Role of Psychiatry in Neurointensive Delirium By Patricia Ibeziako, MD
Delirium is a disorder characterized by mental status changes due to physiologic consequences of a medical disturbance. Core features include rapid onset, fluctuating course, altered consciousness and disturbance of cognition. Children and the elderly are the most commonly affected age groups; however, the lack of age-appropriate diagnostic tools leaves little known regarding the incidence of pediatric delirium. The clinical presentation of delirium in children can differ from adults due to physical, emotional and cognitive developmental stages. Symptoms in children may include inability to sustain attention, restlessness, inconsolability, anxiety and apathy.
“ICU psychosis” is commonly used to describe delirium on intensive care units (ICUs). This is an inaccurate term, since children may present with psychosis and delirium outside of the ICU. The outdated terminology limits successful identification and management of delirium. Forty-six percent of adult delirium cases are misdiagnosed by hospital staff and more cases are unrecognized in children.
Psychiatry consultants are frequently approached for symptom management and to assist with the assessment, diagnosis and acute management of delirium. The experience of delirium can be very traumatic for the family and caretakers. Thirty-three percent of children suffer from posttraumatic stress disorder due to unrecognized delirious experiences. Patients with delirium have longer hospital stays and higher mortality rates, which underscores the necessity for interventions to reduce unfavorable outcomes.
Early involvement of psychiatry as part of the multidisciplinary team is beneficial to identify risk factors, minimize iatrogenic pharmacological agents, provide psychoeducation and optimize efforts to prevent delirium in the pediatric critical care setting.