrent validity; nor did they outperform the DSM–IV–TR diagnostic criteria with respect to sensitivity or positive prediction, but they were very specific. Thus, the non-prediction by the CAM–ICU or ICDSC did not refute the presence of delirium. Between the CAM–ICU and ICDSC, the ICDSC proved to be the more accurate instrument.

Abstract 13924: Covid-19 Registry to Assess Frequency, Management, and Outcomes of Arterial and Venous Thromboembolic Complications (CORONA-VTE)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gregory Piazza ◽  
Umberto Campia ◽  
Julia Snyder ◽  
Samantha Rizzo ◽  
Mariana Pfeferman ◽  
...  
Keyword(s):  
Intensive Care ◽  
Venous Thromboembolism ◽  
Adverse Events ◽  
Care Setting ◽  
Adverse Outcomes ◽  
Major Adverse Cardiovascular Events ◽  
Primary Study ◽  
Thromboembolic Complications ◽  
Intensive Care Setting ◽  
Venous Thromboembolic

Introduction: Cardiovascular complications, including myocardial infarction, ischemic stroke, and pulmonary embolism, represent an important source of adverse outcomes in COVID-19. Hypothesis: Arterial and venous thromboembolic complications are a common complication in COVID-19, especially in the cirtically ill and hospitalized populations. Methods: We analyzed a retrospective cohort of 1114 patients with COVID-19 diagnosed through our healthcare network. The total cohort was analyzed by site of care: intensive care (170 patients), hospitalized non-intensive care (229 patients), and outpatient (715 patients). The primary study outcome was a composite of adjudicated major arterial or venous thromboembolism. Results: Patients with COVID-19 were ethnically (22.3% Hispanic/Latinx) and racially (44.2% non-white) diverse. Cardiovascular risk factors of hypertension (35.8%), hyperlipidemia (28.6%), and diabetes (18.0%) were common. Prophylactic anticoagulation was prescribed in 89.4% of patients with COVID-19 in the intensive care cohort and 84.7% of those in the hospitalized non-intensive care setting. Frequencies of major arterial or venous thromboembolism, major cardiovascular adverse events, and symptomatic venous thromboembolism were highest in the intensive care cohort (35.3%, 45.9%, and 27.0 %, respectively) followed by the hospitalized non-intensive care cohort (2.6%, 6.1%, and 2.2%, respectively). The frequency of adverse events in the outpatient cohort was low. Conclusions: Major arterial or venous thromboembolism, major adverse cardiovascular events, and symptomatic venous thromboembolism occurred with high frequency in COVID-19, especially in the intensive care setting, despite a high utilization rate of thromboprophylaxis.

The Classification of Eating Disorders

2010 ◽  
pp. 7-24 ◽  
Author(s):  
Kathryn H. Gordon ◽  
Jill M. Holm-Denoma ◽  
Ross D. Crosby ◽  
Stephen A. Wonderlich
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Latent Class ◽  
Minority Groups ◽  
Statistical Manual ◽  
Text Revision ◽  
Diagnostic And Statistical Manual ◽  
Key Issues ◽  
Dsm Iv

The purpose of the chapter is to elucidate the key issues regarding the classification of eating disorders. To this end, a review of nosological research in the area of eating disorders is presented, with a particular focus on empirically based techniques such as taxometric and latent class analysis. This is followed by a section outlining areas of overlap between the current Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) eating disorder categories and their symptoms. Next, eating disorder classification models that are alternatives to the DSM-IV-TR are described and critically examined in light of available empirical data. Finally, areas of controversy and considerations for change in next version of the DSM (i.e., the applicability of DSM criteria to minority groups, children, males; the question of whether clinical categories should be differentiated from research categories) are discussed.

scholarly journals Neuronavigation-assisted bedside placement of bolt external ventricular drains in the intensive care setting: a technical note

2020 ◽  
Author(s):  
Ivan Cabrilo ◽  
Claudia L. Craven ◽  
Hazem Abuhusain ◽  
Laura Pradini-Santos ◽  
Hasan Asif ◽  
...  
Keyword(s):  
Intensive Care ◽  
Care Setting ◽  
Technical Note ◽  
Intensive Care Setting
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