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Clinical management of delirium: The response depends on the subtypes. An observational cohort study in 602 patients

Published online by Cambridge University Press:  11 September 2019

Carl Moritz Zipser*
Affiliation:
Department of Neurology and Neurophysiology, University of Zurich, Balgrist University Hospital, Zurich, Switzerland
Silvana Knoepfel
Affiliation:
Department of Consultation Liaison-Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Peter Hayoz
Affiliation:
Department of Consultation Liaison-Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Maria Schubert
Affiliation:
School of Health Professions, Zurich University of Applied Science, Winterthur, Switzerland
Jutta Ernst
Affiliation:
Institute of Nursing Science, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Roland von Känel
Affiliation:
Department of Consultation Liaison-Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Soenke Boettger
Affiliation:
Department of Consultation Liaison-Psychiatry and Psychosomatic Medicine, University of Zurich, University Hospital Zurich, Zurich, Switzerland
*
Author for correspondence: Carl Moritz Zipser, Department of Neurology and Neurophysiology, University of Zurich, Balgrist University Hospital, Forchstrasse 340, 8008Zurich, Switzerland. E-mail: carlmoritz.zipser@balgrist.ch

Abstract

Objective

The hypoactive, hyperactive, and mixed subtypes of delirium differently impact patient management and prognosis, yet the evidence remains sparse. Therefore, we examined the outcome of varying management strategies in the subtypes of delirium.

Methods

In this observational cohort study, 602 patients were managed for delirium over 20 days with the following strategies: supportive care alone or in combination with psychotropics, single, dual, or triple+ psychotropic regimens. Cox regression models were calculated for time to remission and benefit rates (BRs) of management strategies.

Results

Generally, the mixed subtype of delirium caused more severe and persistent delirium, and the hypoactive subtype was more persistent than the hyperactive subtype. The subtypes of delirium were similarly predictive for mortality (P = 0.697) and transfer to inpatient psychiatric care (P = 0.320). In the mixed subtype, overall, psychotropic drugs were administered more often (P = 0.016), and particularly triple+ regimens were administered more commonly compared to hypoactive delirium (P = 0.007). Patients on supportive care benefited most, whereas those on triple+ regimens did worst in terms of remission in all groups of hypoactive, hyperactive, and mixed subtypes (BR: 4.59, CI 2.01–10.48; BR: 4.59, CI 1.76–31.66; BR: 3.36, CI 1.73–6.52; all P < 0.05).

Significance of results

The mixed subtype was more persistent to management than the hypoactive and hyperactive subtypes. Delirium management remains controversial and, generally, supportive care benefited patients most. Psychopharmacological management for delirium requires careful choosing of and limiting the number of psychotropics.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2019

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