142| Delirium – A Conversation With Dr. Kirk Stucky

In this episode, we discuss various aspects of delirium with Dr. Kirk Stucky. Topics covered include definitions and terminology, prevalence, risk factors, functional reserve, hypoactive and hyperactive presentations, pathophysiology, differential diagnosis with dementia, mental health symptoms, cognitive assessment, and prevention/intervention.

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About Kirk

Dr. Stucky obtained his Psy.D. in clinical psychology from Florida Tech in 1995. He completed his internship at Union Memorial Hospital in Baltimore, Maryland, and his residency in medical psychology at Hurley Medical Center in Flint, Michigan. At Hurley he has been a long term member of the Level 1 Trauma team and inpatient rehabilitation team.  He is currently chair of the Department of Behavioral Health and an assistant professor for the Michigan State University College of Human Medicine. He is also the acting Chair of the hospital Ethics Committee.  Being board certified in rehabilitation psychology and clinical neuropsychology, he has been dedicated to advancing the interests of both specialties including the development of integrated training standards and exploring new opportunities for advanced hospital practice.  He has published five books, numerous chapters, and peer reviewed articles on a range of topics including neurorehabilitation, hospital based practice, critical care psychology, ethics, and advanced specialty training.  As the program director of an APPCN, CRPPT, and APA accredited fellowship, he has had the privilege of teaching and supervising trainees for 29 years and mentoring a talented cadre of psychologists who have successfully obtained board certification in clinical neuropsychology, rehabilitation psychology, and health psychology.

References

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Ludolph, P., Stoffers‐Winterling, J., Kunzler, A. M., Rösch, R., Geschke, K., Vahl, C. F., & Lieb, K. (2020, June 12). Non‐Pharmacologic Multicomponent Interventions Preventing Delirium in Hospitalized People. Journal of the American Geriatrics Society, 68(8), 1864–1871. https://doi.org/10.1111/jgs.16565

Magny, E., Le Petitcorps, H., Pociumban, M., Bouksani-Kacher, Z., Pautas, R., Belmin, J., Bastuji-Garin, S., & Lafuente-Lafuente, C. (2018, February 23). Predisposing and precipitating factors for delirium in community-dwelling older adults admitted to hospital with this condition: A prospective case series. PLOS ONE, 13(2), e0193034. https://doi.org/10.1371/journal.pone.0193034

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Mehta, S., Cook, D., Devlin, J. W., Skrobik, Y., Meade, M., Fergusson, D., Herridge, M., Steinberg, M., Granton, J., Ferguson, N., Tanios, M., Dodek, P., Fowler, R., Burns, K., Jacka, M., Olafson, K., Mallick, R., Reynolds, S., Keenan, S., & Burry, L. (2015, March). Prevalence, Risk Factors, and Outcomes of Delirium in Mechanically Ventilated Adults*. Critical Care Medicine, 43(3), 557–566. https://doi.org/10.1097/ccm.0000000000000727

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Morandi, A., Davis, D., Bellelli, G., Arora, R. C., Caplan, G. A., Kamholz, B., Kolanowski, A., Fick, D. M., Kreisel, S., MacLullich, A., Meagher, D., Neufeld, K., Pandharipande, P. P., Richardson, S., Slooter, A. J., Taylor, J. P., Thomas, C., Tieges, Z., Teodorczuk, A., . . . Rudolph, J. L. (2017, January). The Diagnosis of Delirium Superimposed on Dementia: An Emerging Challenge. Journal of the American Medical Directors Association, 18(1), 12–18. https://doi.org/10.1016/j.jamda.2016.07.014

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Perälä, J., Kuoppasalmi, K., Pirkola, S., Härkänen, T., Saarni, S., Tuulio-Henriksson, A., Viertiö, S., Latvala, A., Koskinen, S., Lönnqvist, J., & Suvisaari, J. (2010, September). Alcohol-induced psychotic disorder and delirium in the general population. British Journal of Psychiatry, 197(3), 200–206. https://doi.org/10.1192/bjp.bp.109.070797

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Schwebach, C., & Vempati, A. (2023). Alcohol Withdrawal with Delirium Tremens. Journal of education & teaching in emergency medicine8(3), S1–S33. https://doi.org/10.21980/J8S35N

Sepulveda, E., Franco, J. G., Trzepacz, P. T., Gaviria, A. M., Meagher, D. J., Palma, J., Viñuelas, E., Grau, I., Vilella, E., & de Pablo, J. (2016, May 26). Delirium diagnosis defined by cluster analysis of symptoms versus diagnosis by DSM and ICD criteria: diagnostic accuracy study. BMC Psychiatry, 16(1). https://doi.org/10.1186/s12888-016-0878-6

Serafim, R. B., Soares, M., Bozza, F. A., Lapa e Silva, J. R., Dal-Pizzol, F., Paulino, M. C., Povoa, P., & Salluh, J. I. F. (2017, July 12). Outcomes of subsyndromal delirium in ICU: a systematic review and meta-analysis. Critical Care, 21(1). https://doi.org/10.1186/s13054-017-1765-3

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Slooter, A. J. C., Otte, W. M., Devlin, J. W., Arora, R. C., Bleck, T. P., Claassen, J., Duprey, M. S., Ely, E. W., Kaplan, P. W., Latronico, N., Morandi, A., Neufeld, K. J., Sharshar, T., MacLullich, A. M. J., & Stevens, R. D. (2020, February 13). Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Medicine, 46(5), 1020–1022. https://doi.org/10.1007/s00134-019-05907-4

Smith, T. O., Cooper, A., Peryer, G., Griffiths, R., Fox, C., & Cross, J. (2017). Factors predicting incidence of post-operative delirium in older people following hip fracture surgery: a systematic review and meta-analysis. International journal of geriatric psychiatry32(4), 386–396. https://doi.org/10.1002/gps.4655

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Solano, J. J., Clayton, L. M., Parks, D. J., Polley, S. E., Hughes, P. G., Hennekens, C. H., Shih, R. D., & Alter, S. M. (2021, September 23). Prehospital Ketamine Administration for Excited Delirium with Illicit Substance Co-Ingestion and Subsequent Intubation in the Emergency Department. Prehospital and Disaster Medicine, 36(6), 697–701. https://doi.org/10.1017/s1049023x21000935

Sørensen, H. J., Holst, C., Knop, J., Mortensen, E. L., Tolstrup, J. S., & Becker, U. (2019, February 17). Alcohol and delirium tremens: effects of average number of drinks per day and beverage type. Acta Psychiatrica Scandinavica, 139(6), 518–525. https://doi.org/10.1111/acps.13006

Stollings, J. L., Kotfis, K., Chanques, G., Pun, B. T., Pandharipande, P. P., & Ely, E. W. (2021, August 16). Delirium in critical illness: clinical manifestations, outcomes, and management. Intensive Care Medicine, 47(10), 1089–1103. https://doi.org/10.1007/s00134-021-06503-1

Thom, R. P., Levy-Carrick, N. C., Bui, M., & Silbersweig, D. (2019, October 1). Delirium. American Journal of Psychiatry, 176(10), 785–793. https://doi.org/10.1176/appi.ajp.2018.18070893

Tieges, Z., Evans, J. J., Neufeld, K. J., & MacLullich, A. M. (2017, April 9). The neuropsychology of delirium: advancing the science of delirium assessment. International Journal of Geriatric Psychiatry, 33(11), 1501–1511. https://doi.org/10.1002/gps.4711

Traube, C., Silver, G., Gerber, L. M., Kaur, S., Mauer, E. A., Kerson, A., Joyce, C., & Greenwald, B. M. (2017, May). Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium*. Critical Care Medicine, 45(5), 891–898. https://doi.org/10.1097/ccm.0000000000002324

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van Montfort, S., van Dellen, E., Stam, C., Ahmad, A., Mentink, L., Kraan, C., Zalesky, A., & Slooter, A. (2019). Brain network disintegration as a final common pathway for delirium: a systematic review and qualitative meta-analysis.NeuroImage: Clinical, 23, 101809. https://doi.org/10.1016/j.nicl.2019.101809

van Velthuijsen, E. L., Zwakhalen, S. M. G., Pijpers, E., van de Ven, L. I., Ambergen, T., Mulder, W. J., Verhey, F. R. J., & Kempen, G. I. J. M. (2018, February). Effects of a Medication Review on Delirium in Older Hospitalised Patients: A Comparative Retrospective Cohort Study. Drugs & Aging, 35(2), 153–161. https://doi.org/10.1007/s40266-018-0523-9

Weinrebe, W., Johannsdottir, E., Karaman, M., & Füsgen, I. (2015, March 24). What does delirium cost? Zeitschrift Für Gerontologie Und Geriatrie, 49(1), 52–58. https://doi.org/10.1007/s00391-015-0871-6

Wilson, J. E., Mart, M. F., Cunningham, C., Shehabi, Y., Girard, T. D., MacLullich, A. M. J., Slooter, A. J. C., & Ely, E. W. (2020, November 12). Delirium. Nature Reviews Disease Primers, 6(1). https://doi.org/10.1038/s41572-020-00223-4

Witlox, J., Eurelings, L. S., de Jonghe, J. F., Kalisvaart, K. J., Eikelenboom, P., & van Gool, W. A. (2010). Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA304(4), 443–451. https://doi.org/10.1001/jama.2010.1013

Yang, F. M., Marcantonio, E. R., Inouye, S. K., Kiely, D. K., Rudolph, J. L., Fearing, M. A., & Jones, R. N. (2009, May). Phenomenological Subtypes of Delirium in Older Persons: Patterns, Prevalence, and Prognosis. Psychosomatics, 50(3), 248–254. https://doi.org/10.1176/appi.psy.50.3.248

Zaal, I. J., Devlin, J. W., Peelen, L. M., & Slooter, A. J. C. (2015, January). A Systematic Review of Risk Factors for Delirium in the ICU*. Critical Care Medicine, 43(1), 40–47. https://doi.org/10.1097/ccm.0000000000000625

Zamoscik, K., Godbold, R., & Freeman, P. (2017, June). Intensive care nurses’ experiences and perceptions of delirium and delirium care. Intensive and Critical Care Nursing, 40, 94–100. https://doi.org/10.1016/j.iccn.2017.01.003

 

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