The Department of Anesthesia’s Excellent Presentation on Delirium!

I recently got a pleasant surprise from a colleague who is Professor and Vice-Chair of Faculty Development in the Department of Anesthesia. He invited me to a departmental educational conference…about delirium.

This is a strikingly rare event. I can count on the fingers of one hand about how many times I’ve been invited to participate in meetings about delirium outside of the department of psychiatry. You might consider this odd given how often I express my opinion that delirium is not a primary psychiatric problem per se.

It was very well put together. One of the anesthesia residents delivered an outstanding presentation on delirium, supported by an excellent recent review paper by critical care physicians [1]. In fact, I was going to submit this particular article on our fledgling LinkedIn online journal club, Psychiatry Online Lifelong Learning (POLL) until Dr. George Dawson, MD, DFAPA, submitted the paper by Eric Kandel, “The New Science of Mind and the Future of Knowledge.”

The resident did a great job and his slide presentation was superb. I can present my own take on the information he presented in a few slides of my own.

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One of the tables in the article is a list of non-modifiable risk factors for delirium and it includes depression. I have seen this in other reviews which are otherwise excellent. Depression is not listed as a risk factor at all in many major review articles on delirium. I disagree with including it as a non-modifiable risk factor because depression is treatable and in many cases can be treated to remission–making it modifiable.

Hats off to the Department of Anesthesia!

Reference:

1. Sanders, R. D., et al. (2011). “Anticipating and managing postoperative delirium and cognitive decline in adults.” BMJ 343. http://www.bmj.com/content/343/bmj.d4331

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Comments

  1. Regarding the bullet point on “persisting cognitive impairment”. In my experience that is typically due to persisting delirium. I had a great clinic at one point where we followed people with persistent delirium of all varieties until it resolved and in many cases it took many months. Many of these folks were misdiagnosed with Alzheimers, psychosis, or bipolar disorder based on their acute presentation and studies (especially neuropsychological studies) done at the time. Unless there is good evidence that there is significant neuropathology at the time of the observed impairment and there was another event (surgery, infection, etc) – you always need a high index of suspicion for delirium in these settings.

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