If
depression is the common cold of psychiatry then delirium must be the backache.
It occurs in about 10% of general hospital admissions and yet the number of
treatment trials you can count on the figures of one hand. The latest from
the very serious New England Journal of Medicine is
not a treatment trial but just adds to the need for proper studies in this
area.
The authors, all from Boston, followed 225 people aged over 60 after they
had had cardiac surgery. Anyone
who has worked in this area knows that delirium post cardiac surgery is almost
the norm; what is not so well established is what happens long term. This study
found that 40% of those who developed delirium (about half the sample) had
still not recovered their preoperative cognitive function six months after
surgery compared with about a quarter of those without delirium. As would be
expected those who developed delirium had significantly worse preoperative
cognitive function.
Delirium
is both preventable and treatable (I find haloperidol like “magic dust” in this
condition). Surely we should be doing better than this – anyone up for a large
prevention trial?
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