Delirium: caracterización clínica y sociodemográfica de los pacientes egresados del Hospital Nacional Psiquiátrico en San José, Costa Rica, y recomendaciones de manejo del Delirium para el personal del primer y segundo nivel de atención en los servicios de salud de la Caja Costarricense del Seguro Social
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vii Resumen Introducción: El Delirium se reporta como uno de los desórdenes agudos más comunes en hospitales generales: llega a afectar 11-42% de los adultos mayores. No obstante, a pesar de su elevada incidencia, es un síndrome a menudo subdiagnosticado o mal diagnosticado hasta en el 65-75% de los casos en el servicio de emergencias de hospitales generales, lo cual conlleva un aumento en el deterioro del paciente y mayor costo de su manejo a las finanzas de la seguridad social. Resulta evidente la necesidad de ampliar la educación sobre el abordaje diagnóstico y terapéutico del delirium en Costa Rica, a quienes integran los equipos de salud de un servicio de emergencias de un hospital general con la finalidad de no mal diagnosticar el delirium como una patología psiquiátrica y retardar así su diagnóstico real, dado que encarece el manejo de estos pacientes en el sistema de seguridad social costarricense. Método: Se revisaron 79 expedientes del Hospital Nacional Psiquiátrico (HNP) con diagnóstico de egreso Delirium. La población estudiada fue de pacientes mayores de 65 años, en el período comprendido entre el 1 de Enero de 2009 y el 31 de Diciembre de 2013. Con la totalidad de casos, se realizó análisis descriptivo de los datos consignados en sus respectivos expedientes clínicos. Resultados: El estudio evidencia que al 74.3% no se les realizó exámenes de laboratorio o toma de signos vitales en forma previa a su consulta. Hubo: predominancia femenina y edad promedio de 73.1 años; la mayoría, residentes de San José; tendencia estacional que aumenta los ingresos en marzo y en julio; estancia de hospitalaria promedio de 21 días. La demencia es la mayor comorbilidad psiquiátrica; la principal etiología subyacente de Delirium fue la infecciosa; las comorbilidades no psiquiátricas con mayor incidencia son HTA y DM. Se presentó polifarmacia: 5,2 medicamentos por paciente...
Delirum is reported as one of the most common acute disordes on general hospitals (11- 42%) on elderly patientes. Most of the time it doesn’t get diagnosed up to 65-75% on the emergency room from general hospitals, as a result patients evolution is worst and the cost of their treatment grows beyond expectations to the family as well as to the country. This is why education of the health profesionals on diagnosis and management of Delirium becomes a priority, so that it gets diagnosed as soon as possible and lowers the costs of the Costa Rica’s national health system. Methodology: 79 files from the National Psychiatric Hospital (HNP), whose come out medical diagnosis was Delirium. The population was constituted exclusively by people older than 65, all of the were admitted between January 1, 2009 and Decembre 31, 2013. All the data obtained underwent a descriptive analisis. Results: This study shows that 74,3% of the patients did not have any sort of examination (physical exam or laboratories) before they had their Psychiatric consultation; most of the patients were female, average age was 73,1 years; most lived in San José; there were more hospitalizations on march and july; hospitalization days were 21 on average; main psychiatric comorbidity was Dementia; main Delirium ethiology was an infection; main non psychiatric comorbidities were high blood pressure and Diabetes Mellitus; polypharmacy was present with around 5,2 types of drugs on admission. Most pacients were brought by their family to the National Psychiatric Hospital without a prior medical consultation (51,9%). Most of the patients lived with their families. Phisycal agitation was the most frequent symptom (77,2%). The other symptoms are: insomnia (70,9%), desorientation (68,4%), irritability (58,2%), aggressiveness (53,2%), and hallucinations (53,2%), and hipobulic conduct (32,9%). Hiperactive delirium was on 70,3% of the population...
Delirum is reported as one of the most common acute disordes on general hospitals (11- 42%) on elderly patientes. Most of the time it doesn’t get diagnosed up to 65-75% on the emergency room from general hospitals, as a result patients evolution is worst and the cost of their treatment grows beyond expectations to the family as well as to the country. This is why education of the health profesionals on diagnosis and management of Delirium becomes a priority, so that it gets diagnosed as soon as possible and lowers the costs of the Costa Rica’s national health system. Methodology: 79 files from the National Psychiatric Hospital (HNP), whose come out medical diagnosis was Delirium. The population was constituted exclusively by people older than 65, all of the were admitted between January 1, 2009 and Decembre 31, 2013. All the data obtained underwent a descriptive analisis. Results: This study shows that 74,3% of the patients did not have any sort of examination (physical exam or laboratories) before they had their Psychiatric consultation; most of the patients were female, average age was 73,1 years; most lived in San José; there were more hospitalizations on march and july; hospitalization days were 21 on average; main psychiatric comorbidity was Dementia; main Delirium ethiology was an infection; main non psychiatric comorbidities were high blood pressure and Diabetes Mellitus; polypharmacy was present with around 5,2 types of drugs on admission. Most pacients were brought by their family to the National Psychiatric Hospital without a prior medical consultation (51,9%). Most of the patients lived with their families. Phisycal agitation was the most frequent symptom (77,2%). The other symptoms are: insomnia (70,9%), desorientation (68,4%), irritability (58,2%), aggressiveness (53,2%), and hallucinations (53,2%), and hipobulic conduct (32,9%). Hiperactive delirium was on 70,3% of the population...
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Tesis (especialidad en psiquiatría)--Universidad de Costa Rica. Sistema de Estudios de Posgrado, 2015
Palabras clave
ATENCION HOSPITALARIA - COSTA RICA, ATENCION INTEGRAL DE SALUD - COSTA RICA, DELIRIO, DELIRIO - DIAGNOSTICO - COSTA RICA, DELIRIO - FISIOPATOLOGIA, DELIRIO - PACIENTES - COSTA RICA, DELIRIO - TRATAMIENTO, HOSPITAL NACIONAL PSIQUIATRICO MANUEL ANTONIO CHAPUI (COSTA RICA) - CASOS, HISTORIAS CLINICAS, ESTADISTICAS, ETC. - 2009-2013