Browsing by Author "Meagher, David"

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    A comparison of the revised Delirium Rating Scale (DRS–R98) and the Memorial Delirium Assessment Scale (MDAS) in a palliative care cohort with DSM–IV delirium
    (Cambridge, 2015-08) O'Sullivan, Roisin; Meagher, David; Leonard, Maeve; Watne, Leiv Otto; Hall, Roanna J.; Maclullich, Alasdair M. J.; Trzepacz, Paula; Adamis, Dimitrios; Department of Psychiatry, IU School of Medicine
    Objective: Assessment of delirium is performed with a variety of instruments, making comparisons between studies difficult. A conversion rule between commonly used instruments would aid such comparisons. The present study aimed to compare the revised Delirium Rating Scale (DRS–R98) and Memorial Delirium Assessment Scale (MDAS) in a palliative care population and derive conversion rules between the two scales. Method: Both instruments were employed to assess 77 consecutive patients with DSM–IV delirium, and the measures were repeated at three-day intervals. Conversion rules were derived from the data at initial assessment and tested on subsequent data. Results: There was substantial overall agreement between the two scales [concordance correlation coefficient (CCC) = 0.70 (CI95 = 0.60–0.78)] and between most common items (weighted κ ranging from 0.63 to 0.86). Although the two scales overlap considerably, there were some subtle differences with only modest agreement between the attention (weighted κ = 0.42) and thought process (weighted κ = 0.61) items. The conversion rule from total MDAS score to DRS–R98 severity scores demonstrated an almost perfect level of agreement (r = 0.86, CCC = 0.86; CI95 = 0.79–0.91), similar to the conversion rule from DRS–R98 to MDAS. Significance of results: Overall, the derived conversion rules demonstrated promising accuracy in this palliative care population, but further testing in other populations is certainly needed.
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    How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients
    (BMJ, 2021-04-14) Glynn, Kevin; McKenna, Frank; Lally, Kevin; O’Donnell, Muireann; Grover, Sandeep; Chakrabarti, Subho; Avasthi, Ajit; Mattoo, Surendra K.; Sharma, Akhilesh; Ghosh, Abhishek; Shah, Ruchita; Hickey, David; Fitzgerald, James; Davis, Brid; O'Regan, Niamh; Adamis, Dimitrious; Williams, Olugbenja; Awan, Fahad; Dunne, C.; Cullen, Walter; McInerney, Shane; McFarland, John; Jabbar, Faiza; O'Connell, Henry; Trzepacz, Paula T.; Leonard, Maeve; Meagher, David; Psychiatry, School of Medicine
    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.