Tuesday, 30 April 2013

Downplay on Delirium?

New England Journal of Medicine July 5th 2012 Vol 367 p30-39

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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