Benjamin Liptzin

The Delirium Symptom Interview: An Interview for the Detection of Delirium Symptoms in Hospitalized Patients:

To study delirium in hospitalized elderly, a delirium symptom interview (DSI) was developed by an interdisciplinary group of investigators. This interview was administered in an acute care hospital to 50 patients who were over the age of 65 years. Results from the interview were compared to assessments of major symptoms of delirium made independently by a neurologist and a psychiatrist. This interview had good validity and reliability. The sensitivity of the DSI was .90 and the specificity was .80, when compared with the clinical judgment of a psychiatrist and neurologist. Interrater reliability, using lay interviewers, was .90 for the detection of major symptoms of delirium. These results indicate that the DSI could be used by lay interviewers to assess reliably the symptoms of delirium. (J Geriatr Psychiatry Neurol 1992;5:14–21).

Donepezil in the Prevention and Treatment of Post-Surgical Delirium

OBJECTIVE Delirium is a frequent complication of major surgery in older persons. The authors evaluated the possible benefit of donepezil versus placebo in the prevention and treatment of postoperative delirium in an older population without dementia undergoing elective total joint-replacement surgery. METHODS A sample of 80 patients participated in this randomized, double-blind, placebo-controlled trial of donepezil. Each participant was evaluated before surgery and then received donepezil or placebo for 14 days before surgery and 14 days afterward. Postoperative delirium was assessed with the Delirium Symptom Interview, Confusion Assessment Method, daily medical record, nurse-observation reviews, and DSM-IV diagnostic criteria for delirium. Subsyndromal delirium was also assessed for each participant. RESULTS Delirium, diagnosed by DSM-IV criteria, was found on at least 1 postoperative day in 18.8% of subjects, but there were no significant differences between the donepezil and placebo groups. When delirium was present, it lasted only 1 day, and there was no difference between the groups. Subsyndromal delirium was found on at least 1 postoperative day for 68.8% of subjects, and, when this occurred, lasted 2 days or less, on average. There was no difference between the groups in the occurrence or duration of subsyndromal delirium. There was no difference between the groups in disposition to home or to another facility. CONCLUSIONS This pilot study was unable to demonstrate a benefit for donepezil in preventing or treating delirium in a relatively young and cognitively-intact group of elderly patients undergoing elective orthopedic surgery. Furthermore, postoperative delirium was not a major problem in this population.

Epidemiology of Delirium: An Overview of Research Issues and Findings

This paper provides a review of research issues and findings on the epidemiology of delirium. Despite the fact that research on this important geriatric syndrome has been conducted for many decades, several methodological issues make it difficult to compare findings across studies. In this paper we first discuss broadly methodological issues related to diagnosis, case-finding, and populations studied. We next review data on the occurrence and consequences of the syndrome. A discussion of the design and preliminary results of the Commonwealth-Harvard Study of Delirium in Elderly Hospitalized Patients documents both how we responded to the methodological issues outlined and how these choices influenced our findings. We conclude with a discussion of the needs for further research on the epidemiology of delirium.

Progression and Resolution of Delirium in Elderly Patients Hospitalized for Acute Care

The authors describe the clinical course of delirium in 325 elderly patients hospitalized for acute care. Of those patients who developed DSM-III delirium (n = 91), over two-thirds of patients (69.2%) experienced a prodromal period of at least 1 day prior to meeting full DSM-III criteria. Clinical evidence of delirium frequently persisted after hospital discharge although there was evidence of lessening of the extent of symptoms over time. These findings have implications for discharge planners concerned with providing appropriate supports for those still experiencing delirium symptoms at the time of hospital discharge.

Review of research instruments and techniques used to detect delirium.

Over the past several decades, numerous investigators have studied the syndrome of delirium. Researchers have relied on a number of different case finding methods to detect the syndrome. This paper provides an overview of instruments used in studies of delirium. We assess the validity and reliability of these instruments and compare the advantages and disadvantages of the different methods. We then present the rationale for the development of the Delirium Symptom Interview, an instrument constructed for use in the Commonwealth-Harvard Study of delirium in elderly hospitalized patients.

What Criteria Should Be Used for the Diagnosis of Delirium

DSM-IV made several revisions to the diagnostic criteria for delirium. This paper reviews the empirical data that supported these revisions. More research is needed to evaluate the usefulness of the new criteria and to further define subtypes of delirium.

Diagnosis of affective disorders in the elderly

Abstract Depression is the major affective disorder in the elderly, as in the younger population. Complicating factors in its diagnosis include situational changes, depressive symptoms arising from medical illnesses or drug effects, and difficulty in differentiating the pseudodementia of depression from true dementia. The authors assess possible diagnostic applications of the dexamethasone suppression test, and also comment on specific features of bipolar disorders in the elderly.

Training in Geriatric Psychiatry

The objective of this study was to determine the extent and the barriers to expansion of geriatric psychiatry training in psychiatry training programs in the United States. We mailed a questionnaire to the training directors of all 216 psychiatry residency programs listed with the Accreditation Council for Graduate Medical Education. We received and analyzed 127 responses. Seventy-nine percent of the respondents reported having at least one geriatric specialist on their faculty, and almost half of all reported psychiatry residents take a geriatric rotation. Rates in other medical specialties range from 71% of internal medicine departments to 13% of general surgery departments with any faculty geriatric specialists and from 62% in family practice residents to 3% of neurology residents who take a geriatric rotation. Reported factors inhibiting the introduction of geriatrics into psychiatry residency programs include limited time, insufficient numbers of trained faculty, and insufficient funds. More direct funding supporting the research of geriatric faculty may be needed to stimulate the development of geriatric training.

Financing Academic Departments of Psychiatry

ObjectiveThe authors describe the many financial challenges facing academic departments of psychiatry and the resulting opportunities that may arise.MethodThe authors review the history of financial challenges, the current economic situation, and what may lie ahead for academic departments of psychiatry.ResultsThe current environment has many risks and opportunities for departments of psychiatry. Successful departments will be those that assess their particular strengths and limitations and explore their options for funding.ConclusionDepartments of psychiatry should have multiple funding streams and take advantage of opportunities in their local or regional service area.

The geriatric patient and general hospital psychiatry

The geriatric population in the United States is large and growing. General hospital psychiatrists need to be especially knowledgeable about the issues presented by elderly patients because of their high proportion on medical and surgical services. The special problems involved in treating such patients on inpatient psychiatric units are also discussed.