How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients

• Published in: BMJ open Vol. 11; no. 4; p. e041214
• Main Authors: Glynn, Kevin, McKenna, Frank, Lally, Kevin, O’Donnell, Muireann, Grover, Sandeep, Chakrabarti, Subho, Avasthi, Ajit, Mattoo, Surendra K, Sharma, Akhilesh, Ghosh, Abhishek, Shah, Ruchita, Hickey, David, Fitzgerald, James, Davis, Brid, O'Regan, Niamh, Adamis, Dimitrious, Williams, Olugbenja, Awan, Fahad, Dunne, C, Cullen, Walter, McInerney, Shane, McFarland, John, Jabbar, Faiza, O'Connell, Henry, Trzepacz, Paula T, Leonard, Maeve, Meagher, David
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 14.04.2021; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adult; Age; Clinical medicine; Cross-Sectional Studies; Delirium; delirium & cognitive disorders; Delirium - diagnosis; Delirium - etiology; Dementia; Drug withdrawal; Etiology; geriatric medicine; Humans; Hyperactivity; India; Ireland - epidemiology; Mental Health; Metabolism; Mortality; Palliative Care; Patients; Phenomenology; Psychiatry; Questionnaires; Severity of Illness Index; Tumors; Ireland; India; dementia; psychiatry; delirium & cognitive disorders; geriatric medicine
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-041214

ObjectivesTo investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.DesignCross-sectional study.SettingInternational study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.Participants1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).Primary and secondary outcome measuresHyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.ResultsHypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001).ConclusionsThis study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.