Delirium in Patients with Covid-19
Madhusudhan S1*, Shreekara2, Chandrashekar H3, Pranjal Sharma2, Amit2, Jeevan2 and Anjana R4
1Associate Professor, Department of Psychiatry, Victoria Hospital BMCRI, Bangalore, India
2Psychiatry Residents, Department of Psychiatry, Victoria Hospital BMCRI, Bangalore, India
3Professor and HOD, Department of Psychiatry, Victoria Hospital BMCRI, Bangalore, India
4Psychiatry Senior Resident, Department of Psychiatry, Victoria Hospital BMCRI, Bangalore, India
*Corresponding Author: Madhusudhan S, Associate Professor, Department of Psychiatry, Victoria Hospital BMCRI, Bangalore, India.
December 16, 2021; Published: January 05, 2022
Background: Victoria hospital a specialized COVID center in Bangalore saw more than 10,000 patients with COVID-19 infection who have been admitted to our hospital. Most of the patients that were taken up for the study were moderate to severely ill and at a risk of developing acute delirium, Neurotropic properties of SARS-CoV-2 and its neurological expressions have been established, this study hence was designed to find the prevalence and risk factors for developing acute delirium in patients admitted with COVID-19 infection.
Method: The study includes 10,200 covid infected patient admitted to Victoria hospital, of which about 550 cases were found to have neuropsychiatric symptoms.
Patients who were on life support, prisoners, patients were with pre-existing Psychiatric illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug dependence (Except ADS and NDS), suicide attempt were excluded. Patients with blind deafness were excluded.
The study was designed to determine the prevalence of delirium and to ascertain if there are any associated risk factors for delirium.
Findings: From June 2020 to June 2021, about 10,200 patients with COVID-19 were admitted to Victoria Hospital. Bangalore. Out of which 550 patients having neuropsychiatric symptoms were taken into the study.
The mean age of patients was 60 years. The males account for 68% and females 32%, all were from urban back ground. About 80% of them had medical history, only 10% had past history of alcohol dependence and BPAD.
About 40% of cases were treated in ICU, and 32% of them were treated on Ventilators.
Lab Investigations revealed inflammatory markers to be raised in almost all (C- reactive protein 100%, D-dimmer 64% and Serum ferritin 69%). About 88% are Positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs. In HRCT chest 98% are suggestive of SARS-CoV-2 infection. Treatment given was Steroids (Inj Dexamethasone IV) in 100% cases, antiviral Remdesivir in 85%, Ivermectin or Hydroxychloroquine in 80%, IV antibiotics (Cephalosporin) in 100%, Tocilizumab/Antibody/Plasma therapy in 0%. For Symptomatic delirium treatment Inj Haloperidol Iv 1.5 mg to 5 mg thrice per day to once daily in 98% case, some received Quetiapine 12.5 mg to 100 mg /day in 5% or Tab Olanzapine 2.5 mg to 10 mg per day in 9% cases. Delirium Mortality rate was 45% and recovery rate was 55%.
Conclusions: Severe SARS-CoV2 infection may be associated with COVID-19 delirium and high mortality, (more than 50%) in covid delirium patients. Hypoxia could be the main reason for delirium in Covid 19. Elevated inflammatory markers were associated with Delirium in covid 19 patients.
Keywords: Delirium; SARS-CoV-2; Inflammatory Markers Mortality
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