Hospital-treated deliberate self-poisoning patients: Drug-induced delirium and clinical outcomes
Objective: Drug-induced delirium has been attributed to opioid, benzodiazepine, antipsychotic, antihistaminic and anticholinergic drug groups at therapeutic doses. Delirium also occurs in hospital-treated self-poisoning (at supra-therapeutic doses), although the causative drug classes are not well e...
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| Veröffentlicht in: | Australian and New Zealand journal of psychiatry 2022-02, Vol.56 (2), p.154-163 |
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| container_title | Australian and New Zealand journal of psychiatry |
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| creator | Gale, Lindsay McGill, Katie Twaddell, Scott Whyte, Ian M Lewin, Terry J Carter, Gregory L |
| description | Objective:
Drug-induced delirium has been attributed to opioid, benzodiazepine, antipsychotic, antihistaminic and anticholinergic drug groups at therapeutic doses. Delirium also occurs in hospital-treated self-poisoning (at supra-therapeutic doses), although the causative drug classes are not well established and co-ingestion is common. We tested the magnitude and direction of association of five major drug groups with incident cases of delirium.
Methods:
A retrospective longitudinal cohort (n = 5131) study was undertaken of deliberate and recreational/chronic misuse poisoning cases from a regional sentinel toxicology unit. We described ingestion and co-ingestion patterns and estimated the unadjusted and adjusted odds for developing a drug-induced delirium. We also estimated the odds of drug-induced delirium being associated with three outcomes: intensive care unit admission, general hospital length of stay and discharge to home.
Results:
Drug-induced delirium occurred in 3.9% of cases (n = 200). The unadjusted odds ratios for development of delirium were increased for anticholinergics 10.79 (5.43–21.48), antihistamines 6.10 (4.20–8.84) and antipsychotics 2.99 (2.20–4.06); non-significant for opioids 1.31 (95% confidence interval = [0.81, 2.13]); and reduced for benzodiazepines 0.37 (0.24–0.58); with little change after adjustment for age, gender and co-ingestion. Delirium was associated with intensive care unit admission, longer length of stay and discharge destination.
Conclusion:
Drug-induced delirium was uncommon in this population. Co-ingestion was common but did not alter the risk. In contrast to drug-induced delirium at therapeutic doses in older populations, opioids were not associated with delirium and benzodiazepines were protective. Drug-induced delirium required increased clinical services. Clinical services should be funded and prepared to provide additional supportive care for these deliriogenic drug group ingestions. |
| doi_str_mv | 10.1177/00048674211009608 |
| format | Article |
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Drug-induced delirium has been attributed to opioid, benzodiazepine, antipsychotic, antihistaminic and anticholinergic drug groups at therapeutic doses. Delirium also occurs in hospital-treated self-poisoning (at supra-therapeutic doses), although the causative drug classes are not well established and co-ingestion is common. We tested the magnitude and direction of association of five major drug groups with incident cases of delirium.
Methods:
A retrospective longitudinal cohort (n = 5131) study was undertaken of deliberate and recreational/chronic misuse poisoning cases from a regional sentinel toxicology unit. We described ingestion and co-ingestion patterns and estimated the unadjusted and adjusted odds for developing a drug-induced delirium. We also estimated the odds of drug-induced delirium being associated with three outcomes: intensive care unit admission, general hospital length of stay and discharge to home.
Results:
Drug-induced delirium occurred in 3.9% of cases (n = 200). The unadjusted odds ratios for development of delirium were increased for anticholinergics 10.79 (5.43–21.48), antihistamines 6.10 (4.20–8.84) and antipsychotics 2.99 (2.20–4.06); non-significant for opioids 1.31 (95% confidence interval = [0.81, 2.13]); and reduced for benzodiazepines 0.37 (0.24–0.58); with little change after adjustment for age, gender and co-ingestion. Delirium was associated with intensive care unit admission, longer length of stay and discharge destination.
Conclusion:
Drug-induced delirium was uncommon in this population. Co-ingestion was common but did not alter the risk. In contrast to drug-induced delirium at therapeutic doses in older populations, opioids were not associated with delirium and benzodiazepines were protective. Drug-induced delirium required increased clinical services. Clinical services should be funded and prepared to provide additional supportive care for these deliriogenic drug group ingestions.</description><identifier>ISSN: 0004-8674</identifier><identifier>EISSN: 1440-1614</identifier><identifier>DOI: 10.1177/00048674211009608</identifier><identifier>PMID: 33938265</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Aged ; Antipsychotic Agents - adverse effects ; Benzodiazepines - therapeutic use ; Delirium - chemically induced ; Delirium - epidemiology ; Hospitals ; Humans ; Length of Stay ; Retrospective Studies</subject><ispartof>Australian and New Zealand journal of psychiatry, 2022-02, Vol.56 (2), p.154-163</ispartof><rights>The Royal Australian and New Zealand College of Psychiatrists 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c340t-1d5db9f735c654757eb81d4bdd22dc259d9121dc6686fcb6983382233d734a4c3</citedby><cites>FETCH-LOGICAL-c340t-1d5db9f735c654757eb81d4bdd22dc259d9121dc6686fcb6983382233d734a4c3</cites><orcidid>0000-0001-7693-3948 ; 0000-0002-4510-4001 ; 0000-0002-9800-862X ; 0000-0001-8180-1798</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/00048674211009608$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/00048674211009608$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33938265$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gale, Lindsay</creatorcontrib><creatorcontrib>McGill, Katie</creatorcontrib><creatorcontrib>Twaddell, Scott</creatorcontrib><creatorcontrib>Whyte, Ian M</creatorcontrib><creatorcontrib>Lewin, Terry J</creatorcontrib><creatorcontrib>Carter, Gregory L</creatorcontrib><title>Hospital-treated deliberate self-poisoning patients: Drug-induced delirium and clinical outcomes</title><title>Australian and New Zealand journal of psychiatry</title><addtitle>Aust N Z J Psychiatry</addtitle><description>Objective:
Drug-induced delirium has been attributed to opioid, benzodiazepine, antipsychotic, antihistaminic and anticholinergic drug groups at therapeutic doses. Delirium also occurs in hospital-treated self-poisoning (at supra-therapeutic doses), although the causative drug classes are not well established and co-ingestion is common. We tested the magnitude and direction of association of five major drug groups with incident cases of delirium.
Methods:
A retrospective longitudinal cohort (n = 5131) study was undertaken of deliberate and recreational/chronic misuse poisoning cases from a regional sentinel toxicology unit. We described ingestion and co-ingestion patterns and estimated the unadjusted and adjusted odds for developing a drug-induced delirium. We also estimated the odds of drug-induced delirium being associated with three outcomes: intensive care unit admission, general hospital length of stay and discharge to home.
Results:
Drug-induced delirium occurred in 3.9% of cases (n = 200). The unadjusted odds ratios for development of delirium were increased for anticholinergics 10.79 (5.43–21.48), antihistamines 6.10 (4.20–8.84) and antipsychotics 2.99 (2.20–4.06); non-significant for opioids 1.31 (95% confidence interval = [0.81, 2.13]); and reduced for benzodiazepines 0.37 (0.24–0.58); with little change after adjustment for age, gender and co-ingestion. Delirium was associated with intensive care unit admission, longer length of stay and discharge destination.
Conclusion:
Drug-induced delirium was uncommon in this population. Co-ingestion was common but did not alter the risk. In contrast to drug-induced delirium at therapeutic doses in older populations, opioids were not associated with delirium and benzodiazepines were protective. Drug-induced delirium required increased clinical services. Clinical services should be funded and prepared to provide additional supportive care for these deliriogenic drug group ingestions.</description><subject>Aged</subject><subject>Antipsychotic Agents - adverse effects</subject><subject>Benzodiazepines - therapeutic use</subject><subject>Delirium - chemically induced</subject><subject>Delirium - epidemiology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Retrospective Studies</subject><issn>0004-8674</issn><issn>1440-1614</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kD1PwzAQhi0EoqXwA1hQRhYXn7-SsKHyKVVigTk4tlO5SuxgJwP_nlQtLEhMd9I97yPdi9AlkCVAnt8QQnghc04BCCklKY7QHDgnGCTwYzTf3fEOmKGzlLaEAAORn6IZYyUrqBRz9PEcUu8G1eIhWjVYkxnbutrGac-SbRvcB5eCd36T9Wpw1g_pNruP4wY7b0Z9CEQ3dpnyJtOt806rNgvjoENn0zk6aVSb7MVhLtD748Pb6hmvX59eVndrrBknAwYjTF02ORNaCp6L3NYFGF4bQ6nRVJSmBApGS1nIRteyLNj0AWXM5IwrrtkCXe-9fQyfo01D1bmkbdsqb8OYKioo8HKnnlDYozqGlKJtqj66TsWvCki1K7b6U-yUuTrox7qz5jfx0-QELPdAUhtbbcMY_fTuP8ZvPcWAxg</recordid><startdate>202202</startdate><enddate>202202</enddate><creator>Gale, Lindsay</creator><creator>McGill, Katie</creator><creator>Twaddell, Scott</creator><creator>Whyte, Ian M</creator><creator>Lewin, Terry J</creator><creator>Carter, Gregory L</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7693-3948</orcidid><orcidid>https://orcid.org/0000-0002-4510-4001</orcidid><orcidid>https://orcid.org/0000-0002-9800-862X</orcidid><orcidid>https://orcid.org/0000-0001-8180-1798</orcidid></search><sort><creationdate>202202</creationdate><title>Hospital-treated deliberate self-poisoning patients: Drug-induced delirium and clinical outcomes</title><author>Gale, Lindsay ; McGill, Katie ; Twaddell, Scott ; Whyte, Ian M ; Lewin, Terry J ; Carter, Gregory L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c340t-1d5db9f735c654757eb81d4bdd22dc259d9121dc6686fcb6983382233d734a4c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Antipsychotic Agents - adverse effects</topic><topic>Benzodiazepines - therapeutic use</topic><topic>Delirium - chemically induced</topic><topic>Delirium - epidemiology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gale, Lindsay</creatorcontrib><creatorcontrib>McGill, Katie</creatorcontrib><creatorcontrib>Twaddell, Scott</creatorcontrib><creatorcontrib>Whyte, Ian M</creatorcontrib><creatorcontrib>Lewin, Terry J</creatorcontrib><creatorcontrib>Carter, Gregory L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Australian and New Zealand journal of psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gale, Lindsay</au><au>McGill, Katie</au><au>Twaddell, Scott</au><au>Whyte, Ian M</au><au>Lewin, Terry J</au><au>Carter, Gregory L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hospital-treated deliberate self-poisoning patients: Drug-induced delirium and clinical outcomes</atitle><jtitle>Australian and New Zealand journal of psychiatry</jtitle><addtitle>Aust N Z J Psychiatry</addtitle><date>2022-02</date><risdate>2022</risdate><volume>56</volume><issue>2</issue><spage>154</spage><epage>163</epage><pages>154-163</pages><issn>0004-8674</issn><eissn>1440-1614</eissn><abstract>Objective:
Drug-induced delirium has been attributed to opioid, benzodiazepine, antipsychotic, antihistaminic and anticholinergic drug groups at therapeutic doses. Delirium also occurs in hospital-treated self-poisoning (at supra-therapeutic doses), although the causative drug classes are not well established and co-ingestion is common. We tested the magnitude and direction of association of five major drug groups with incident cases of delirium.
Methods:
A retrospective longitudinal cohort (n = 5131) study was undertaken of deliberate and recreational/chronic misuse poisoning cases from a regional sentinel toxicology unit. We described ingestion and co-ingestion patterns and estimated the unadjusted and adjusted odds for developing a drug-induced delirium. We also estimated the odds of drug-induced delirium being associated with three outcomes: intensive care unit admission, general hospital length of stay and discharge to home.
Results:
Drug-induced delirium occurred in 3.9% of cases (n = 200). The unadjusted odds ratios for development of delirium were increased for anticholinergics 10.79 (5.43–21.48), antihistamines 6.10 (4.20–8.84) and antipsychotics 2.99 (2.20–4.06); non-significant for opioids 1.31 (95% confidence interval = [0.81, 2.13]); and reduced for benzodiazepines 0.37 (0.24–0.58); with little change after adjustment for age, gender and co-ingestion. Delirium was associated with intensive care unit admission, longer length of stay and discharge destination.
Conclusion:
Drug-induced delirium was uncommon in this population. Co-ingestion was common but did not alter the risk. In contrast to drug-induced delirium at therapeutic doses in older populations, opioids were not associated with delirium and benzodiazepines were protective. Drug-induced delirium required increased clinical services. Clinical services should be funded and prepared to provide additional supportive care for these deliriogenic drug group ingestions.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>33938265</pmid><doi>10.1177/00048674211009608</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-7693-3948</orcidid><orcidid>https://orcid.org/0000-0002-4510-4001</orcidid><orcidid>https://orcid.org/0000-0002-9800-862X</orcidid><orcidid>https://orcid.org/0000-0001-8180-1798</orcidid></addata></record> |
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| ispartof | Australian and New Zealand journal of psychiatry, 2022-02, Vol.56 (2), p.154-163 |
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| language | eng |
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| source | Access via SAGE; MEDLINE |
| subjects | Aged Antipsychotic Agents - adverse effects Benzodiazepines - therapeutic use Delirium - chemically induced Delirium - epidemiology Hospitals Humans Length of Stay Retrospective Studies |
| title | Hospital-treated deliberate self-poisoning patients: Drug-induced delirium and clinical outcomes |
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