Critical Care Medicine
Journal Article Annotations
2019, 3rd Quarter
Critical Care Medicine
Annotations by O. Joseph Bienvenu, MD, PhD
September 2019
- Treatment and Outcomes in Adult Designated Psychiatric Emergency Service Units.
PUBLICATION #1 — Critical Care Medicine
Post-traumatic stress disorder (PTSD) related symptoms following an experience of delirium.
Grover S, Sahoo S, Chakrabarti S, Avasthi A.
Abstract:
J Psychosom Res.2019 Aug;123:109725. doi: 10.1016/j.jpsychores.2019.05.003. Epub 2019 May 24.
AIM:
To evaluate the prevalence of symptoms of PTSD and its correlates after 2 weeks of recovery, among patients who developed delirium.
METHODOLOGY:
A prospective study designed was followed, in which subjects diagnosed with delirium were evaluated 2 weeks after resolution of symptoms of delirium, for PTSD symptoms by using Impact of Events Scale-Revised version (IES-R).
RESULTS:
59 patients were evaluated for PTSD 2 weeks after resolution of delirium and the total mean IES-R score was 27.81 (SD-11.41). Based on the IES-cut-off scores of the scale, 30.5% of the patients (n = 18) were considered to have substantial symptoms of PTSD, 22% (n = 13) had probable symptoms of PTSD and 15.3% were considered to have partial symptoms of PTSD after resolution of delirium. None of the demographic or clinical factors were associated with development of PTSD. Those with PTSD symptoms had significantly higher prevalence of fluctuation of symptoms, while experiencing delirium and had significantly higher mean scores for the items of motor agitation, attentional deficits, higher total severity score on the Delirium Rating Scale-revised-98 version (DRS-R98) and higher DRS-R-98 total score. Higher severity of delirium as indicated by the total DRS-R98 score and the total DRS-R98 severity score were associated with higher severity of PTSD symptoms. The IES-R total score did not have any significant correlation with duration of illness, duration of delirium or Charlson Co-morbidity index.
CONCLUSIONS:
This study suggests that about one-third of patients who develop delirium go on to develop symptoms of PTSD, after recovery from delirium. Development of PTSD symptoms is associated with severity of delirium. Hence, it is important to treat the delirium adequately and provide psychological support to the patients who develop delirium, after recovery from delirium.
PMID: 31376870
Annotation
The findings:
In hospital-delirium severity, as measured with the DRS-R98, was associated with PTSD symptom severity 2 weeks after recovery from delirium. Delirium symptoms associated with PTSD symptoms included agitation and attentional deficits. As in previous studies of delirium in ICUs, duration of delirium was not associated with PTSD symptom severity.
Strength and weaknesses:
A strength is that the authors followed patients with delirium in any hospital setting, not just intensive care units (ICUs), and they also assessed delirium severity and associated symptoms, not just duration.
Relevance:
This is one of the few studies to show a direct link between delirium and posttraumatic stress symptoms. Most prior studies provided indirect evidence of a link between delirium in the ICU and later PTSD symptoms – e.g., PTSD was associated with amount of administered sedatives and memories of frightening nightmare-like experiences.
Type of study: Prospective cohort
