The assessment of postoperative delirium at the Port of Spain General Hospital

Objective: To determine the incidence of post-operative delirium at the Port of Spain General Hospital, Trinidad and Tobago. Design and Methodology: Post-operative delirium (POD) is a relatively common occurrence particularly in the elderly (>65 yr.), after prolonged surgery and after major orthopaedic surgery. It is linked to longer hospitalization and a more prolonged recovery to full functional status. This study aimed to establish the incidence of POD at the Port of Spain General Hospital during the period September 2017 to March 2018. After obtaining consent, patients were screened using the 4 'A's Test questionnaire pre- and postoperatively. Post-operative testing was done on days 0, 1 and 2 between the hours of 18:00 and 22:00. Results: Sixty-one (61) patients were recruited. A total of 42 underwent surgery and were screened using the 4AT questionnaire. Eighteen (42.8%) displayed cognitive impairment post-operatively, with 9 (21.4%) having delirium according to the 4AT score. Delirium occurred more frequently after general anaesthesia (26.7%) compared to regional anaesthesia (8.4%). Vasopressor use was associated with a higher risk of POD (66.6%). There was an association between gynaecological malignancy and POD (3/9, 33.3%). Conclusion: The incidence of POD in elderly patients at a tertiary level hospital in Trinidad was 21.4%. At risk patients were those who underwent general anaesthesia, those who received vasopressors and those with gynaecological malignancy. We recommend that the 4AT tool be modified for our population to more accurately detect delirium.

Neuropsychiatric manifestations of typhoid fever

Neuropsychiatric manifestations of typhoid fever are not uncommon, occurring in 18 of 40 consecutive patients at the University hospital of the West Indies. The clinical presentation ranges from a confusional state to hallucinations or meningism, and the diagnosis may be missed or unduly delayed unless there is a strong index of suspicion (AU)

Common psychological illnesses in the elderly

The elderly are especially prone to psychological illness. Cognitive impairment increases with age and as this is a primary symptom of many common disorders, it constitutes a major health problem. The elderly also frequently become depressed and have the highest suicide rate of all age groups. Given the increasing numbers of elderly persons in the population, the primary care physician must assume the reponsibility of evaluating, diagnosing and initiating psychiatric treatment with an emphasis on early and accurate diagnosis, and the detection of underlying causes, many of which are reversible (AU)