Use of the laboratory in a teaching hospital. Implications for patient care, education, and hospital costs.
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Biomedical subjects
Publications and source records attributed to B Liptzin.
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DSM-IV made several revisions to the diagnostic criteria for delirium. This paper reviews the empirical data that supported these revisions. More research is needed to evaluate the usefulness of the new criteria and to further define subtypes of delirium.
To study delirium in hospitalized elderly, a delirium symptom interview (DSI) was developed by an interdisciplinary group of investigators. This interview was administered in an acute care hospital to 50 patients who were over the age of 65 years. Results from the interview were compared to assessments of major symptoms of delirium made independently by a neurologist and a psychiatrist. This interview had good validity and reliability. The sensitivity of the DSI was .90 and the specificity was .80, when compared with the clinical judgment of a psychiatrist and neurologist. Interrater reliability, using lay interviewers, was .90 for the detection of major symptoms of delirium. These results indicate that the DSI could be used by lay interviewers to assess reliably the symptoms of delirium.
The number of elderly women is growing in absolute numbers and in proportion to the U. S. population. Current epidemiologic research indicates that the most frequent psychiatric disorders among older women are phobias, severe cognitive impairment, dysthymia, and major depressive episode without grief. The rates of all of these disorders, except for cognitive impairment, are lower for older than for younger women. The rates of psychiatric disorders in older women are higher than in older men, except for alcohol abuse-dependence, which is higher in men. Depression is a common psychiatric problem in older women. The differential diagnosis includes other medical disorders, drug effects, normal grief, and early dementia. Older depressed women may present with physical complaints rather than complaints of depression, and thus be misdiagnosed. Treatment consists of psychotherapy, antidepressant medication, and activities to improve self-esteem. Dementia affects 4 percent of elderly women over age 65, and 20 percent of those over age 85. The most common cause is Alzheimer's disease. Current research is focusing on abnormalities in the cholinergic system in the brain. A careful psychiatric evaluation may identify medical conditions, including depression, which can be treated and can lead to improvements in the patient's functioning.