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Impact of an educational workshop upon psychiatrists’ attitudes towards delirium care

Published online by Cambridge University Press:  21 March 2017

N. A. O’Regan
Affiliation:
Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
M. M. Mohamad
Affiliation:
Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick, Ireland Department of Adult Psychiatry, University Hospital Limerick, Limerick, Ireland Graduate Entry Medical School, University of Limerick, Limerick, Ireland
D. J. Meagher*
Affiliation:
Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Limerick, Ireland Department of Adult Psychiatry, University Hospital Limerick, Limerick, Ireland
*
*Address for correspondence: Professor D. Meagher, Graduate Entry Medical School, University of Limerick, Ireland.(Email: [email protected])

Abstract

Objectives

Improving knowledge about delirium care is a key target for health care. We describe the implementation of a four-part workshop focusing upon key aspects of delirium care.

Methods

Attitudes towards and understanding of delirium diagnosis and management amongst psychiatrists were surveyed before and immediately after an educational workshop.

Results

There were 62 participants. Pre-workshop, delirium was rated highly relevant to psychiatry. Overall level of confidence in diagnosis was modest, with the behavioural and psychological symptoms of dementia considered the most challenging differential diagnosis. Only nine participants (15%) correctly identified DSM-5 delirium criteria. Preferred assessment of attention varied with six different approaches endorsed. Confidence was higher for managing hyperactive compared with hypoactive delirium (p<0.001). Pharmacotherapy was more frequently endorsed for hyperactive compared with hypoactive presentations, with haloperidol the most popular agent (p<0.001). A total of 41 (66%) participants completed post-workshop assessments. Post-workshop, there were significant increases to the perceived relevance of delirium (p = 0.003), confidence in overall diagnosis (p<0.001) accuracy of awareness of DSM-5 criteria (p<0.001), and confidence in treating different presentations (p<0.001). The Months Backward Test was the preferred bedside test of attention (38/40 respondents).

Conclusions

This interactive educational intervention impacted positively upon knowledge and attitudes amongst psychiatrists towards key aspects of delirium care. Further investigation can examine the impact upon longer term knowledge and behaviour.

Type
Original Research
Copyright
© College of Psychiatrists of Ireland 2017 

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References

Adamis, D, Meagher, D, Murray, O, O’Neill, D, O’Mahony, E, Mulligan, O, McCarthy, G (2016). Evaluating attention in delirium: a comparison of bedside tests of attention. Geriatrics and Gerontology International 16, 10281035.CrossRefGoogle Scholar
Adamis, D, Treloar, A, Martin, FC, Macdonald, AJ (2007). A brief review of the history of delirium as a mental disorder. History of Psychiatry 18, 459469.CrossRefGoogle ScholarPubMed
Boettger, S, Breitbart, W, Passik, S (2011). Haloperidol and risperidone in the treatment of delirium and its subtypes. European Journal of Psychiatry 25, 5967.Google Scholar
Brajtman, S, Higuchi, K, McPherson, C (2006). Caring for patients with terminal delirium: palliative care unit and home care nurses’ experiences. International Journal of Palliative Nursing 12, 150156.CrossRefGoogle ScholarPubMed
Davis, D, MacLullich, A (2009). Understanding barriers to delirium care: a multicentre survey of knowledge and attitudes amongst UK junior doctors. Age and Ageing 38, 559563.CrossRefGoogle ScholarPubMed
Fisher, JM, Gordon, AL, MacLullich, AM, Tullo, E, Davis, DH, Blundell, A, Field, RH, Teodorczuk, A (2015). Towards an understanding of why undergraduate teaching about delirium does not guarantee gold-standard practice – results from a UK national survey. Age and Ageing 44, 166170.CrossRefGoogle Scholar
Fong, TG, Jones, RN, Shi, P, Marcantonio, ER, Yap, L, Rudolph, JL, Yang, FM, Kiely, DK, Inouye, SK (2009). Delirium accelerates cognitive decline in Alzheimer disease. Neurology 72, 15701575.CrossRefGoogle ScholarPubMed
Gaudreau, JD, Gagnon, P, Harel, F, Roy, MA, Tremblay, A (2005). Psychoactive medications and risk of delirium in hospitalized cancer patients. Journal of Clinical Oncology 23, 67126718.CrossRefGoogle ScholarPubMed
González, M, Martínez, G, Calderón, J, Villarroel, L, Yuri, F, Rojas, C, Jeria, A, Valdivia, G, Marín, PP, Carrasco, M (2009). Impact of delirium on short-term mortality in elderly inpatients: a prospective cohort study. Psychosomatics 50, 234238.CrossRefGoogle ScholarPubMed
Hally, O, Cooney, C. (2005). Delirium in the hospitalized elderly: an audit of NCHD prescribing practice. Irish Journal of Psychological Medicine 22, 133136.CrossRefGoogle Scholar
Hui, D, Reddy, A, Palla, S, Bruera, E (2011). Neuroleptic prescription pattern for delirium in patients with advanced cancer. Journal of Palliative Care 27, 141147.CrossRefGoogle ScholarPubMed
Jenkin, RP, Al-Attar, A, Richardson, S, Myint, PK, MacLullich, AM, Davis, DH (2016). Increasing delirium skills at the front door: results from a repeated survey on delirium knowledge and attitudes. Age and Ageing 45, 517522.CrossRefGoogle ScholarPubMed
Leonard, M, Adamis, D, Saunders, J, Trzepacz, PT, Meagher, D (2015). A longitudinal study of delirium phenomenology indicates widespread neural dysfunction. Palliative and Supportive Care 13, 187196.CrossRefGoogle ScholarPubMed
Liu, CY, Juang, YY, Liang, HY, Lin, NC, Yeh, EK (2004). Efficacy of risperidone in treating the hyperactive symptoms of delirium. International Clinical Psychopharmacology 19, 165168.CrossRefGoogle ScholarPubMed
Lonergan, E, Luxenberg, J, Areosa-Sastre, A, Wyller, TB (2009). Benzodiazepines for delirium. Cochrane Database Systematic Review 21, CD006379.Google Scholar
Lyne, J, O’Donoghue, B, Bonnar, M, Golden, D, McInerney, C, Callanan, I, Ryan, M (2010). Reasons for referral and consultation liaison psychiatry diagnoses. Irish Journal of Psychological Medicine 27, 123129.CrossRefGoogle ScholarPubMed
MacLullich, AM, Beaglehole, A, Hall, RJ, Meagher, DJ (2009). Delirium and long-term cognitive impairment. International Review of Psychiatry 21, 3042.CrossRefGoogle ScholarPubMed
Mac Sweeney, R, Barber, V, Page, V, Ely, EW, Perkins, GD, Young, JD, McAuley, DF (2010). A national survey of the management of delirium in UK intensive care units. Quarterly Journal of Medicine 103, 243251.CrossRefGoogle ScholarPubMed
Meagher, D (2009). Motor subtypes of delirium: past, present and future. International Review of Psychiatry 21, 5973.CrossRefGoogle ScholarPubMed
Meagher, D, Leonard, M, Donnelly, S, Conroy, M, Adamis, D, Trzepacz, PT (2011). A longitudinal study of motor subtypes in delirium: relationship with other phenomenology, etiology, medication exposure and prognosis. Journal of Psychosomatic Research 71, 395403.CrossRefGoogle ScholarPubMed
Meagher, DJ, McLoughlin, L, Leonard, M, Hannon, N, Dunne, C, O’Regan, N (2013). What do we really know about the treatment of delirium with antipsychotics? Ten key issues for delirium pharmacotherapy. The American Journal of Geriatric Psychiatry 21, 12231238.CrossRefGoogle ScholarPubMed
Meagher, DJ, Moran, M, Raju, B, Gibbons, D, Donnelly, S, Saunders, J, Trzepacz, PT (2007). Phenomenology of delirium. Assessment of 100 adult cases using standardised measures. British Journal of Psychiatry 190, 135141.CrossRefGoogle ScholarPubMed
Meagher, J, Leonard, M, Donoghue, L, O’Regan, N, Timmons, S, Exton, C, Cullen, W, Dunne, C, Adamis, D, Maclullich, AJ, Meagher, D (2015). Months backward test: a review of its use in clinical studies. World Journal of Psychiatry 5, 305314.CrossRefGoogle ScholarPubMed
Morandi, A, Davis, D, Taylor, JK, Bellelli, G, Olofsson, B, Kreisel, S, Teodorczuk, A, Kamholz, B, Hasemann, W, Young, J, Agar, M, de Rooij, SE, Meagher, D, Trabucchi, M, MacLullich, AM (2013). Consensus and variations in opinions on delirium care: a survey of European delirium specialists. International Psychogeriatrics 25, 20672075.CrossRefGoogle ScholarPubMed
Namba, M, Morita, T, Imura, C, Kiyohara, E, Ishikawa, S, Hirai, K (2007). Terminal delirium: families’ experience. Palliative Medicine 21, 587594.CrossRefGoogle ScholarPubMed
O’Hanlon, S, O’Regan, N, Maclullich, AM, Cullen, W, Dunne, C, Exton, C, Meagher, D (2014). Improving delirium care through early intervention: from bench to bedside to boardroom. Journal of Neurology, Neurosurgery and Psychiatry 85, 207211.CrossRefGoogle ScholarPubMed
O’Regan, NA, Ryan, DJ, Boland, E, Connolly, W, McGlade, C, Leonard, M, Clare, J, Eustace, JA, Meagher, D, Timmons, S (2014). Attention! A good bedside test for delirium? Journal of Neurology, Neurosurgery, and Psychiatry 85, 11221131.CrossRefGoogle ScholarPubMed
O’Sullivan, R, Inouye, S, Meagher, D (2014). Delirium and depression: inter-relationship and overlap in elderly people. Lancet Psychiatry 1, 303311.CrossRefGoogle ScholarPubMed
Pandharipande, P, Shintani, A, Peterson, J, Pun, BT, Wilkinson, GR, Dittus, RS, Bernard, GR, Ely, EW (2006). Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 104, 2126.CrossRefGoogle ScholarPubMed
Platt, MM, Breitbart, W, Smith, M, Marotta, R, Weisman, H, Jacobsen, PB (1994). Efficacy of neuroleptics for hypoactive delirium. Journal of Neuropsychiatry and Clinical Neurosciences 6, 6667.Google ScholarPubMed
Ramaswamy, R, Dix, EF, Drew, JE, Diamond, JJ, Inouye, SK, Roehl, BJ (2011). Beyond grand rounds: a comprehensive and sequential intervention to improve identification of delirium. Gerontologist 51, 122131.CrossRefGoogle ScholarPubMed
Ryan, DJ, O’Regan, NA, Caoimh, , Clare, J, O’Connor, M, Leonard, M, McFarland, J, Tighe, S, O’Sullivan, K, Trzepacz, PT, Meagher, D, Timmons, S (2013). Delirium in an adult acute hospital population: predictors, prevalence and detection. British Medical Journal Open 7, 3.Google Scholar
Siddiqi, N, House, AO, Holmes, JD (2006). Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age and Ageing 35, 350364.CrossRefGoogle ScholarPubMed
Sockalingam, S, Tan, A, Hawa, R, Pollex, H, Abbey, S, Hodges, BD (2014). Interprofessional education for delirium care: a systematic review. Journal of Interprofessional Care 28, 345351.CrossRefGoogle ScholarPubMed
Teodorczuk, A, Mukaetova-Ladinska, E, Corbett, S, Welfare, M (2013). Reconceptualizing models of delirium education: findings of a Grounded Theory study. International Psychogeriatrics 25, 645655.CrossRefGoogle ScholarPubMed
Tropea, J, Slee, J, Holmes, AC, Gorelik, A, Brand, CA (2008). Use of antipsychotic medications for the management of delirium: an audit of current practice in the acute care setting. International Psychogeriatrics 21, 172179.CrossRefGoogle ScholarPubMed
Witlox, J, Eurelings, LS, De Jonghe, JF, Kalisvaart, KJ, Eikelenboom, P, Van Gool, WA (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. Journal of the American Medical Association 304, 443451.CrossRefGoogle ScholarPubMed
Yanamadala, M, Wieland, D, Heflin, MT (2013). Educational interventions to improve recognition of delirium: a systematic review. Journal of the American Geriatrics Society 61, 19831993.CrossRefGoogle ScholarPubMed
Young, J, Murthy, L, Westby, M, Akunne, A, O’Mahony, R (2010). Diagnosis, prevention, and management of delirium: summary of NICE guidance. British Medical Journal 341, c3704.CrossRefGoogle ScholarPubMed
Zaal, IJ, Devlin, JW, Hazelbag, M, Klein Klouwenberg, PM, van der Kooi, AW, Ong, DS, Cremer, OL, Groenwold, RH, Slooter, AJ (2015). Benzodiazepine-associated delirium in critically ill adults. Intensive Care Medicine 41, 21302137.CrossRefGoogle ScholarPubMed