Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and Participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2e2.1; P ¼ .00] and in Model 2 (OR 1.4; CI 1.1e1.9; P ¼ .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6e1.2, P ¼ .36; OR 1.1; CI 0.8e1.4; P ¼ .42) or in Model 2 (OR 0.8, CI 0.6e1.2, P ¼ .27; OR 1.1, CI 0.8e1.4, P ¼ .63).

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Second-generation antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are considered first-line treatments for anxiety. Recent studies in major depressive disorder have suggested that antidepressants are more effective for severely depressed patients than for mildly depressed patients [1,2]. As a consequence, guidelines for the treatment of milder depression have changed. Little is known, however, about whether this relationship between baseline severity and antidepressant efficacy also holds for anxiety disorders. Objective: To examine the influence of baseline severity of anxiety on antidepressant efficacy for generalized anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and panic disorder (PD). Methods: Data from Food and Drug Administration (FDA) reviews of approved second-generation antidepressants was used. All premarketing randomized controlled trials of secondgeneration antidepressants for the short-term treatment of an anxiety disorder were included, with the exception of three trials with incompatible primary outcomes. Baseline symptom scores and change in symptom scores were extracted for placebo and treatment groups in each study. For PD, remission rates were also extracted. Hedges' g was calculated from the change score and its standard deviation for GAD, SAD, OCD, and PTSD. For 10 trials, data on the standard deviation or remission rate was missing; multiple imputation was used to impute these missing data. Mixed-effects meta-regression was used to investigate the effects of treatment group, baseline severity, and their interaction on the standardized change from baseline or the remission rate (for PD only). Results: Fifty-six trials with a total of 14,710 participants were included. Placebo effect sizes ranged from 0.49 for OCD to 1.03 for GAD, while drug effect sizes ranged from 0.83 for OCD to 1.35 for GAD. Increasing baseline severity did not predict greater improvement in drug groups compared to placebo groups. Standardized regression coefficients of the interaction term between baseline severity and treatment group were 0.04 (95% confidence interval −0.13 to 0.20, p = 0.65) for GAD, −0.06 (−0.20 to 0.09, p = 0.43) for SAD, 0.04 (−0.07 to 0.16, p = 0.46) for OCD, 0.16 (−0.22 to 0.53, p = 0.37) for PTSD, and 0.002 (−0.10 to 0.10, p = 0.96) for PD. For OCD, baseline severity did predict improvement in both placebo and drug groups equally (b = 0.11, 95% confidence interval 0.05 to 0.17, p = 0.001). Conclusions: No relationship between baseline severity and the drug-placebo difference was found for anxiety disorders. These results suggest that mildly or moderately anxious patients may experience as much benefit from antidepressants as severely anxious patients. The size of the drug-placebo difference was small to moderate; whether these effects may be considered clinically relevant remains a matter of debate. If considered clinically rel...

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