Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Response

Barbara C van Munster and Se De Rooij
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.14-4-455
Clin Med August 2014
Barbara C van Munster
AAcademic Medical Centre, Amsterdam and Gelre Hospitals, Apeldoorn, the Netherlands
Roles: Medical specialist
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Se De Rooij
BAcacemic Medical Centre, Amsterdam, the Netherlands
Roles: Professor
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

Editor – We would like to thank our colleague for his thoughtful comments and would like to respond point by point.

  1. We regret not mentioning the references for the Diagnostic Statistical Manual (DSM) criteria. Although both clinicians and researchers can be expected to be familiar with the formal well defined DSM criteria, it was an error to not put the reference in our reference list. We agree with the fact that acute onset does not mean ‘1 day’, as we adhere to the DSM criteria. Our table did mention ‘acute’ without defining it. We believe that the speed of onset is dependent on the cause of delirium, with postoperative delirium taking around 2 days and sepsis just a few hours.

  2. The underdiagnosis of delirium is a frequent problem and might be partly related to the fluctuation of symptoms throughout the day.1 Missing delirium symptoms could prevent appropriate treatment of the underlying disorder of the patient and could be seen as a medical omission. We agree there is no need for the admission of patients with behavioural and psychological symptoms of dementia (BPSD) to hospital, but this diagnosis is not always easy for a general practitioner (GP) with limited time for observation.

  3. Our manuscript aimed to give an overview of delirium by summarising the important aspects and presenting some new insights based on important papers of the recent years. Our review is not exhaustive, and more important highlights have been published recently. We believe the meta-analysis of Witlox has the highest level of evidence on survival and delirium, and we expect delirium researchers of the included studies would have been able to discriminate well between BPSD and delirium.2 The confusion assessment method (CAM) is not the ‘gold standard’ test for delirium. The more strict the definition of delirium (according to DSM criteria), the stronger the association with mortality can be expected. This may be an explanation for the lack of association between CAM positive delirium and survival in the Australian cohort.

  4. We agree that testing of hearing is important for all diseases that use cognitive testing – not just for delirium, but also dementia and depression. Importantly, hearing loss is also a risk factor for delirium, and this is often underreported. Additionally, there are other important impairments that can influence performance on cognitive functional testing, such as visual impairment and language problems. In general, one could expect that healthcare workers and researchers involved in delirium research take possible impairments into consideration.

Footnotes

  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

  • © 2014 Royal College of Physicians

References

  1. ↵
    1. Michaud L,
    2. Büla C,
    3. Berney A,
    4. et al.
    Delirium: guidelines for general hospitals. J Psychosom Res 2007;62:371–83.doi:10.1016/j.jpsychores.2006.10.004
    OpenUrlCrossRefPubMed
  2. ↵
    1. Witlox J,
    2. Eurelings LS,
    3. de Jonghe JF,
    4. et al.
    Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 2010;28;304:443–51.doi:10.1001/jama.2010.1013
    OpenUrlCrossRef
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Response
Barbara C van Munster, Se De Rooij
Clinical Medicine Aug 2014, 14 (4) 455; DOI: 10.7861/clinmedicine.14-4-455

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Response
Barbara C van Munster, Se De Rooij
Clinical Medicine Aug 2014, 14 (4) 455; DOI: 10.7861/clinmedicine.14-4-455
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • JAK-inhibition as a therapeutic strategy for refractory primary systemic vasculitides
  • Response
  • Functional disorders and chronic pain
Show more Letters to the editor

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians