Psychosomatics 43:183-194, June 2002
© 2002 The Academy of Psychosomatic Medicine
The Delirium Experience
Delirium Recall and Delirium-Related Distress in Hospitalized Patients With Cancer, Their Spouses/Caregivers, and Their Nurses
William Breitbart, M.D.,
Christopher Gibson, Ph.D., and
Annie Tremblay, M.D.
Received January 18, 2002; accepted January 31, 2002. From the Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York. Department of Psychiatry, Hotel Dieu Quebec, Quebec City, Canada. Address for correspondence and reprints: Dr. William Breitbart, Chief, Psychiatry Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1242 Second Avenue, Box 421, New York, New York 10021. Email;Breitbaw{at}mskcc.org
We conducted a systematic examination of the experience of delirium in a sample of 154 hospitalized patients with cancer. Patients all met DSM-IV criteria for delirium and were rated with the Memorial Delirium Assessment Scale as a measure of delirium severity, phenomenology, and resolution. Of the 154 patients assessed, 101 had complete resolution of their delirium and were administered the Delirium Experience Questionnaire (DEQ—a face-valid measure that assesses delirium recall and distress related to the delirium episode). Spouse/caregivers and primary nurses were also administered the DEQ to assess distress related to caring for a delirious patient. Fifty-four (53.5%) patients recalled their delirium experience. Logistic-regression analysis demonstrated that short-term memory impairment (odds ratio [OR] = 38.4), delirium severity (OR = 11.3), and the presence of perceptual disturbances (OR = 6.9) were significant predictors of delirium recall. Mean delirium-related distress levels (on a 0–4 numerical rating scale of the DEQ) were 3.2 for patients who recalled delirium, 3.75 for spouses/caregivers, and 3.09 for nurses. Logistic-regression analysis demonstrated that the presence of delusions (OR = 7.9) was the most significant predictor of patient distress. Patients with "hypoactive" delirium were just as distressed as patients with "hyperactive" delirium. Karnofsky Performance Status (OR = 9.1) was the most significant predictor of spouse/caregiver distress. Delirium severity (OR =5.2) and the presence of perceptual disturbances (OR =3.6) were the most significant predictors of nurse distress. In conclusion, a majority of patients with delirium recall their delirium as highly distressing. Delirium is also a highly distressing experience for spouses/caregivers and nurses who are caring for delirious patients. Prompt recognition and treatment of delirium is critically important to reduce suffering and distress.
Key Words: Delirium • Distress
This article has been cited by other articles:
|
|
|
|
 
W. Breitbart and Y. Alici
Agitation and Delirium at the End of Life: "We Couldn't Manage Him"
JAMA,
December 24, 2008;
300(24):
2898 - 2910.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Leonard, B Raju, M Conroy, S Donnelly, P. Trzepacz, J Saunders, and D Meagher
Reversibility of delirium in terminally ill patients and predictors of mortality
Palliative Medicine,
October 1, 2008;
22(7):
848 - 854.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M Agar, D. Currow, J Plummer, R Chye, and B Draper
Differing management of people with advanced cancer and delirium by four sub-specialties
Palliative Medicine,
July 1, 2008;
22(5):
633 - 640.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C.-K. Fang, H.-W. Chen, S.-I. Liu, C.-J. Lin, L.-Y. Tsai, and Y.-L. Lai
Prevalence, Detection and Treatment of Delirium in Terminal Cancer Inpatients: A Prospective Survey
Jpn. J. Clin. Oncol.,
January 31, 2008;
(2008)
hym155v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. DiMartini, M. A. Dew, R. Kormos, K. McCurry, and P. Fontes
Posttraumatic Stress Disorder Caused by Hallucinations and Delusions Experienced in Delirium
Psychosomatics,
October 1, 2007;
48(5):
436 - 439.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Namba, T. Morita, C. Imura, E. Kiyohara, S. Ishikawa, and K. Hirai
Terminal delirium: families' experience
Palliative Medicine,
October 1, 2007;
21(7):
587 - 594.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. R. Fann, C. M. Alfano, S. Roth-Roemer, W. J. Katon, and K. L. Syrjala
Impact of Delirium on Cognition, Distress, and Health-Related Quality of Life After Hematopoietic Stem-Cell Transplantation
J. Clin. Oncol.,
April 1, 2007;
25(10):
1223 - 1231.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Bosisio, A. Caraceni, L. Grassi, and the Italian Delirium Study Group (IDSG)
Phenomenology of Delirium in Cancer Patients, as Described by The Memorial Delirium Assessment Scale (MDAS) and The Delirium Rating Scale (DRS)
Psychosomatics,
December 1, 2006;
47(6):
471 - 478.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. H. Pitkala, J. V. Laurila, T. E. Strandberg, and R. S. Tilvis
Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial.
J. Gerontol. A Biol. Sci. Med. Sci.,
February 1, 2006;
61(2):
176 - 181.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A Spiller and J. C Keen
Hypoactive delirium: assessing the extent of the problem for inpatient specialist palliative care
Palliative Medicine,
January 1, 2006;
20(1):
17 - 23.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J.-D. Gaudreau, P. Gagnon, M.-A. Roy, F. Harel, and A. Tremblay
Association Between Psychoactive Medications and Delirium in Hospitalized Patients: A Critical Review
Psychosomatics,
August 1, 2005;
46(4):
302 - 316.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Hallenbeck
Palliative Care in the Final Days of Life: "They Were Expecting It at Any Time"
JAMA,
May 11, 2005;
293(18):
2265 - 2271.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Morita, K. Hirai, Y. Sakaguchi, S. Tsuneto, and Y. Shima
Family-Perceived Distress From Delirium-Related Symptoms of Terminally Ill Cancer Patients
Psychosomatics,
April 1, 2004;
45(2):
107 - 113.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Centeno, A. Sanz, and E. Bruera
Delirium in advanced cancer patients
Palliative Medicine,
April 1, 2004;
18(3):
184 - 194.
[Abstract]
[PDF]
|
|
|
Get information about faster international access.
Privacy Policy
Copyright © 2002
Academy of Psychosomatic Medicine.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
