PDF
ePub
Citation
Print
Abstract
Objectives
Several studies have delineated the relationship between hearing disturbances and the prevalence or characteristics of psychotic symptoms; however, most of those studies focused on psychiatric patients and not general inpatients. Delirium has a high incidence among general inpatients, and patients with delirium are easily affected by psychotic symptoms that lead to irritable behaviors. This study examined the relationship between hearing disturbance and psychotic symptoms among patients with delirium.
Methods
At the Asan Medical Center in Seoul, South Korea, this study examined 27 inpatients who had both delirium and hearing disturbances between January 1, 2009 and December 31, 2018, and 146 inpatients at the Asan Medical Center who had delirium but no hearing disturbances between July 1, 2018 and December 31, 2018. This study investigated whether the two groups showed differences in the prevalence and characteristics of delirium symptoms, particularly psychotic symptoms. In addition, the correlation between clinical characteristics of delirium and the recommended dosage of antipsychotics was analyzed in patients who had been diagnosed with delirium and had hearing disturbances.
Results
Compared to inpatients who only had delirium, those who had both delirium and hearing disturbances had a significantly higher prevalence of hallucination and delusion.
Conclusion
The prevalence of psychotic symptoms, such as hallucination and delusion, was higher in patients who had both delirium and hearing disturbances, which is in line with the results from previous studies on psychiatric patients. Physicians should focus on improving communication with such patients by employing non-verbal communication methods. J Korean Neuropsychiatr Assoc 2019;58(3):209-215
REFERENCES
1.Inouye SK., Westendorp RG., Saczynski JS. Delirium in elderly people. Lancet. 2014. 383:911–922.
2.Inouye SK. Delirium in older persons. N Engl J Med. 2006. 354:1157–1165.
3.Pandharipande P., Jackson J., Ely EW. Delirium: acute cognitive dysfunction in the critically ill. Curr Opin Crit Care. 2005. 11:360–368.
4.Webster R., Holroyd S. Prevalence of psychotic symptoms in delirium. Psychosomatics. 2000. 41:519–522.
5.Lautenschlager NT., Förstl H. Organic psychosis: insight into the biology of psychosis. Curr Psychiatry Rep. 2001. 3:319–325.
6.Fujii D., Ahmed I. Characteristics of psychotic disorder due to traumatic brain injury: an analysis of case studies in the literature. J Neuropsychiatry Clin Neurosci. 2002. 14:130–140.
7.Cummings JL. Organic psychosis. Psychosomatics. 1988. 29:16–26.
8.Cutting J. The phenomenology of acute organic psychosis: comparison with acute schizophrenia. Br J Psychiatry. 1987. 151:324–332.
9.Meagher DJ., Moran M., Raju B., Gibbons D., Donnelly S., Saunders J, et al. Phenomenology of delirium: assessment of 100 adult cases using standardised measures. Br J Psychiatry. 2007. 190:135–141.
10.Sandberg O., Gustafson Y., Brännström B., Bucht G. Clinical profile of delirium in older patients. J Am Geriatr Soc. 1999. 47:1300–1306.
11.Gupta N., de Jonghe J., Schieveld J., Leonard M., Meagher D. Delirium phenomenology: what can we learn from the symptoms of delirium? J Psychosom Res. 2008. 65:215–222.
12.Boksa P. On the neurobiology of hallucinations. J Psychiatry Neurosci. 2009. 34:260–262.
13.Johns LC., Rossell S., Frith C., Ahmad F., Hemsley D., Kuipers E, et al. Verbal self-monitoring and auditory verbal hallucinations in patients with schizophrenia. Psychol Med. 2001. 31:705–715.
14.Blakemore SJ., Smith J., Steel R., Johnstone CE., Frith CD. The perception of self-produced sensory stimuli in patients with auditory hallucinations and passivity experiences: evidence for a breakdown in self-monitoring. Psychol Med. 2000. 30:1131–1139.
15.Hirano Y., Hirano S., Maekawa T., Obayashi C., Oribe N., Monji A, et al. Auditory gating deficit to human voices in schizophrenia: a MEG study. Schizophr Res. 2010. 117:61–67.
16.Kiran C., Chaudhury S. Understanding delusions. Ind Psychiatry J. 2009. 18:3–18.
17.Corlett PR., Taylor JR., Wang XJ., Fletcher PC., Krystal JH. Toward a neurobiology of delusions. Prog Neurobiol. 2010. 92:345–369.
18.Berrios GE. Musical hallucinations. A historical and clinical study. Br J Psychiatry. 1990. 156:188–194.
19.Stefanis N., Thewissen V., Bakoula C., van Os J., Myin-Germeys I. Hearing impairment and psychosis: a replication in a cohort of young adults. Schizophr Res. 2006. 85:266–272.
20.White NJ. Complex visual hallucinations in partial blindness due to eye disease. Br J Psychiatry. 1980. 136:284–286.
21.Menon GJ., Rahman I., Menon SJ., Dutton GN. Complex visual hallucinations in the visually impaired: the Charles Bonnet syndrome. Surv Ophthalmol. 2003. 48:58–72.
22.Fuchs T. [Delusion syndromes in sensory impediment–overview and model presentation]. Fortschr Neurol Psychiatr. 1993. 61:257–266.
23.Ross CA., Peyser CE., Shapiro I., Folstein MF. Delirium: phenomeno-logic and etiologic subtypes. Int Psychogeriatr. 1991. 3:135–147.
24.Andreasen NC., Pressler M., Nopoulos P., Miller D., Ho BC. Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs. Biol Psychiatry. 2010. 67:255–262.
25.Trzepacz PT., Mittal D., Torres R., Kanary K., Norton J., Jimerson N. Vali-dation of the Delirium Rating Scale-revised-98: comparison with the Delirium Rating Scale and the Cognitive Test for Delirium. J Neuropsychiatry Clin Neurosci. 2001. 13:229–242.
26.Cooper AF., Kay DWK., Curry AR., Garside RF., Roth M. Hearing loss in paranoid and affective psychoses of the elderly. Lancet. 1974. 304:851–854.
27.Cooper AF., Garside RF., Kay DWK. A comparison of deaf and non-deaf patients with paranoid and affective psychoses. Br J Psychiatry. 1976. 129:532–538.
28.Zimbardo PG., Andersen SM., Kabat LG. Induced hearing deficit generates experimental paranoia. Science. 1981. 212:1529–1531.
29.Johnson MK., Hashtroudi S., Lindsay DS. Source monitoring. Psychol Bull. 1993. 114:3–28.
30.Maher BA. Anomalous experience in everyday life: its significance for psychopathology. The Monist. 1999. 82:547–570.
31.Thewissen V., Myin-Germeys I., Bentall R., de Graaf R., Vollebergh W., van Os J. Hearing impairment and psychosis revisited. Schizophr Res. 2005. 76:99–103.
32.Premack D., Woodruff G. Does the chimpanzee have a theory of mind? Behav Brain Sci. 1978. 1:515–526.
33.Dudley R., Taylor P., Wickham S., Hutton P. Psychosis, delusions and the “jumping to conclusions” reasoning bias: a systematic review and meta-analysis. Schizophr Bull. 2016. 42:652–665.
34.Saba PR., Keshavan MS. Musical hallucinations and musical imagery: prevalence and phenomenology in schizophrenic inpatients. Psychopathology. 1997. 30:185–190.
Table 1.
Korean Standard Classification of Disease-7 code for hearing disturbances
Table 2.
Comparison between hearing disturba ance group and no hearing disturba ance group
Table 3.
Correlation between clinical characteristics of delirium and recommended dosage of antipsychotics
| τ | p-value | |
|---|---|---|
| Fluctuation of symptom severity Motor agitation Sleep-wake cycle disturbance Orientation† | −0.124 0.373 0.225 0.322 | 0.483 0.035∗ 0.205 0.048∗ |
| Language | 0.385 | 0.030∗ |
| Lability of affect | 0.199 | 0.262 |
| Delusions | 0.287 | 0.105 |
| Perceptions and hallucinations | ||
| Visual hallucination | −0.147 | 0.407 |
| Auditory hallucination | 0.030 | 0.866 |
| Auditory hallucination‡ | 0.228 | 0.198 |
XML Download