scholarly journals Frequency of delirium and subsyndromal delirium in an adult acute hospital population

2014 ◽  
Vol 205 (6) ◽  
pp. 478-485 ◽  
Author(s):  
D. Meagher ◽  
N. O'Regan ◽  
D. Ryan ◽  
W. Connolly ◽  
E. Boland ◽  
...  
Keyword(s):  
General Hospital ◽  
Rating Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Acute Hospital ◽  
Point Prevalence ◽  
Point Prevalence Study ◽  
Subsyndromal Delirium ◽  
Confusion Assessment ◽  
Dsm Iv

BackgroundThe frequency of full syndromal and subsyndromal delirium is understudied.AimsWe conducted a point prevalence study in a general hospital.MethodPossible delirium identified by testing for inattention was evaluated regarding delirium status (full/subsyndromal delirium) using categorical (Confusion Assessment Method (CAM), DSM-IV) and dimensional (Delirium Rating Scale-Revised-98 (DRS-R98) scores) methods.ResultsIn total 162 of 311 patients (52%) screened positive for inattention. Delirium was diagnosed in 55 patients (17.7%) using DSM-IV, 52 (16.7%) using CAM and 58 (18.6%) using DRS-R98⩾12 with concordance for 38 (12.2%) individuals. Subsyndromal delirium was identified in 24 patients (7.7%) using a DRS-R98 score of 7–11 and 41 (13.2%) using 2/4 CAM criteria. Subsyndromal delirium with inattention (v. without) had greater disturbance of multiple delirium symptoms.ConclusionsThe point prevalence of delirium and subsyndromal delirium was 25%. There was modest concordance between DRS-R98, DSM-IV and CAM delirium diagnoses. Inattention should be central to subsyndromal delirium definitions.

Delirium classification by the diagnostic and statistical manual – a moving target

2015 ◽  
Vol 27 (6) ◽  
pp. 881-882 ◽  
Author(s):  
Karin J. Neufeld
Keyword(s):  
Rating Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Classification Systems ◽  
Diagnostic Systems ◽  
Delirium Assessment ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Medical Inpatients ◽  
Dsm Iv

The following paper, entitled “A Comparison of Delirium Diagnosis in Elderly Medical Inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 Criteria” by Adamis and colleagues, reports the results of a single delirium assessment of 200 medical inpatients, aged 70 years and older. The aim was to compare the prevalence of delirium using two different diagnostic classification systems (DSM-5 and DSM-IV) and two commonly used research tools (Confusion Assessment Method and the Delirium Rating Scale-Revised ‘98). This editorial focuses on the comparison of the two versions of the DSM. The authors conclude that, while both diagnostic systems identify a core concept of delirium, the DSM-IV criteria are the most inclusive of the four approaches and the DSM-5, the most restrictive, identifying a prevalence of 19.5% and 13%, respectively in this sample. Furthermore, they conclude that these two systems do not appear to detect the same patients: only 14 of 26 (54%) individuals identified as delirious by the more exclusive DSM-5 criteria were also identified as such by DSM-IV.

scholarly journals Un análisis cualitativo del rendimiento del Método de Evaluación de la Confusión

2015 ◽  
Vol 17 (2) ◽  
Author(s):  
Carmen Carrera castro
Keyword(s):  
Sensitivity And Specificity ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Confusion Assessment ◽  
Revisión Sistemática ◽  
Reliability Sensitivity ◽  
Dsm Iv ◽  
Academic Search

<p>Objetivo: el objetivo de esta revisión sistemática descriptiva fue realizar una síntesis y análisis cualitativo sobre el rendimiento de la escala Confusion Assessment Method (CAM) como herramienta diagnóstica en el síndrome confusional agudo (SCA). Metodología: se investigó en PubMed, PsychoInfo, MEDES, SciELO, Cochrane Plus, Medline, Embase, Central, CUIDEN, Google Académico, Academic Search, revistas, libros y búsquedas manuales de referencias bibliográficas en otros medios de divulgación científicos. Lo descriptores fueron los del MeSH: delirium, reliability, sensitivity and specificity, y el término libre: confusion assessment method, que generaron 756 artículos potencialmente aptos, desde el 2009 hasta el 2014. Resultados: se hallaron 0,66 % estudios diagnósticos, de los cuales dos fueron de validación y adaptación cultural al tailandés, uno al alemán, uno de validación en pacientes de cuidados paliativos y el último fue un estudio de cohorte comparativo de evaluación sobre el rendimiento de la escala CAM en comparación con el Manual diagnóstico y estadístico de los trastornos mentales (DSM-IV) y la Clasificación Internacional de Enfermedades (CIE-10). Conclusión: la escala CAM es una herramienta diagnóstica válida, fiable y segura con alto rendimiento, cuando es manejada por profesionales adiestrados para el diagnóstico clínico del SCA. Es necesario desarrollar más investigaciones en la práctica rutinaria de los profesionales de enfermería.</p>

Validation study of the European Portuguese version of the Confusion Assessment Method (CAM)

2014 ◽  
Vol 27 (5) ◽  
pp. 777-784 ◽  
Author(s):  
Sónia Martins ◽  
Carla Lourenço ◽  
João Pinto-de-Sousa ◽  
Filipe Conceição ◽  
José Artur Paiva ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Predictive Value ◽  
Convergent Validity ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Intermediate Care ◽  
Reference Standard ◽  
Confusion Assessment ◽  
European Portuguese ◽  
Dsm Iv

ABSTRACTBackground:The Confusion Assessment Method (CAM) is the most widely used delirium screening instrument. The aim of this study was to evaluate the reliability and validity of the European Portuguese version of CAM.Methods:The sample included elderly patients (≥65 years), admitted for at least 48 h, into two intermediate care units (ICMU) of Intensive Medicine and Surgical Services in a university hospital. Exclusion criteria were: score ≤11 on the Glasgow Coma Scale (GCS), blindness/deafness, inability to communicate and to speak Portuguese. For concurrent validity, a blinded assessment was conducted by a psychiatrist (DSM-IV-TR, as a reference standard) and by a trained researcher (CAM). This instrument was also compared with other cognitive measures to evaluate convergent validity. Inter-rater reliability was also assessed.Results:In this sample (n = 208), 25% (n = 53) of the patients had delirium, according to DSM-IV-TR. Using this reference standard, the CAM had a moderate sensitivity of 79% and an excellent specificity of 99%. The positive predictive value was 95%, indicating a strong ability to confirm delirium with a positive test result, and the negative predictive value was lower (93%). Good convergent validity was also found, in particular with Mini-Mental State Examination (MMSE) (rs = −0.676; p ≤0.01) and Digit Span Test (DST) forward (rs = −0.605; p ≤0.01), as well as a high inter-rater reliability (diagnostic k = 1.00; single items’ k between 0.65 and 1.00).Conclusion:Robust results on concurrent and convergent validity and good reliability were achieved. This version was shown to be a valid and reliable instrument for delirium detection in elderly patients hospitalized in intermediate care units.

A prospective cohort study on predictors of mortality of delirium in an emergency observational unit

QJM ◽  
2020 ◽  
Author(s):  
S Pal ◽  
N Sharma ◽  
S M Singh ◽  
S Kumar ◽  
A K Pannu
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Rating Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Rapid Screening ◽  
Confusion Assessment

Summary Background Delirium is often an underdiagnosed and underestimated neuropsychiatric syndrome, especially in low- and middle-income countries. Aim To document the prevalence and clinical profile of delirium and to detect the baseline parameters associated with in-hospital mortality. Design A prospective cohort study conducted between January 2016 to December 2016 at an adult medical emergency observational unit of an academic hospital in north India. Methods Confusion Assessment Method for the intensive care unit was used for screening and diagnosis of delirium. Subtypes of delirium and severity were defined with the Richmond agitation-sedation scale and Delirium Rating Scale-Revised-98 (DRS-R-98). Results Out of 939 screened patients, 312 (33.2%) had delirium, including 73.7% unrecognized cases. The mean age was 49.1 ± 17.3 years (range 17–90), and only 33.3% of the patients were above 60 years. The prevalence of hypoactive, mixed and hyperactive delirium was 39.1, 33.7 and 27.2%, respectively. Usual predisposing factors were alcohol use disorder (57.4%) and hypertension (51.0%), and infections remain the most common precipitating factors (42.0%). In total, 96.1% of patients received midazolam before delirium onset, and physical restraints were used in 73.4%. Mortality was higher in delirium (19.9% vs. 6.4%). The independent predictors of death in delirium were low diastolic blood pressure (P-value = 0.000), Glasgow coma scale score &lt;15 (P = 0.026), high Acute Physiology and Chronic Health Evaluation II score (P = 0.007), high DRS-R-98 severity score (P = 0.000) and hyperactive delirium (P = 0.024). Conclusion Rapid screening with Confusion Assessment Method for the intensive care unit detected a high prevalence of delirium (even in young patients), and it associated with high mortality.

Screening, Assessment und Diagnostik von Delirien

Pflege ◽  
2007 ◽  
Vol 20 (4) ◽  
pp. 191-204 ◽  
Author(s):  
Wolfgang Hasemann ◽  
Reto W. Kressig ◽  
Doris Ermini-Fünfschilling ◽  
Mena Pretto ◽  
Rebecca Spirig
Keyword(s):  
American Psychiatric Association ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
World Health ◽  
Confusion Assessment ◽  
Internationale Klassifikation Der Krankheiten ◽  
Icd 10 ◽  
Screening Assessment ◽  
Dsm Iv ◽  
Health Organization

Ein Delir ist eine akute Verschlechterung der Aufmerksamkeit und Kognition. Für die Diagnosestellung stehen zwei Klassifikationssysteme zur Verfügung: Das Diagnostische und Statistische Manual Psychischer Störungen (DSM) (American Psychiatric Association, 2000) und die Internationale Klassifikation der Krankheiten (ICD) (World Health Organization, 2006). Während sich die Kernsymptome beider Klassifikationssysteme ähneln, bedarf es für die Diagnose des Delirs nach ICD-10 zusätzlicher Kriterien: Psychomotorischer Störungen, Störungen des Schlaf-Wach-Zyklus und affektiver Störungen. Daher gilt die Diagnosestellung nach ICD als strengeres Verfahren. In Abhängigkeit der untersuchten Population werden bis zu 60% der Delirien, die mittels DSM-IV Kriterien festgestellt wurden, verpasst. Für die klinische Praxis stehen zahlreiche Screening- und Assessmentinstrumente zur Verfügung. In der Regel basieren diese auf den DSM-Kriterien. In diesem Beitrag werden zwei Instrumente vorgestellt, welche Pflegefachpersonen im Rahmen des Basler Delirmanagementprogramms des Universitätsspitals Basel, Schweiz, einsetzen. Das Screening erfolgt mittels der von Schuurmans (2001) entwickelten Delir-Beobachtungs-Screening-Skala (Delirium Observatie Screening Schaal, DOS), das Assessment mittels der von Inouye, van Dyck, Alessi, Balkin, Siegal und Horwitz (1990) entwickelten Confusion Assessment Method (CAM). Während die DOS ein reines Beobachtungsinstrument ist, benötigt die CAM ein strukturiertes Interview, klassischerweise (z.B.) den Minimentalstatus nach Folstein, Folstein und McHugh (1975). Beide Instrumente wurden mittels wissenschaftlicher Kriterien ins Deutsche übersetzt. Dieser Artikel stellt die übersetzten Versionen von DOS und CAM vor, diskutiert ihren Einsatz in einer Schweizer Risikogruppe für Delir und liefert den theoretischen Hintergrund der Diagnosestellung eines Delirs auf den Grundlagen von DSM-IV und ICD-10.

Delir-Diagnostik

2007 ◽  
Vol 20 (2-3) ◽  
pp. 135-139
Author(s):  
B. Dittrich ◽  
G. Gatterer ◽  
T. Frühwald ◽  
U. Sommeregger
Keyword(s):  
Confusion Assessment Method ◽  
Assessment Method ◽  
Psychische Störung ◽  
Confusion Assessment

Zusammenfassung: Das Delir (“akuter Verwirrtheitszustand”) bezeichnet eine psychische Störung, die plötzlich auftritt, durch eine rasche Fluktuation von Bewusstseinslage und Aufmerksamkeitsleistung gekennzeichnet ist und eine organische Ursache hat. Dieses Störungsbild nimmt bei Patienten im höheren Lebensalter deutlich an Häufigkeit zu und verursacht durch verlängerte Krankenhausaufenthalte und ungünstige Krankheitsverläufe erhebliche Kosten im Gesundheitssystem. Daher erscheint eine möglichst frühe Erkennung deliranter Zustandsbilder gerade im Rahmen der Geriatrie von großer Bedeutung. Zu diesem Zweck wurde eine deutsche Version der international weit verbreiteten Confusion Assessment Method entwickelt, die für die Bedürfnisse einer Abteilung für Akutgeriatrie modifiziert wurde. Dargestellt werden die Entwicklung und erste Erfahrungen mit diesem Instrument.

3-Minute Diagnostic Interview for Confusion Assessment Method--Chinese Version

2020 ◽  
Author(s):  
Dong-Liang Mu ◽  
Pan-Pan Ding ◽  
Shu-Zhe Zhou ◽  
Mei-Jing Liu ◽  
Xin-Yu Sun ◽  
...  
Keyword(s):  
Confusion Assessment Method ◽  
Assessment Method ◽  
Diagnostic Interview ◽  
Chinese Version ◽  
Confusion Assessment
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