Biomedical subjects
L P Aakerlund
Publications and source records attributed to L P Aakerlund.
[Somatic illness in psychiatric patients].
Psychiatric patients are a vulnerable group in society and have been shown to suffer from a wide range of somatic diseases when admitted to the psychiatric department. During a three month period we examined 174 newly admitted psychiatric patients with the purpose of investigating 1) the frequency of somatic illness, 2) the value of routine blood tests as a screening tool for somatic illness and 3) a possible causality between somatic disease and psychiatric illness. Fifty percent of the patients suffered from a somatic disease and 31% of the patients had a previously undiagnosed disease. The somatic disease was found to be the main cause of admission in 16% of the patients. Older patients and patients with alcohol abuse were found to have the highest prevalence of somatic disease. In conclusion, we found no indication for a screening programme of blood tests, but recommend that selected blood tests based on the clinical examination and history of the individual patient should be taken. Psychiatric patients have a high prevalence of somatic disease, and it is important to direct clinical attention towards this when giving care to psychiatric patients.
Postoperative delirium: treatment with supplementary oxygen.
We have assessed postoperative delirium in 24 patients undergoing thoracotomy for pulmonary malignancy throughout their stay in hospital. Arterial oxygen saturation was measured with a pulse oximeter on the night before operation and on the second night after operation. Five patients (21%) developed clinically significant postoperative delirium, and delirium occurred in all patients who had inadequate oxygenation. All cases of delirium occurred on day 3 after surgery. Factors which were not associated with delirium were age, intake of alcohol or consumption of drugs before operation, fever, type of operation, duration of surgery, anxiety and psychosocial stress before operation, postoperative metabolic derangement or hypotension during operation. Mean arterial oxygen saturation on the second night after operation (the night preceding delirium) was smaller in patients with delirium than in other patients (median 88% vs 95%, P < 0.05). When patients were delirious, the first treatment of choice was supplementary oxygen and all patients were treated successfully by this simple regimen. In two patients, supplementary treatment with zuclopenthixol 6 mg daily was necessary. We conclude that hypoxaemia may be a contributing factor in postoperative brain dysfunction, as postoperative delirium was associated with hypoxaemia and was treated successfully with supplementary oxygen.
Writing disturbances: an indicator for postoperative delirium.
OBJECTIVE: To study the writing ability pre- and postoperatively in patients undergoing major surgery. METHOD: In an open study twenty-four consecutive patients undergoing thoracotomy for pulmonary malignancy were monitored for postoperative delirium throughout their stay in the hospital. The writing ability was tested on a preoperative day and on the third day after the operation. Main outcome measures were delirium according to the DSM-III-R criteria and writing ability assessed on items such as reluctance to write and motor-, spatial-, syntactical- and spelling disorders. RESULTS: Five patients (21%) developed delirium according to the DSM-III-R criteria. The writing of all patients with delirium was severely impaired with features like reluctance to write, motor disability and spatial disturbances. No patient without delirium developed these disturbances. CONCLUSIONS: These results suggest that testing of writing ability may be useful in the diagnosis of delirium. The Delirium Writing Test is proposed as a diagnostic tool.