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1.
Anaesthesia ; 77 Suppl 1: 49-58, 2022 01.
Article in English | MEDLINE | ID: covidwho-1612834

ABSTRACT

Delirium is a common condition affecting hospital inpatients, including those having surgery and on the intensive care unit. Delirium is also common in patients with COVID-19 in hospital settings, and the occurrence is higher than expected for similar infections. The short-term outcomes of those with COVID-19 delirium are similar to that of classical delirium and include increased length of stay and increased mortality. Management of delirium in COVID-19 in the context of a global pandemic is limited by the severity of the syndrome and compounded by the environmental constraints. Practical management includes effective screening, early identification and appropriate treatment aimed at minimising complications and timely escalation decisions. The pandemic has played out on the national stage and the effect of delirium on patients, relatives and healthcare workers remains unknown but evidence from the previous SARS outbreak suggests there may be long-lasting psychological damage.


Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Delirium/epidemiology , Delirium/psychology , Health Personnel/psychology , Brain/metabolism , COVID-19/metabolism , COVID-19/therapy , Delirium/metabolism , Delirium/therapy , Humans , Inflammation Mediators/metabolism , Intensive Care Units/trends
3.
Neurol Sci ; 42(4): 1527-1530, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1130795

ABSTRACT

BACKGROUND: COVID-19 patients present with delirium during their hospitalization. AIMS: To assess the incidence of delirium in hospitalized COVID-19 patients and analyze the possible association with demographic, clinical, laboratory, and pharmacological factors. METHODS: COVID-19 patients were assessed for clinical signs of delirium and administered the assessment test for delirium and cognitive impairment (4AT) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scales. RESULTS: Out of the 56 patients of our cohort, 14 (25.0%) experienced delirium. The use of low molecular weight heparin (LMWH) (enoxaparin 1 mg/kg/daily) was less frequent in patients with delirium (p = 0.004) and was accompanied by lower C reactive protein (CRP) levels (p = 0.006). DISCUSSION: The use of LMWH was associated with absence of delirium, independently of comorbidities and age. CONCLUSIONS: The use of LMWH may help preventing the occurrence of delirium in COVID-19 patients, with possible reduction of length of stay in the hospital and sequelae.


Subject(s)
Anticoagulants/therapeutic use , COVID-19/complications , Delirium/etiology , Delirium/prevention & control , Enoxaparin/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Aged , Aged, 80 and over , C-Reactive Protein/analysis , COVID-19/psychology , Cognition Disorders/etiology , Cognition Disorders/psychology , Cohort Studies , Comorbidity , Confusion/psychology , Delirium/psychology , Female , Humans , Inpatients , Length of Stay , Male , Neuropsychological Tests
6.
J Alzheimers Dis ; 79(1): 31-36, 2021.
Article in English | MEDLINE | ID: covidwho-949040

ABSTRACT

Patients admitted with COVID-19 can develop delirium due to predisposing factors, isolation, and the illness itself. Standard delirium prevention methods focus on interaction and stimulation. It can be challenging to deliver these methods of care in COVID settings where it is necessary to increase patient isolation. This paper presents a typical clinical vignette of representative patients in a tertiary care hospital and how a medical team modified an evidence-based delirium prevention model to deliver high-quality care to COVID-19 patients. The implemented model focuses on four areas of delirium-prevention: Mobility, Sleep, Cognitive Stimulation, and Nutrition. Future studies will be needed to track quantitative outcome measures.


Subject(s)
Alzheimer Disease/diagnosis , Alzheimer Disease/therapy , COVID-19/prevention & control , Delirium/prevention & control , Aged , Alzheimer Disease/psychology , COVID-19/epidemiology , COVID-19/psychology , Delirium/epidemiology , Delirium/psychology , Humans , Male
9.
Psychosomatics ; 61(6): 585-596, 2020.
Article in English | MEDLINE | ID: covidwho-726823

ABSTRACT

BACKGROUND: The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as one of the biggest health threats of our generation. A significant portion of patients are presenting with delirium and neuropsychiatric sequelae of the disease. Unique examination findings and responses to treatment have been identified. OBJECTIVE: In this article, we seek to provide pharmacologic and treatment recommendations specific to delirium in patients with COVID-19. METHODS: We performed a literature search reviewing the neuropsychiatric complications and treatments in prior coronavirus epidemics including Middle Eastern respiratory syndrome and severe acute respiratory syndrome coronaviruses, as well as the emerging literature regarding COVID-19. We also convened a work group of consultation-liaison psychiatrists actively managing patients with COVID-19 in our hospital. Finally, we synthesized these findings to provide preliminary pharmacologic recommendations for treating delirium in these patients. RESULTS: Delirium is frequently found in patients who test positive for COVID-19, even in the absence of respiratory symptoms. There appears to be a higher rate of agitation, myoclonus, abulia, and alogia. No data are currently available on the treatment of delirium in patients with COVID-19. Extrapolating from general delirium treatment, Middle Eastern respiratory syndrome/severe acute respiratory syndrome case reports, and our experience, preliminary recommendations for pharmacologic management have been assembled. CONCLUSIONS: COVID-19 is associated with neuropsychiatric symptoms. Low-potency neuroleptics and alpha-2 adrenergic agents may be especially useful in this setting. Further research into the pathophysiology of COVID-19 will be key in developing more targeted treatment guidelines.


Subject(s)
Adrenergic alpha-2 Receptor Agonists/therapeutic use , Antipsychotic Agents/therapeutic use , Brain Diseases/physiopathology , Coronavirus Infections/physiopathology , Delirium/drug therapy , Dopamine Agonists/therapeutic use , Pneumonia, Viral/physiopathology , Betacoronavirus , Brain Diseases/psychology , COVID-19 , Central Nervous System Depressants/therapeutic use , Coronavirus Infections/psychology , Delirium/physiopathology , Delirium/psychology , GABA Modulators/therapeutic use , Humans , Lorazepam/therapeutic use , Melatonin/therapeutic use , Pandemics , Pneumonia, Viral/psychology , Practice Guidelines as Topic , SARS-CoV-2
10.
J Neurol ; 268(3): 751-757, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-688846

ABSTRACT

BACKGROUND: Evidence of immune-mediated neurological syndromes associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection is limited. We therefore investigated clinical, serological and CSF features of coronavirus disease 2019 (COVID-19) patients with neurological manifestations. METHODS: Consecutive COVID-19 patients with neurological manifestations other than isolated anosmia and/or non-severe headache, and with no previous neurological or psychiatric disorders were prospectively included. Neurological examination was performed in all patients and lumbar puncture with CSF examination was performed when not contraindicated. Serum anti-gangliosides antibodies were tested when clinically indicated. RESULTS: Of the 349 COVID-19 admitted to our center between March 23rd and April 24th 2020, 15 patients (4.3%) had neurological manifestations and fulfilled the study inclusion/exclusion criteria. CSF examination was available in 13 patients and showed lymphocytic pleocytosis in 2 patients: 1 with anti-contactin-associated protein 2 (anti-Caspr2) antibody encephalitis and 1 with meningo-polyradiculitis. Increased serum titer of anti-GD1b antibodies was found in three patients and was associated with variable clinical presentations, including cranial neuropathy with meningo-polyradiculitis, brainstem encephalitis and delirium. CSF PCR for SARS-CoV-2 was negative in all patients. CONCLUSIONS: In SARS-Cov-2 infected patients with neurological manifestations, CSF pleocytosis is associated with para- or post-infectious encephalitis and polyradiculitis. Anti-GD1b and anti-Caspr2 autoantibodies can be identified in certain cases, raising the question of SARS-CoV-2-induced secondary autoimmunity.


Subject(s)
COVID-19/complications , Nervous System Diseases/etiology , Nervous System Diseases/immunology , Adult , Aged , Aged, 80 and over , Antibodies/cerebrospinal fluid , COVID-19/cerebrospinal fluid , Delirium/etiology , Delirium/psychology , Encephalitis/etiology , Encephalitis/psychology , Female , Gangliosides/immunology , Humans , Leukocytosis/cerebrospinal fluid , Male , Membrane Proteins/cerebrospinal fluid , Middle Aged , Nerve Tissue Proteins/cerebrospinal fluid , Nervous System Diseases/cerebrospinal fluid , Neurologic Examination , Radiculopathy/etiology , Radiculopathy/psychology , Spinal Puncture
12.
Psychosomatics ; 61(5): 544-550, 2020.
Article in English | MEDLINE | ID: covidwho-616923
14.
Anaesthesiol Intensive Ther ; 52(2): 132-138, 2020.
Article in English | MEDLINE | ID: covidwho-291501

ABSTRACT

In March 2020, the World Health Organisation announced the COVID-19 pandemic caused by the SARS-CoV-2 virus. As well as respiratory failure, the SARS-CoV-2 may cause central nervous system (CNS) involvement, including delirium occurring in critically ill patients (ICU delirium). Due attention must be paid to this subject in the face of the COVID-19 pandemic. Delirium, the detection of which takes less than two minutes, is frequently underestimated during daily routine ICU care, but it may be a prodromal symptom of infection or hypoxia associated with severe respiratory failure. During the COVID-19 pandemic, systematic delirium monitoring using validated tests (CAM-ICU or ICDSC) may be sacrificed. This is likely to be due to the fact that the main emphasis is placed on organisational issues, i.e. the lack of ventilators, setting priorities for limited mechanical ventilation options, and a shortage of personal protective equipment. Early identification of patients with delirium is critical in patients with COVID-19 because the occurrence of delirium may be an early symptom of worsening respiratory failure or of infectious spread to the CNS mediated by potential neuroinvasive mechanisms of the coronavirus. The purpose of this review is to identify problems related to the development of delirium during the COVID-19 epidemic, which are presented in three areas: i) factors contributing to delirium in COVID-19, ii) potential pathophysiological factors of delirium in COVID-19, and iii) long-term consequences of delirium in COVID-19. This article discusses how healthcare workers can reduce the burden of delirium by identifying potential risk factors and difficulties during challenges associated with SARS-CoV-2 infection.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Delirium/etiology , Intensive Care Units , Pneumonia, Viral/complications , COVID-19 , Delirium/diagnosis , Delirium/prevention & control , Delirium/psychology , Humans , Pandemics , SARS-CoV-2
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