Chapter 5: Clinical assessment and diagnosis

Footnotes

Saito, Matsui, Otani et al (2005) have described Liepmann's phenomenon in benzodiazepine withdrawal delirium. They described how a patient with delirium whose eyes were closed responded affirmatively to suggestions made to him about what he could see; whales, birds etc.

The use of skin potential measurement seems a simple non-invasive way of predicting delirium in a small series of intensive care patients (Shiihara, Nogami, Chigira et al (2001).

Anticholinergic delirium may be reversed by physostigmine injection and this is used as a diagnostic test in some centres in patients with altered mental states in emergency departments. Schneir and colleagues report a case-note (chart) review study, primarily focussed on safety, of 39 such tests over a period in excess of 6 years in a department with 37,00 visits per year (2003). Patients ranged in age from 18-68. In only one case was there a serious complication- convulsions- attributed to the injection; and even in this case, the patient had already had a convulsion before the administration of physostigmine. This does seem a safe procedure in the relatively young patients in this series, but its utility and safety in the recognition of and management of delirium more generally is not established.

In the assessment of delirious patients in which cerebral hypoxia is implicated, it might be thought that oximetry might not be feasible. However Bliwise and colleagues have shown that, at least in a dementia sample, overnight oximetry is feasible, even at home (Bliwise, Lee, Wood-Siverio et al (2005)

 Reference List Chapter 5

Bliwise, D. L., Lee, J. H., Wood-Siverio, C., et al (2005) Feasibility of ambulatory overnight oximetry in consecutive patients in a dementia clinic. Journal of the American Geriatrics Society, 53, (3) 545-546

Saito, M., Matsui, Y., Otani, Y., et al (2005) Liepmann's phenomenon during benzodiazepine withdrawal. American Journal of Psychiatry, 162, (4) 811 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15800165&query_hl=157

Schneir, A. B., Offerman, S. R., Ly, B. T., et al (2003) Complications of diagnostic physostigmine administration to emergency department patients. Annals of Emergency Medicine, 42, (1) 14-19 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12827117&dopt=Abstract

Shiihara, Y., Nogami, T., Chigira, M., et al (2001) Sleep-wake rhythm during stay in an intensive care unit: a week's long-term recording of skin potentials. Psychiatry & Clinical Neurosciences, 55, (3) 279-280 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11422875&dopt=Abstract