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Misdiagnosing delirium as depression in medically ill elderly patients.
Arch Intern Med. 1995 Dec 11-25; 155(22):2459-64.AI

Abstract

BACKGROUND

Delirium, a common and often overlooked syndrome in acutely ill elderly patients, may present with signs and symptoms of depression.

OBJECTIVE

To determine (1) how often health care providers mistake delirium for a depressive disorder in older hospitalized patients referred to a psychiatric consultation service for depressive symptoms and (2) which signs and symptoms of depression and delirium characterize these patients.

SUBJECTS

Patients older than 60 years, admitted to a Veterans Affairs teaching hospital, and consecutively referred to a psychiatric consultation service for evaluation and treatment of a depressive disorder.

METHODS

The diagnosis of delirium was based on two independent assessments: (1) a clinical interview by a member of the psychiatric consultation service and (2) a structured bedside evaluation performed by one of the investigators, who was not a member of the psychiatric consultation service. The investigator administered the Confusion Assessment Method Instrument, Mini-Mental State Examination, digit span forward, and months of year backward. The investigator also administered the Diagnostic Interview Schedule items for depression to elicit depressive symptoms.

RESULTS

Twenty-eight (41.8%) of the 67 subjects referred for evaluation or treatment of a depressive disorder were found to be delirious. Compared with nondelirious subjects, the delirious subjects were older and more impaired in activities of daily living. The delirious subjects often endorsed depressive symptoms, such as low mood (60%), worthlessness (68%), and frequent thoughts of death (52%). The referring health care provider had considered delirium in the differential diagnosis of the mood disturbance in only three subjects.

CONCLUSION

Health care providers should consider the diagnosis of delirium in hospitalized elderly patients who appear to be depressed.

Authors+Show Affiliations

Department of Medicine, Oregon Health Sciences University, Portland, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

7503605

Citation

Farrell, K R., and L Ganzini. "Misdiagnosing Delirium as Depression in Medically Ill Elderly Patients." Archives of Internal Medicine, vol. 155, no. 22, 1995, pp. 2459-64.
Farrell KR, Ganzini L. Misdiagnosing delirium as depression in medically ill elderly patients. Arch Intern Med. 1995;155(22):2459-64.
Farrell, K. R., & Ganzini, L. (1995). Misdiagnosing delirium as depression in medically ill elderly patients. Archives of Internal Medicine, 155(22), 2459-64.
Farrell KR, Ganzini L. Misdiagnosing Delirium as Depression in Medically Ill Elderly Patients. Arch Intern Med. 1995 Dec 11-25;155(22):2459-64. PubMed PMID: 7503605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Misdiagnosing delirium as depression in medically ill elderly patients. AU - Farrell,K R, AU - Ganzini,L, PY - 1995/12/11/pubmed PY - 1995/12/11/medline PY - 1995/12/11/entrez SP - 2459 EP - 64 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 155 IS - 22 N2 - BACKGROUND: Delirium, a common and often overlooked syndrome in acutely ill elderly patients, may present with signs and symptoms of depression. OBJECTIVE: To determine (1) how often health care providers mistake delirium for a depressive disorder in older hospitalized patients referred to a psychiatric consultation service for depressive symptoms and (2) which signs and symptoms of depression and delirium characterize these patients. SUBJECTS: Patients older than 60 years, admitted to a Veterans Affairs teaching hospital, and consecutively referred to a psychiatric consultation service for evaluation and treatment of a depressive disorder. METHODS: The diagnosis of delirium was based on two independent assessments: (1) a clinical interview by a member of the psychiatric consultation service and (2) a structured bedside evaluation performed by one of the investigators, who was not a member of the psychiatric consultation service. The investigator administered the Confusion Assessment Method Instrument, Mini-Mental State Examination, digit span forward, and months of year backward. The investigator also administered the Diagnostic Interview Schedule items for depression to elicit depressive symptoms. RESULTS: Twenty-eight (41.8%) of the 67 subjects referred for evaluation or treatment of a depressive disorder were found to be delirious. Compared with nondelirious subjects, the delirious subjects were older and more impaired in activities of daily living. The delirious subjects often endorsed depressive symptoms, such as low mood (60%), worthlessness (68%), and frequent thoughts of death (52%). The referring health care provider had considered delirium in the differential diagnosis of the mood disturbance in only three subjects. CONCLUSION: Health care providers should consider the diagnosis of delirium in hospitalized elderly patients who appear to be depressed. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/7503605/Misdiagnosing_delirium_as_depression_in_medically_ill_elderly_patients_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/155/pg/2459 DB - PRIME DP - Unbound Medicine ER -