Does the Etiology, Phenomenology and Motor Subtype of Delirium Differ When It Occurs in Patients With An Underlying Dementia?: A Multi-Site, International Study.

OBJECTIVES: To compare the etiology, phenomenology and motor subtype of delirium in patients with and without an underlying dementia. METHODS: A combined dataset (n = 992) was collated from two databases of older adults (>65 years) from liaison psychiatry and palliative care populations in Ireland and India. Phenomenology and severity of delirium were analysed using the Delirium Symptom Rating Scale Revised (DRS-R98) and contributory etiologies for the delirium groups were ascertained using the Delirium Etiology Checklist (DEC). Delirium motor subtype was documented using the abbreviated version of the Delirium Motor Subtype Scale (DMSS4). RESULTS: Delirium superimposed on dementia (DSD) showed greater impairment in short term memory, long term memory and visuospatial ability than the delirium group but showed significantly less perceptual disturbance, temporal onset and fluctuation. Systemic infection, cerebrovascular and other Central nervous system etiology were associated with DSD while metabolic disturbance, organ insufficiency and intracranial neoplasm were associated with the delirium only group. CONCLUSION: The etiology and phenomenology of delirium differs when it occurs in the patient with an underlying dementia. We discuss the implications in terms of identification and management of this complex condition.

Service users' perception and attitude toward telemedicine-based treatment for substance use disorders: A qualitative study from India.

Aim: We aimed to assess the service user's acceptability, feasibility, and attitude toward telemedicine practice and compare it with in-person consultation in substance use disorder (SUD). Materials and Methods: We recruited 15 adult patients with SUD who accessed both telemedicine and in-person care. We conducted in-depth interviews on awareness and access, facilitators and barriers, treatment satisfaction, and therapeutic relationship in the telemedicine context. We performed a conventional content analysis of the interview excerpts and used inductive and deductive coding. We assumed that social, personal, and logistic contexts influence patients' perceptions and experiences with telemedicine-based addiction care (TAC). Results: Most participants were middle-aged men (40.5 years, 86.7%), dependent on two or more substances (86.7%), and had a history of chronic, heavy substance use (use ~16 years, dependence ~11.5 years). Patients' perspectives on TAC could broadly be divided into three phases: pre-consultation, consultation, and post-consultation. Patients felt that TAC improved treatment access with adequate autonomy and control; however, there were technical challenges. Patients expressed privacy concerns and feared experiencing stigma during teleconsultation. They reported missing the elaborate inquiry, physical examination, and ritual of visiting their doctors in person. Additionally, personal comfort and technical difficulties determine the satisfaction level with TAC. Overall perception and suitability of TAC and the decision to continue it developed in the post-consultation phase. Conclusion: Our study provides an in-depth insight into the barriers and facilitators of telemedicine-based SUD treatment access, use, and retention; it also helps to understand better the choices and preferences for telehealth care vis-à-vis standard in-person care for SUDs.

Assist-linked brief intervention to reduce risky pattern of substance use in male workers employed at a tertiary care hospital in India: A randomized controlled trial.

Background: Substance use in workplace leads to adverse effects both on the employees and on the workplace. Existing research focuses on alcohol-related harm, while workplace use of other substances has been neglected. There are no randomized controlled studies of brief interventions in Indian hospital settings. Aim: To evaluate the efficacy of World Health Organization (WHO) alcohol, smoking, and substance involvement screening test (ASSIST)-linked brief intervention (ALBI) for reducing risky patterns of substance use in male workers at a tertiary-care hospital in North India. Material and Methods: The study was conducted in two phases. In Phase-I, a random list of 400 employees was generated from the entire pool of male hospital workers, of which 360 participated. Data on the ASSIST risk categories (mild, moderate, and high) were generated from Phase I. In Phase-II, moderate- or high-risk subjects ('ASSIST screen-positive') were randomized into intervention and control groups, with 35 screen-positive subjects in each group. The intervention group was provided a 15-30-min structured session per ALBI protocol, while the control group was given a 15-30-min general talk on health-related consequences associated with substance use. The subjects were compared on ASSIST score, WHO quality-of-life brief version (WHOQOL-BREF) and readiness to change questionnaire (RCQ) at baseline and at 3-month follow up. Results: The prevalence of moderate-to-high-risk use of tobacco, alcohol, and cannabis in the total sample was 28.6%, 27.5%, and 6.9%, respectively. At 3-months postintervention follow-up of the randomized sample, recipients of ALBI had significant reduction of ASSIST scores for all substances compared to the control group (p < 0.001). More participants receiving ALBI were ready to change to RCQ action stage (p values for tobacco, alcohol, and cannabis <0.001, <0.001 and 0.007, respectively). WHOQOL-BREF scores significantly improved in ALBI group across all domains. Conclusion: ALBI was effective in reducing risky substance use, increasing readiness to change and improving the QOL of the subjects at workplace setting.

The therapeutic relationships, empathy, and satisfaction in teleconsultation for substance use disorders: Better or worse than in-person consultation?

Context: Telemedicine has become one of the essential modes of healthcare delivery. Different aspects of the physician-patient relationship during tele and in-person consultation need to be studied. Aims: This study aimed to compare perceived empathy and therapeutic relationship between tele and in-person consultation and assess the patient's satisfaction during teleconsultation for substance use disorder (SUD). Methodology: We consecutively recruited 100 adult patients with SUD, registered to the tele-addiction service between June and September 2020, and experienced both video and in-person consultations. We assessed therapeutic relationships, perceived empathy (for teleconsultation and in-person consultation), and patients' satisfaction (with teleconsultation) with specific scales. We compared the scores of the therapeutic relationship and physician empathy scales for tele and in-person consultation. Results: The mean age of the patients was 35.5 (±10.4) years. Sixty percent had alcohol, followed by opioids (42%) and cannabis dependence (24%). Sixty percent of patients had comorbid tobacco dependence. Telehealth satisfaction (TSS) rating shows around 40% of patients had difficulty accessing the telehealth service and 7% felt their privacy was poorly respected. The mean total therapeutic relation (STAR) (t = -14.4; P <.001), positive collaboration (t = -12.8; P <.001), positive clinical input (t = -11.9; P <.001), and total Patient's Perceptions of Physician Empathy (PPPE) score (t = -8.4; P < .001) were lower in the teleconsultation than in-person consultation group. TSS was positively correlated with positive collaboration, positive clinician input, and STAR total score. Conclusions: Our study suggests a stronger therapeutic relationship and higher physician empathy during in-person consultations. Poor accessibility and privacy concerns were critical challenges in telehealth service. TSS and therapeutic relationships positively influence each other.

Six-month buprenorphine-naloxone treatment is associated with neurocognitive function improvement in opioid dependence.

Background and Aim: The number of longitudinal studies on cognitive functions in patients on buprenorphine-based agonist treatment is limited. Our objective was to assess the change in neurocognitive functions over the first 6 months of buprenorphine-naloxone (BNX) treatment for opioid dependence (OD) and compare cognitive functions on BNX and controls. Methods: We selected 60 patients with OD aged 18 to 55 years and 20 sex-matched controls; and excluded patients with other substance dependence, human immunodeficiency virus (HIV), head injury, epilepsy, and severe mental illness. We assessed patients thrice: at baseline, 3, and 6 months and Controls once. Cognitive tests included Wisconsin card sorting test (WCST), Iowa gambling task (IGT), trail making tests A and B (TMT-A and B), verbal and visual N-back test (NBT), and standard progressive matrices (SPM). We measured with-in group effect size with Cohen's D (d). Results: A total of 24 participants completed at least one follow-up; 17 completed both follow-up assessments. All participants were men. At baseline, the patients performed worse than healthy controls in IGT, TMT-A, and B, and visual and verbal NBT. At 3 months, the performance of visual NBT improved significantly (d = 1.2 for NBT1; 1.3 for NBT2). At 6 months, additional performance improvements were seen in WCST ("perseverative error" d = 1.2), IGT ("net total score" d = 1.2), TMT-A (d = 1.1), and verbal NBT ("omission error" d = 1.7). Except for visual-NBT, results did not differ between patients and controls at both follow-ups. Conclusion: Cognitive flexibility, decision making, attention, working memory, and psychomotor speed showed improvements over 6 months of a stable dose of BNX.

Depressive symptoms in early alcohol or opioid abstinence: course & correlates.

BACKGROUND: Depressive symptoms are common during abstinence from psychoactive substances. Research caveats limit the study of persistence of significant depressive symptoms beyond four weeks of abstinence. This prospective study examined the course and correlates of depressive symptoms in patients with alcohol or opioid use disorder over 5-8 weeks. METHODS: Sample consisted of 100 men randomly selected out of 307 inpatient men with either alcohol or opioid use disorder. Weekly assessments focused on depressive symptoms (HDRS, BDI), and their correlates (HAM-A for anxiety symptoms, CIWA-Ar and COWS for withdrawal symptoms, OCDS and OCDUS for craving for alcohol and opioids respectively). Other correlates assessed were severity of dependence and family support. PRISM (Psychiatric Research Interview for Substance and Mental disorders) was used for diagnosis of substance-induced depression and major depressive episode. Repeated measures ANOVA was used for weekly comparison of depressive symptoms. RESULTS: Participants were dependent on opioids (56%), or alcohol (41%), or both (3%). Mean age was 33.5 years. Eighty-eight participants completed the study. Substance-induced depressive episode was diagnosed by PRISM in 59% participants. Weekly assessments of depressive symptoms recorded significant reductions (p < 0.0001; Wilk's Lambda for HDRS and BDI 137.01 and 105.4 respectively). Baseline depressive symptoms correlated significantly with anxiety, withdrawal symptoms, and negatively with social support. No participant was diagnosed with a major depressive episode at 6-8 weeks. CONCLUSION: Depressive symptoms in early alcohol or opioid abstinence resolve significantly over a month; therefore, clinicians should exercise watchful waiting before starting antidepressant therapy.

How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients.

OBJECTIVES: To investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology. DESIGN: Cross-sectional study. SETTING: International study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings. PARTICIPANTS: 1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV). PRIMARY AND SECONDARY OUTCOME MEASURES: Hyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory. RESULTS: Hypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001). CONCLUSIONS: This study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.

Sexual dysfunction in men on buprenorphine - naloxone-based substitution therapy.

BACKGROUND: The literature on sexual dysfunction in patients on buprenorphine-naloxone (BNX) substitution is limited. MATERIALS AND METHODS: This research aimed to study the prevalence and correlates of sexual dysfunction in men on BNX substitution therapy. We recruited consecutive forty men from BNX clinic, who had received BNX for at least 6 months, who were free from any recent illicit drug use (confirmed by urine chromatographic immune assay), and who were either married or had a stable sexual partner. Men with other psychiatric and substance use disorders (except tobacco) were excluded from the study. Data for the control group were obtained from a published study (with similar selection criteria) from our center. We assessed sexual dysfunction with two cross-culturally validated instruments: Arizona Sexual Experience Scale (ASEX) and International Index of Erectile Function. RESULTS: The sample had a mean age of 31.6 (±8) years; the mean duration of BNX treatment was 9 (±4.2) months and the mean BNX dose was 4.5 (±1.6) mg. ASEX showed the prevalence of sexual dysfunction to be 40%. The IIEF demonstrated intercourse dissatisfaction (95%) and hypoactive sexual desire (92.5%) as almost universal, while 77.5% of the participants reported erectile dysfunction. In comparison to the published data, these figures were significantly more than among the controls. We found no correlation of sexual dysfunction with marital status, age, duration or dose of BNX, duration of illicit opioid use, the severity of opioid dependence, and tobacco dependence. CONCLUSION: All men on BNX maintenance therapy must be screened for sexual dysfunction. With the rapid scaling up of office-based BNX substitution, assessment and management of sexual dysfunction ought to be incorporated in the training curriculum.

Stigma and its correlates among caregivers of schizophrenia: A study from North India.

This study aimed to study stigma experienced by caregivers of patients with schizophrenia. One hundred caregivers of patients with schizophrenia were evaluated on Stigma scale for caregivers of people with mental illness (CPMI), Explanatory model interview catalogue stigma scale (EMIC), General health questionnaire-12 (GHQ), Self-report attitude towards medications questionnaire and Knowledge of mental illness scale (KMI). On CPMI the score was higher for affective component (2.3±0.5) than for cognitive (1.9±0.9) and behavioural (1.8±0.6) components. More than half of caregivers 'agreeing' or 'strongly agreeing' on 20 out of 22 items of CPMI indicated high level of stigma. On EMIC the stigma score was 21.7±6.3. Higher level of affiliate and/or associative stigma was associated with shorter duration of illness and treatment, shorter duration of being in the caregiver role, younger, female and non-earning caregivers, prescription of higher number of pills, caregivers who less often accompany the patient to the hospital and caregivers experienced more psychological morbidity. To conclude this study suggests that caregivers of patients with schizophrenia experience substantial stigma; hospital and community level programs and services are required to reduce and prevent the same.

Symptom profile of alcohol withdrawal delirium: factor analysis of Delirium Rating Scale-Revised-98 version.

BACKGROUND: The symptom profile of alcohol withdrawal delirium (AWD), relative to deliriums of other etiology, remains uncertain. OBJECTIVE: To evaluate the factor structure of symptoms in patients with AWD, as assessed by the Delirium Rating Scale-Revised-98 (DRS-R-98). METHOD: A total of 112 patients aged 18 years or more with AWD were assessed on DRS-R-98. RESULTS: The mean age of participants was 44.2 years. About two-third of the patients developed delirium within 24 hours of the last intake of alcohol and the mean duration of delirium at the time of assessment was 3.9 days. In 46% of cases the delirium was attributed solely to alcohol withdrawal; in the remaining subjects alcohol withdrawal was a major contributory factor. Three separate principal component analysis (whole sample, pure AWD and AWD with associated etiologies) were carried out. In all the factor analyses, one of the factors included cognitive symptoms (attention, orientation and visuospatial disturbances) along with or without short- and long-term memory impairment; the second factor included motoric symptoms along with sleep-wake cycle disturbances; the third factor included psychotic symptoms. For the whole group and subgroup of AWD with associated etiologies, items of higher level thinking (i.e. language disturbances and thought process abnormality) loaded along with cognitive symptoms. In pure AWD group, these items along with memory disturbances loaded with psychotic symptoms. CONCLUSIONS: Results of the current factor analyses suggest that the factor structure of pure AWD is different from AWD with associated etiologies. Hence, attention to the symptom profile of patients with AWD may provide clues to delirium etiology.

Stigma and its correlates in patients with schizophrenia attending a general hospital psychiatric unit.

BACKGROUND: Very few studies from India have studied stigma experienced by patients with schizophrenia. AIM OF THE STUDY: To study stigma in patients with schizophrenia (in the form of internalized stigma, perceived stigma and social-participation-restriction stigma) and its relationship with specified demographic and clinical variables (demographic variables, clinical profile, level of psychopathology, knowledge about illness, and insight). MATERIALS AND METHODS: Selected by purposive random sampling, 100 patients with schizophrenia in remission were evaluated on internalized stigma of mental illness scale (ISMIS), explanatory model interview catalog stigma scale, participation scale (P-scale), positive and negative syndrome scale for schizophrenia, global assessment of functioning scale, scale to assess unawareness of mental disorder, and knowledge of mental illness scale. RESULTS: On ISMIS scale, 81% patients experienced alienation and 45% exhibited stigma resistance. Stereotype endorsement was seen in 26% patients, discrimination experience was faced by 21% patients, and only 16% patients had social withdrawal. Overall, 29% participants had internalized stigma when total ISMIS score was taken into consideration. On P-scale, 67% patients experienced significant restriction, with a majority reporting moderate to mild restriction. In terms of associations between stigma and sociodemographic variables, no consistent correlations emerged, except for those who were not on paid job, had higher participation restriction. Of the clinical variables, level of functioning was the only consistent predictor of stigma. While better knowledge about the disorder was associated with lower level of stigma, there was no association between stigma and insight. CONCLUSION: Significant proportion of patients with schizophrenia experience stigma and stigma is associated with lower level of functioning and better knowledge about illness is associated with lower level of stigma.

Sexual dysfunctions in alcohol-dependent men: A study from north India.

BACKGROUND & OBJECTIVES: Sexual dysfunctions have been reported in alcohol-dependent men. Most of the studies conducted had limitation of using non-validated measures of sexual dysfunction and sampling design. This study was, therefore, conducted to determine the typology, demographic and clinical correlates of sexual dysfunction in alcohol-dependent men. METHODS: One hundred and one patients with alcohol dependence (AD) attending the Drug De-addiction and Treatment Centre and 50 healthy controls were evaluated in this cross-sectional study. Participants in both the groups were assessed on Arizona Sexual experience scale (ASEX), Dyadic Adjustment Scale (DAS), Hamilton Depression Rating Scale (HDRS) and State-Trait Anxiety Inventory (STAI). In addition, patients with AD were assessed on Severity of Alcohol Dependence Questionnaire (SADQ) for severity of AD and revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar) to ensure that no participant was in active alcohol withdrawal state. RESULTS: Overall, 58.4 per cent of patients in the AD group had sexual dysfunction. Among the domains, the highest frequency was seen for dysfunction for arousal (57.4%), followed by problems in desire (54.4%), erection (36.6%), satisfaction with orgasm (34.6%) and ability to reach orgasm was least affected (12.87%). The patient and control groups differed significantly in overall dyadic adjustment, in the domains of dyadic satisfaction and affective expression. INTERPRETATION & CONCLUSIONS: The finding of this study showed that a significant proportion of patients with AD has sexual dysfunction. Longitudinal studies using validated assessment tools should be done to confirm these findings.

How Do Indian Substance Users Perceive Stigma Towards Substance Use Vis-A-Vis Their Family Members?

Perceived stigma towards substance use may determine family members' willingness to help in the treatment process of a substance user. This study aimed to compare the perceived stigma towards substance use among Indian substance users and their family members. Fifty dyads each of alcohol- and opioid-dependent men and their family members were recruited through purposive sampling. Perceived stigma was assessed using Perceived Stigma of Substance Abuse Scale (PSAS) in both the dependent men and the family members. PSAS scores of patients and the family members correlated with each other in both the alcohol- and opioid-dependent groups. Being currently employed predicted higher PSAS scores among patients, while being unmarried predicted higher PSAS scores among family members.

Cocaine dependence: a case series from India.

BACKGROUND: Cocaine use and dependence is a wellknown phenomenon in the West but has not been reported in the medical literature from India, despite recent media reports of its use by drug abusers and seizure by authorities. METHODS: We report 5 patients with cocaine dependence who came for treatment to the Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. RESULTS: All the patients were young adult men (age range 20-27 years). They were either unemployed or in medium level occupation. All used cocaine by 'snorting' (inhaling cocaine hydrochloride salt in a powder form through the nose so that cocaine gets rapidly absorbed into the bloodstream through the nasal mucosal epithelial capillary vasculature). None reported smoking or inhaling the vapour of heated freebase cocaine ('crack'). All reported intense and specific craving for cocaine (and met criteria for dependence syndrome as per ICD-10), though 3 patients were also dependent on opioid preparations (heroin, dextropropoxyphene or codeine containing cough syrups). We started them on clonidine for opioid detoxification followed by naltrexone. Since there is no approved medication for cocaine withdrawal or relapse prevention, our focus was on relapse prevention counselling using cognitive behavioural principles. The outcome was variable. CONCLUSION: Cocaine dependence is present among the population in India. Patients are not necessarily from the affluent class. This case series of cocaine dependence, the first from India, intends to be both a curtain raiser and an eye opener.

Sexual dysfunction in patients with alcohol and opioid dependence.

There are limited numbers of studies which have evaluated the sexual dysfunction (SD) in patients with alcohol and opioids dependence. This article reviews the existing literature. Electronic searches were carried out using the PubMed, Google Scholar, and ScienceDirect to locate the relevant literature. Subjects addicted to heroin or on methadone maintenance treatment (MMT) or buprenorphine maintenance treatment (BMT) show higher rates of SD in comparison to the general population. SD rates have ranged 34-85% for heroin addicts, 14-81% for MMT, 36-83% for BMT, and 90% for naltrexone maintenance. The rates of SD in alcohol-dependent population have ranged 40-95.2%, with rates being consistently much higher in alcohol-dependent population than in the healthy controls or social drinkers. The common SDs reported have been erectile dysfunction followed by premature ejaculation, retarded ejaculation and decreased sexual desire among men, and dyspareunia and vaginal dryness among women. This review suggests that long-term use of alcohol and opioids are associated with SD in almost all domains of sexual functioning. There is a need to increase the awareness of clinicians about this association as many times SD in patients with substance abuse lead to poor treatment compliance and relapse. Further, there is a need to carry out more number of studies to understand the relationship in a better way.

Sexual dysfunction in men seeking treatment for opioid dependence: a study from India.

INTRODUCTION: There is limited literature on opioid dependence patients for the prevalence of sexual dysfunction as assessed by validated questionnaires. AIM: To study the prevalence and specified demographic and clinical correlates of sexual dysfunction in men seeking treatment for opioid dependence by using multiple validated instruments. METHODS: Men with opioid dependence for at least 1 year as per DSM-IV (confirmed by Mini International Neuropsychiatric Interview) (OD group, N=100) and matched healthy controls (HC group, N=50) were evaluated for sexual dysfunction. MAIN OUTCOME MEASURES: Arizona Sexual Experience Questionnaire (ASEX), International Index of Erectile Function (IIEF) and Changes in Sexual Functioning Questionnaire Short-Form (CSFQ-14). RESULTS: In men seeking treatment for opioid dependence sexual dysfunction was recorded in 48% by ASEX, and in at least one of the domains in 92% by IIEF and in 90% by CSFQ; in comparison with the healthy controls, the prevalence of sexual dysfunction in patients with opioid dependence was significantly higher by each measure. CONCLUSIONS: Compared with healthy controls, sexual dysfunction rates are higher in patients seeking treatment for opioid dependence.

Interpersonal violence against wives by substance dependent men.

BACKGROUND: Indian research on intimate partner violence (IPV) with substance use covers only alcohol, and very few studies have reported on IPV with other substances. The study aims to assess IPV against wives by substance dependent men. METHODS: The study sample was recruited by convenient sampling from men (and their wives) seeking treatment at a de-addiction centre in North India between October, 2011 and February, 2012. The consenting wives self-administered the violence questionnaire. RESULTS: 267 wives were recruited into the study. The prevalence rates for IPV were: 55% for the whole sample, 63.19% for alcohol dependence and 42.33% for opioid dependence. IPV was associated with higher age of husband, lower education or unemployment of either spouse, lower income of family and nuclear family structure. CONCLUSIONS: Present research confirms that IPV against wives is highly prevalent among substance dependent men, more with alcohol dependence as compared to opioid dependence. Addressing IPV should be an integral part of substance abuse management.

Do motor subtypes of delirium in child and adolescent have a different clinical and phenomenological profile?

OBJECTIVE: To explore the frequency of different motor subtypes of delirium in children and adolescents and to study the relationship of motor subtypes with other symptoms, etiology and outcome of delirium. METHODS: Forty-nine consecutive patients, aged 8-19 years, diagnosed as having delirium as per DSM-IV-TR were assessed on Delirium Rating Scale-Revised 98 (DRS-R-98), amended Delirium Motor Symptom Scale (DMSS), delirium etiology checklist and risk factors for delirium. Different motoric subtypes of delirium were compared with each other for symptoms of delirium as assessed by DRS-R-98, risk factors, etiology and outcome. RESULTS: More than half (53%) of patients were classified as having hyperactive delirium, this was followed by the mixed (26.5%) and the hypoactive (16%) subtype. When the different subtypes were compared with each other, the 3 motor subtypes did not differ from each other in terms of frequency and severity of other symptoms except for minor differences. Hallucinations are more common in patients with hyperactive and mixed subtype. There is no significant difference in the outcome of delirium across different subtypes. CONCLUSION: Unlike in adults, motoric subtypes of delirium in child and adolescents do not differ from each other with respect to other symptoms, risk factors and outcome.