It never hurts to look around you to see what other people are doing about delirium. I found out there’s a European Delirium Association (EDA), and the link to the website is on the right hand side of this page. They have a lot of nice tools and guides there for detection and prevention of delirium. Most of them are available as free downloads. One set is really nice and it’s connected with the EDA Stop Delirium Project downloadable from the page called Delirium Stop Box. It uses little case vignettes describing delirium from the patient’s perspective, called How Would You Feel? They’re these neat little cards, one example of which is below:
What might you do for George? One thing might be to think of delirium first rather than a primary psychotic disorder and about the risk factors for delirium in the elderly, such as old age and pain. You might also think about hypoactive delirium since he’s not behaviorally disruptive. In fact he’s polite. He doesn’t raise a ruckus, which is not typically how many health professionals conceptualize delirium, though hypoactive delirium is probably at least as common as hyperactive delirium and perhaps more deadly.
The EDA also publishes the Annals of Delirium, and the following is an excerpt from an editorial in Vol 3 November 2010, the most recent edition:
Delirium has a long way to go before it gets the attention it deserves, before it is present in the public consciousness in the way cancer is, or even HIV. Bearing in mind the prevalence of delirium and the impact it has on patients and families we may believe it is only a matter of time, but I believe that the process is going far too slowly. Some countries are doing better than others and some areas of medicine are making greater inroads, which can only benefit us all in the long run. In the UK, however, if you search for delirium on the BBC website you are directed to the music page and the group Delirium Tremens.
Funny, that’s sort of how I feel about how things are going in the U.S. I actually admire the EDA.
And keep an eye out for a forthcoming practical book about how to detect and manage delirium in the ICU by Valerie Page and Wes Ely. The title is Delirium in the Critically Ill and is being published by Cambridge University Press (CUP), the same publisher of our handbook, Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry (see link on the right). CUP’s summary:
This clinical handbook explains why delirium goes unrecognised in most ICUs and describes simple tools the bedside clinician can use to detect it, even in the ventilated patient. It is in an easy-to-read format and illustrated with figures, case reports and patient testimony. This book contains all you need to know in order to prevent, diagnose and manage delirium in your patients. Delirium in Critical Care is essential reading for all members of the intensive care multidisciplinary team, including senior and junior physicians, and nurses.
The EDA also announced the start of a new delirium organization here in the United States called the American Delirium Society (ADS); the link for their brand new site is also on my blog page on the right. The inaugural conference will be in Indianapolis, Indiana from June 5-7, 2011 at the Omni Severin Hotel in downtown Indianapolis. Registration and payment is available on line.
And now for another installment of…you guessed it, Delirium Word Search! This one originally came from the EDA website but I noticed a couple of mistakes in it. I stumbled on a word search puzzle maker on the internet and corrected it. It’s a bit more challenging than the first one you tackled in my blog and some of the words are on the diagonal. The words you’re to find are just below the puzzle in this one:
Delirium Word Search!
A I F R T S L E E P Y Z A U N C L C S V L I L L M U H A L L U C I N A T I O N C T L D O C E L O F D O D I T U N E C T E K E O E C G E F I N L K U P C M X U R N R G I F I R A E E R M A T A H A R E R N T I H Y H I E T P S S T I N I A C T O T R S O I A E U D O C E N O I T A T I G A M P N L A O C O N F U S E D K V G N I L B M A R E R A C X