DRUGS AND DELIRIUM: A PROSPECTIVE STUDY ON PSYCHOLOGICAL IMPACT
N. Revathi, K. Sai Sriram, V. Vasanth Kumar
Benzodiazepines, Critical care, CAM-ICU, Drug-induced, Delirium, Evidence-based study, Haloperidol, ICUS, Intensive care unit, Lorazepam, Observational, Prospective, Terminal care.
Drug induced delirium is reported in intensive care unit patients, especially in the Geriatrics, polypharmacy, pre-disposing drug sensitivities or in improper drug regimens. The most common types of delirium in these cohort patients are hypoactive and mixed-type of delirium which develops in 2-24 hours from admission. As per a study, delirium is known to develop due to an imbalance in the synthesis, release, and inactivation of some neurotransmitters, specifically by acetylcholine deficiency and dopamine activation. Delirium usually presents as a group of symptoms with an acute onset and a fluctuating course which have been categorized into cognitive and behavioral groups. This is a prospective observational cohort study conducted at Gleneagles Aware Global Hospitals, L.B Nagar, Hyderabad for a study period of six months. 200 patients admitted with the hospitalization history of more than 24 hours in critical care units were enrolled as study population. Patient data collection form, contains the socio-demographic details of the patients and Observational study Informed Consent form was prepared for patients understanding for agreeing to participate in the study. The psychological distress assessment was done using CAM-ICU Worksheet and NEECHAM Confusion Scale. In this study, drugs being the major factor to affect the delirium development (at least once during their course of hospitalization) were assessed. It is concluded that Haloperidol and lorazepam administration in the critically patients showed no clinical significance in the development. However other Benzodiazepines administered showed clinical significance (p-value 0.342) with development of delirium, indicating ICU patients are at risk of developing drug induced delirium at a probability of 3.42% as per thus study, which is temporary within the ICU during the course of hospitalization (resolves with relevant patient orientated management) and should be closely monitored during the course of hospitalization.