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Delirium in elderly: the role of psychiatric expertise in a multi-disciplinary team

Mariana Arnaoudova

Abstract

INTRODUCTION: Delirium is a neurocognitive disorder frequently observed in elderly patients and can be found in any medical condition. Our experience of consulting elderly patients is that delirium is often unrecognized and respectively under-treated. The aim of our study was to evaluate the association between delirium and some risk factors and to elicit important diagnostic and therapeutic issues that could be of practical application to various specialists, dealing with elderly patients with delirium.

PATIENTS AND METHODS: We studied 35 consecutive delirious patients (age 60-88), consulted or admitted at a gerontopsychiatric clinic. The patients came from different hospital settings of the university hospital. The ICD-10 and DSM-IV criteria for delirium and dementia were used. A psychiatric interview, clinical psychiatric and mental status examination, physical, laboratory examination and head computed tomography (CT) were performed. Cognitive impairment was recorded by Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT). Descriptive statistic and correlation analysis were applied.

RESULTS AND DISCUSSION: Dementia was diagnosed in 23 (65.7%) out of all 35 delirious patients. Delirium was associated with factors such as prior cognitive impairment (dementia), advanced age, medical conditions and alcohol abuse. Without significant influence on the development of delirium were gender, marital status and education. Much of the disputable diagnostic issues are associated with the fact that no concrete speciality is dealing with the different aspects of delirium. The risk factors (predisposing and precipitating) provoking delirium should be concerned. The role of psychiatry services should be not restricted only to placement issues and acute treatment.

CONCLUSION: Delirium in elderly is a serious medical problem, requiring precise and appropriate diagnosis and management. The fact that delirium is often multifactorial in origin necessitates a broad intervention strategy. The attention should be on prevention, primary and secondary, mostly by active psychiatric consultation.

Keywords: delirium, elderly, risk factors, diagnosis, management, psychiatric expertise


Keywords

delirium; elderly; risk factors; diagnosis; management; psychiatric expertise

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DOI: http://dx.doi.org/10.14748/ssm.v46i2.682
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About The Author

Mariana Arnaoudova
Medical University of Varna
Bulgaria

Department of psychiatry and medical psychology, St. Marina University Hospital of Varna

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