Post-traumatic Stress Disorder Following Acute Delirium
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Post‑traumatic Stress Disorder Following Acute Delirium Corey Bolton1,2 · Sarah Thilges1 · Carissa Lane1,2 · Jacob Lowe1,2 · Patricia Mumby1
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Delirium is a significant medical condition that is common in hospitalized patients. Beyond the increased risk of mortality, patients who experience an episode of delirium often go on to develop long-term psychiatric disturbance, including symptoms of post-traumatic stress disorder (PTSD). While there is a growing interest in understanding the complex relationship between delirium and PTSD, the existing literature is sparse and lacking harmony. Thus, this review seeks to develop a unified and thorough description of the cognitive and psychiatric underpinnings of post-delirium PTSD with the aims of promoting awareness of this condition amongst clinicians in medical settings, improving patient care, and sparking further research on this topic. While specific underlying mechanisms are yet unclear, PTSD was found to be associated with delirium in that delirious patients may have decreased factual recall of hospital events and increased hallucinations/delusions of a traumatic nature. Several potential interventions were identified, as well as suggestions for future research and clinical practice. Keywords Delirium · Post-traumatic stress disorder · PTSD, ICU · Sedation · Psychopathology
Introduction
Delirium Subtypes
Delirium is an acute medical condition marked by disturbance in attention, awareness, and other cognitive domains that has a rapid onset and fluctuating course. Amongst individuals admitted to the hospital, the prevalence of delirium ranges from 14 to 24% with these numbers only rising with the severity of medical illness and length of hospital stay, affecting up to 70–87% of individuals in intensive care (American Psychiatric Association, 2013). Delirium has been associated with numerous negative health outcomes including increased risk of mortality, extended length of hospital stay, and likelihood of institutionalization (e.g., to a skilled nursing/rehabilitation facility) after discharge (Lam, Tay, Chan, Ding, & Chong, 2014; Yamaguchi, Tsukioka, & Kishi, 2014). While medical outcomes have long been studied in patients with delirium, there has been recent interest in understanding the psychiatric outcomes in this population.
Within the diagnosis of delirium, there are three subtypes with each offering unique clinical presentations based on motoric presentation and arousal disturbance although they may lack concordance in criteria (Meagher et al., 2011). Generally, hypoactive delirium is classified by lethargy, somnolence, slowed communication and responses, and decreased proactive movement versus hyperactive delirium which is represented by restlessness, agitation, and hallucination/delusions. Mixed subtype is a delirium presentation which includes some features of hyper- and hypoactive delirium. There may also be an indication that prevalence of subtypes varies based on patient fa
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