Comparison of verbal and computerised months backwards tests in a hospitalized older population.

BACKGROUND: Delirium is extremely prevalent, yet underdiagnosed, in older patients and is associated with prolonged length of hospital stay and higher mortality rates. Impaired attention is the cardinal deficit in delirium and is a required feature in diagnostic criteria. The verbal months backwards test (MBT) is the most sensitive bedside test of attention, however, hospital staff occasionally have difficulty with its administration and interpretation. We hypothesise that the MBT on an electronic tablet may be easier and more consistent to use for both experienced and unexperienced medical professionals and, if the diagnostic efficacy was similar, aid delirium diagnosis. AIM: We aim to investigate the correlation of the verbal MBT with a computerised MBT application. METHODS: Participants recruited (age > 65, n = 75) were allocated to different cohorts (Dementia and Delirium (DMDL), Dementia (DM), Delirium (DL), No Neurocognitive Disorder (NNCD)) and were administered both the verbal and electronic versions. RESULTS: Correlation between measurements were: overall Spearman's rho = 0.772 (p < 0.0001); DMDL rho = 0.666 (p < 0.0001); DL rho = 0.778 (p = 0.039); DM rho = 0.378 (p = 0.203); NNCD rho = 0.143 (p = 0.559). DISCUSSION: Overall, and for the delirious subset, statistically significant agreement was present. Poor inter-test correlation existed in the groups without delirium (DM, NNCD). CONCLUSIONS: The MBTc correlates well with the MBTv in patients who are clinically suspected to have delirium but has poor correlation in patients without delirium. Visuospatial cognition and psychomotor deficits in a dementia cohort and mechanical factors (such as tremor, poor fingernail hygiene and visual impairment) in a group with no neurocognitive disorder may limit the utility of the MBTc in a hospitalised older population.

A decade of service development: audit of service users' experience of a rural Psychiatry of Later Life (POLL) service.

INTRODUCTION: The HSE "Vision for change", national service plan and other policies emphasise the importance of incorporating the views of service users and carers in the design and delivery of mental health services. AIMS: To obtain the views of service users in relation to a rural POLL service. Compare our service to best practice and address issues identified. Repeat the audit cycle based on recommendations. METHODOLOGY: New referrals to the POLL service were identified, and a pseudo-anonymised audit tool questionnaire was posted to these patients after initially making a telephone contact and obtaining informed consent. Results were compared to standards set by our team based on local and national policies. We used Microsoft Excel and performed a thematic analysis of qualitative data in the fourth cycle. This audit has been repeated on four occasions: 2012, 2013, 2016 and 2019. RESULTS: More than 90% of patients marked as being benefited by the POLL team. Overall, most positive responses pertained to supportive and professional staff, resolution of disease symptoms, psycho-education and attentive follow-up whereas negative responses were in relation to limited access to disabled parking spaces, perceived inadequate discharge planning and non-resolution of disease symptoms in few patients. CONCLUSION: Involving POLL patients in audit provided useful insights to improve the quality of service. We resolved the issue of disabled parking access and have developed a service information leaflet and a discharge leaflet. We intend to focus more on psychoeducation and discharge planning based on the results of the current cycle.

Hyperactive delirium following administration of intra-articular corticosteroid.

Intra-articular administration of corticosteroids is a commonly used treatment for osteoarthritis as well as other inflammatory disorders of the joints. It is well known that delirium and psychosis can arise following the administration of oral corticosteroids but there are few documented cases of the development of acute hyperactive delirium with psychosis following intra-articular administration. We describe a case of an 82-year-old female patient with moderate dementia who developed a delirium with psychosis which responded well to a first-generation antipsychotic.

Hyponatraemia-associated catatonia.

This is a case report highlighting the impact of low sodium levels on one's mental status. For the first time in the literature, we see two discrete episodes of catatonia associated with hyponatraemia occurring in the same patient. On both occasions, his serum sodium levels were depleted; he became profoundly psychotic with catatonic symptoms. Recovery, with complete resolution of all symptoms, was associated with normalisation of these levels. This case exemplifies the profound effect that electrolyte imbalances, in particular sodium depletion can have on a patient's mental status and is for the first time, we see this effect on two temporally unrelated occasions in the same patient.

The potential for antimicrobials to adversely affect mental state.

This is a case report highlighting the influence that antimicrobials (clarithromycin in particular) can have on one's mental state. We discuss the case of a middle-aged woman who presented to an acute admissions unit under Irish Mental Health Act for involuntary admission because of concerns expressed by her family and general practitioner regarding a recent change in behaviour and onset of irritable mood. This lady was diagnosed with an episode of mania that was thought to be precipitated by a combination of psychosocial stressors, recent discontinuation of psychotropic medication and complicated by a recent course of clarithromycin.