Radka Neužilová Michalčáková

Poststroke delirium incidence and outcomes: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).

Objective: To describe the epidemiology and time spectrum of delirium using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and to validate a tool for delirium assessment in patients in the acute poststroke period. Design: A prospective observational cohort study. Setting: The stroke unit of a university hospital. Patients: A consecutive series of 129 patients with stroke (with infarction or intracerebral hemorrhage, 57 women and 72 men; mean age, 72.5 yrs; age range, 35–93 yrs) admitted to the stroke unit of a university hospital were evaluated for delirium incidence. Interventions: None. Measurements and Main Results: Criterion validity and overall accuracy of the Czech version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) were determined using serial daily delirium assessments with CAM-ICU by a junior physician compared with delirium diagnosis by delirium experts using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria that began the first day after stroke onset and continued for at least 7 days. Cox regression models using time-dependent covariate analysis adjusting for age, gender, prestroke dementia, National Institutes of Stroke Health Care at admission, first-day Sequential Organ Failure Assessment, and asphasia were used to understand the relationships between delirium and clinical outcomes. An episode of delirium based on reference Diagnostic and Statistical Manual assessment was detected in 55 patients with stroke (42.6%). In 37 of these (67.3%), delirium began within the first day and in all of them within 5 days of stroke onset. A total of 1003 paired CAM-ICU/Diagnostic and Statistical Manual of Mental Disorders daily assessments were completed. Compared with the reference standard for diagnosing delirium, the CAM-ICU demonstrated a sensitivity of 76% (95% confidence interval [CI] 55% to 91%), a specificity of 98% (95% CI 93% to 100%), an overall accuracy of 94% (95% CI 88% to 97%), and high interrater reliability (&kgr; = 0.94; 95% CI 0.83–1.0). The likelihood ratio of the CAM-ICU in the diagnosis of delirium was 47 (95% CI 27–83). Delirium was an independent predictor of increased length of hospital stay (hazard ratio 1.63; 95% CI 1.11–2.38; p = .013). Conclusions: Poststroke delirium may frequently be detected provided that the testing algorithm is appropriate to the time profile of poststroke delirium. Early (first day after stroke onset) and serial screening for delirium is recommended. CAM-ICU is a valid instrument for the diagnosis of delirium and should be considered an aid in delirium screening and assessment in future epidemiologic and interventional studies in patients with stroke.

Towards a predictive model for post-stroke delirium

Primary objective: To assess predisposing and precipitating risk factors and create a predictive model for post-stroke delirium. Research design: A prospective observational study in a cohort of consecutive patients with ischemic stroke or intracerebral haematoma admitted within 24 hours of stroke onset. Methods: Patients were assessed daily for delirium during the first week by means of DSM-IV criteria and risk factors were recorded. Results: One hundred patients completed a 7-day evaluation (47 women and 53 men, median age 77 years). An episode of delirium was detected in 43 patients (43%). Using multivariate logistic regression, a predictive statistical model was developed that utilized independent risk factors: age (OR = 1.08; 95% CI = 1.02–1.15); intracerebral haemorrhage (OR = 6.11; 95% CI = 1.62–22.98), lesion volume > 40 ccm (OR = 3.99; 95% CI = 1.29–12.39) and either elevated gamma-glytamyl transferase (OR = 4.88; 95% CI = 1.45–16.35) and elevated serum bilirubin (OR = 3.70; 95% CI = 1.32–10.38) or maximum sequential organ failure assessment score >2 (OR = 3.33; 95% CI = 1.06–10.45) with acceptable sensitivity and specificity (69.0% and 80.7%). In ischemic strokes, total anterior circulation infarctions were more frequently associated with delirium (73.3% developed delirium) compared with the remainder of the groups combined (p = 0.004; OR = 6.66; 95% CI = 1.85–24.01). Conclusion: Higher age, metabolic disturbances, intracerebral haemorrhage and larger ischemic hemispheric strokes increase the risk of post-stroke delirium.

Interparental conflict appraisal and general fearfulness in middle adolescence

The purpose of this study is to analyze relationships between interparental conflict and experienced fears in middle adolescents. A total of 534 fifteen-year-old adolescents from the European Longitudinal Study of Pregnancy and Childhood (49% girls) completed measures of interparental conflict (Childrens Perceptions of Interparental Conflict Scale) and their subjective experienced fears (free-response method Cake of Fear). Multiple linear regression analyses indicate that sex significantly predicted the number of reported fears as did feelings of own efficacy in coping with interparental conflict. Girls tend to report more fears and higher conflict frequency, intensity, and threat than boys; the growing feeling of coping efficacy with parental conflict decreases the amount of reported fears only in the group of boys.

Fears in Czech Adolescents A Longitudinal Study

The present study investigates developmental patterns of fear in adolescence. It is based on longitudinal data collected as a part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC) project. A total of 186 Czech adolescents (43% girls) were assessed repeatedly at the age of 11, 13, and 15 years. The free-response method was used to examine individual-specific fears. Fear occurrence, content, and intensity changes in 19 general fear categories in the age groups studied were investigated. The findings reveal that the most common fears of 11- and 13-year-old adolescents were related to school. However, at the age of 15, the most common fear category was the fear of losing someone, or the fear of something happening to somebody. Furthermore, we found that developmental trajectories of fear categories are characterized by a transition from the specific and concrete fears of childhood to the more general and abstract fears of adolescents.

Déjà Vu Experiences in Healthy Czech Adults.

Abstract The study examines the prevalence of déjà vu in healthy Czech adults and explores its relationships with a number of variables: age, sex, neuroticism, depression, the degree of irritability in the limbic system, perceived stress, and finally attachment avoidance and anxiety. The participants were 365 healthy adults ranging from 18 to 70 years recruited in the Czech Republic (mean age = 29.05; SD = 11.17) who filled out online questionnaires. Déjà vu experiences were reported by 324 (88.8%) of them. Persons who experienced déjà vu were younger than the persons who had not experienced it. We found that sex, levels of neuroticism, depression, perceived stress, and attachment did not serve as predictors of experiences of déjà vu phenomena. Finally, those who had reported déjà vu experiences reported more limbic system irritability symptoms. We discuss the possibility that déjà vu reports together with other studied variables mainly reflect the participants’ willingness to report “extraordinal” experiences.