Intensive care unit psychosis-sundowning: A challenging phenomenon

Assad, Salman; Ghani, Usman; Sulehria, Touqeer; Mansoor, Taimur; Ameer, Muhammad Atif

doi:10.4103/0972-5229.200008

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…Many SS cases were found among adults subjected to post-acute and institutionalized care. SS has been attributed to mostly older populations with neurodegenerative diseases, such as AD and Parkinson's (PD), and is linked to a clinically similar phenomenon colloquially known as "intensive care syndrome (ICS) psychosis" [5]. The clinical characterization of ICS began in the 1950s as reports of extreme behavioral changes and reduced cognitive function steadily increased among patients in intensive care units (ICU).…”

Section: Overview Of Circadian Rhythm Regulation and Dysregulationmentioning

confidence: 99%

The hidden link between circadian entropy and mental health disorders

et al. 2022

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The high overlapping nature of various features across multiple mental health disorders suggests the existence of common psychopathology factor(s) (p-factors) that mediate similar phenotypic presentations across distinct but relatable disorders. In this perspective, we argue that circadian rhythm disruption (CRD) is a common underlying p-factor that bridges across mental health disorders within their age and sex contexts. We present and analyze evidence from the literature for the critical roles circadian rhythmicity plays in regulating mental, emotional, and behavioral functions throughout the lifespan. A review of the literature shows that coarse CRD, such as sleep disruption, is prevalent in all mental health disorders at the level of etiological and pathophysiological mechanisms and clinical phenotypical manifestations. Finally, we discuss the subtle interplay of CRD with sex in relation to these disorders across different stages of life. Our perspective highlights the need to shift investigations towards molecular levels, for instance, by using spatiotemporal circadian “omic” studies in animal models to identify the complex and causal relationships between CRD and mental health disorders.

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Section: Overview Of Circadian Rhythm Regulation and Dysregulationmentioning

confidence: 99%

The hidden link between circadian entropy and mental health disorders

et al. 2022

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“…The prevalent hypoactive delirium subtype is accompanied by psychomotor retardation, rather than the agitation 2 associated with nocturnal hyperactivity or "sundowning." 18 A group with hypoactive delirium may provide a more homogenous motor phenotype, with slower or fewer movements compared to other subtypes. We hypothesized that altered patterns of motor activity or immobility, that reflect sleep and wakefulness patterns, would allow us to discriminate the presence and timing of hypoactive postoperative delirium.…”

Section: Scientific Investigationsmentioning

confidence: 99%

Early Postoperative Actigraphy Poorly Predicts Hypoactive Delirium

Maybrier

King

Crawford

et al. 2019

Journal of Clinical Sleep Medicine

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Study Objectives: Delirium is a postoperative complication accompanied by disturbances in attention, cognition, arousal, and psychomotor activity. Wrist actigraphy has been advocated to study inactivity and inferred sleep patterns during delirium. We hypothesized that altered patterns of motor activity or immobility, reflective of disordered sleep and wakefulness patterns, would serve as predictive markers of hypoactive postoperative delirium. Methods: Eighty-four elderly surgical patients were classified into three groups based on the timing of hypoactive delirium following surgery: intact with no delirium throughout postoperative days (POD) 0-5 (n = 51), delirium during POD 0-1 (n = 24), and delirium during POD 2-5 (n = 13). Delirium was detected on daily Confusion Assessment Method evaluations and chart review. Actigraphy measures were calculated from accelerometry signals acquired on the first postoperative day (POD 0, 16:00-23:00) and night (POD 0, 23:00-POD 1, 06:00). Results: Actigraphy metrics showed substantial interpatient variability. Among the three patient groups, only those without delirium showed greater movement during the day compared to night and also fewer minutes of night immobility (P = .03 and P = .02, Wilcoxon rank-sum tests). These patients were poorly discriminated from those with delirium during either POD 0-1 or POD 2-5, using differences in day and night activity (C-statistic, 95% confidence interval [CI]: 0.66 [0.53-0.79] and C-statistic, 95% CI: 0.71 [0.55-0.87], respectively). Inclusion of low-frequency signals improved performance of immobility measures without affecting those based on activity. Cognitively intact patients during POD 0-5 were distinguished from those with delirium during POD 0-1, based on differences in the number of day and night immobile minutes (C-statistic 0.65, 95% CI: [0.53-0.78]). Actigraphy metrics with the strongest association to delirium incidence were not reliably correlated with an increased risk during POD 0-5, when accounting for patient age, sex, intensive care unit admission, and Charlson Comorbidity Index (adjusted odds ratio of 1.7, 95% CI: [1.0-3.0], P = .09, likelihood ratio test). Conclusions: Early postoperative wrist actigraphy metrics that serve as markers of sleep and wakefulness offer limited capacity as sole predictors or markers of hypoactive delirium.

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“…Un reporte de World Alzheimer Report en el 2018 indicó que a nivel mundial 50 millones de personas fueron diagnosticadas con demencia y se pronostica que para el año 2030 los diagnósticos se tripliquen. Es por ello que las personas con demencia manifiestan un comportamiento alterado en horas específicas del atardecer y anochecer; entre las manifestaciones surgen desorientación, agitación, confusión, inquietud y comportamientos agresivos que preocupan a los cuidadores denominado síndrome del ocaso (Assad, Ghani, Sulehria, Mansoor, & Ameer, 2017).…”

Section: Introductionunclassified

Abordaje multidisciplinario del síndrome de sundowning en deterioro neurocognitivo

et al. 2021

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Las neurociencias son vitales para la atención de las personas mayores a partir de los sesenta años y más, debe ser orientada en la prevención, terapéutica, neurorehabilitación y abordaje de cuidados paliativos encaminados para brindar un soporte en el cuidado de la persona mayor enferma en etapas agudas cuando surge la aparición del síndrome de sundowning que significa el deterioro de funciones cognitivas relacionadas con el trastornos del sueño y el aparecimiento de síntomas dependiendo la jornada nocturna y diurna. Por consiguiente, en la población geriátrica de manera fisiológica se activa el ciclo circadiano del sueño durante el atardecer para la conciliación normal del mismo; es aquí cuando aparece el síndrome de sundowning de manera patológica caracterizándose por un conjunto de signos y síntomas que se presentan en pacientes con deterioro neurocognitivo. Este síndrome debe abordarse de manera multidisciplinaria debido a que esta agrupación de perturbaciones del comportamiento tanto emocionales, físicas y cognitivas son derivadas de las diferentes demencias aunadas a los grandes síndromes geriátricos que agudizan el cuadro clínico tornando a los pacientes con aumento de los grados de dependencia y fragilidad resultado del deterioro de la calidad de vida, bienestar físico y mental del adulto mayor.

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Intensive care unit psychosis-sundowning: A challenging phenomenon

Cited by 3 publications

References 5 publications

The hidden link between circadian entropy and mental health disorders

The hidden link between circadian entropy and mental health disorders

Early Postoperative Actigraphy Poorly Predicts Hypoactive Delirium

Abordaje multidisciplinario del síndrome de sundowning en deterioro neurocognitivo

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