María Victoria Ocampo

MMSE items that predict incident delirium and hypoactive subtype in older medical inpatients

Because hypoactive delirium is especially under-recognized, we analyzed which Mini-Mental State Examination (MMSE) items predicted incident delirium and its hypoactive motor presentation. Over a 1-year period, older medical inpatients (n=291) were consecutively screened on admission with the Confusion Assessment Method-Spanish (CAM-S) to exclude prevalent delirium. Nondelirious patients were evaluated the same day with the MMSE, followed by daily ratings with the CAM-S. Those who became CAM-S positive were rated using the Delirium Rating Scale-Revised-98 to assess severity and motor subtype. Disorientation to time (OR 4.4, 95% CI 1.7-11.1) and place (OR 3.8, 95% CI 1.7-8.2) at admission were risk factors for delirium at follow-up and together correctly classified 88.3% of subjects as to delirium status. Disorientation to time and place, and visuoconstructional impairment were each associated with either hypoactive or mixed subtype (p<0.05 χ(2) test). Simple bedside evaluation of cognitive function in nondelirious patients revealed deficits that detected patients at risk for developing incident delirium at follow-up (especially hypoactive or mixed). We recommend patients with orientation deficits be monitored closely for emergence of delirium. A separate evaluation for possible dementia or other causes of cognitive impairment at admission should be considered too.

Características clínicas de 276 pacientes tratados con terapia electroconvulsiva en una clínica universitaria de Medellín, Colombia*

OBJECTIVE To describe the socio-demographic and clinical characteristics of patients undergoing Electroconvulsive Therapy with Anesthesia and Relaxation (ECTAR) for 10 years in a university clinic. METHODOLOGY Review of 276 medical records of patients who had undergone ECTAR between 1997 and 2007 at the Clínica Universitaria Bolivariana de Medellín, Colombia. Data was collected through an instrument designed for that purpose and then was analyzed. RESULTS During 10 years, more than 2000 ECT procedures were performed; most of the patients were female 67.4%, between 15 and 86 years old. The first indication was a major depressive episode without psychotic symptoms (56.5%) almost half of the patients had a minor and temporary complication, and no major complications or deaths were reported. Pre-oxygenation, intravenous anesthesia and muscular relaxation were used in all procedures. CONCLUSIONS The ECT used in a third-level hospital with participation of a trained, interdisciplinary team (psychiatrist, anesthesiologist, nursing assistants) and the use of the modified technique (oxygenation, monitoring, general anesthesia, and relaxation is safe for certain psychiatric pathologies disorders that have not responded to medication or when medication is counter-indicated.Resumen Objetivo Describir las caracteristicas sociodemograficas y clinicas de los pacientes tratados durante un periodo de diez anos con terapia electroconvulsiva con anestesia y relajacion (TECAR) en una clinica universitaria. Metodologia Se revisaron 276 historias clinicas de los pacientes tratados con TECAR entre 1997 y 2007 en la Clinica Universitaria Bolivariana de Medellin, Colombia. Los datos fueron recolectados con un instrumento disenado para tal fin y luego fueron analizados. Resultados En los diez anos, se realizaron mas de 2.000 sesiones de TECAR. La mayoria de los pacientes fueron mujeres (67,4%) entre 15 y 86 anos de edad; la principal indicacion fue el episodio depresivo mayor sin sintomas psicoticos (56,5%). Casi la mitad de los pacientes presentaron alguna complicacion menor y transitoria, y no se presento ningun deceso. En la totalidad de los procedimientos se utilizo preoxigenacion, anestesia intravenosa y relajacion muscular. Conclusiones La terapia electroconvulsiva realizada en un hospital de tercer nivel, con la participacion de un equipo interdisciplinario entrenado (psiquiatra, anestesiologo, auxiliar de enfermeria) y utilizando la tecnica modificada (oxigenacion, monitorizacion, anestesia general y relajacion muscular) es segura para algunas patologias psiquiatricas que no han respondido a medicamentos, o en casos en los que exista contraindicacion para los medicamentos.