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Delirium; Dementia; Occupational therapy Delirio; Demencia; Terapia ocupacional Deliri; Demència; Teràpia ocupacional Background: Delirium and dementia are two of the most common geriatric syndromes, which requires innovative rehabilitation approaches. Aim: We aimed at determining which occupational therapy and physiotherapy interventions are applied with older people with delirium and dementia in different care settings. We also identified the assessment tools that were used. Materials and methods: We conducted a literature search for scientific articles published from 2012 to 2022 (PubMed, MEDLINE, AMED and CINAHL) with adults aged >65 years including experimental study designs with randomized or non-randomized intervention, exploratory studies, pilot studies, quasi-experimental studies, case series and/or clinical cases. Studies that did not use interventions that could be classified as occupational therapy or physiotherapy were excluded. Results: After applying the exclusion criteria, 9 articles were selected. The most widely used assessment to define dementia was the MMSE (N = 5; 55.5%), whereas the CAM (N = 2; 22.2%), CAM-ICU (N = 2; 22.2%) and RASS (N = 3; 33.3%) were the most widely used to define delirium. The rehabilitation interventions that were most frequently performed were early mobilization, inclusion of the caregiver during treatment, modification of the environment to encourage orientation and autonomy, the interprofessional systemic approach and engaging persons in meaningful activities. Conclusions: Despite the growing evidence on its effectiveness, the role of physiotherapy and occupational therapy interventions in the prevention and treatment of people with dementia and delirium is still emerging. More research is needed to investigate if effective occupational therapy programs known to reduce the behavioral and psychological symptoms in people with dementia are also useful for treating delirium and specifically delirium superimposed on dementia. Regarding physiotherapy, it is crucial to know about the amount and timing of intervention required. Further studies are needed including older adults with delirium superimposed on dementia to define the role of the interprofessional geriatric rehabilitation team.

De la més sensible capacitat d’entendre les malalties mentals, d’una compromesa voluntat de trencar estigmes i d’una obsessiva necessitat de profunditzar en el poder de la ment. D’aquí neix l’assaig i exposició “Projectant amb paranoia”, que té la predisposició clara que els arquitectes es deixin endur pels seus somnis des de la seva faceta més onírica, que projectin sense límits ni convencions i que ho plasmin als dissenys a través de la infinitat de recursos que els brinda l’arquitectura. De la más sensible capacidad de entender las enfermedades mentales, de una comprometida voluntad de romper estigmas y de una obsesiva necesidad de profundizar en el poder de la mente. De ahí nace el ensayo y exposición “Proyectando con paranoia”, que tiene la predisposición clara de que los arquitectos se dejen llevar por sus sueños desde su faceta más onírica, que proyecten sin límites ni convenciones y que lo plasmen en los diseños en a través de la infinidad de recursos que les brinda la arquitectura. From the most sensitive ability to understand mental illnesses, from a committed will to break stigmas and from an obsessive need to delve into the power of the mind. Hence the essay and exhibition "Projecting with paranoia" was born, which has the clear predisposition for architects to allow themselves to be taken away by their dreams from their most dreamlike facet, that they project without limits or conventions and that they embody it in the designs through the infinity of resources provided by architecture.

Màster Oficial de Psicogerontologia, Facultat de Psicologia, Universitat de Barcelona. Curs: 2021-2022. Tutor: Feliciano Villar Posada, [spa] La presencia de delirios es un síntoma frecuente en casos de demencia, y su abordaje no farmacológico es particularmente desafiante para los profesionales, especialmente debido a sus implicaciones éticas. Esta investigación tiene como objetivo explorar las prácticas habituales y la percepción de buenas prácticas para el manejo de situaciones que involucran delirios en personas con demencia en centros residenciales. Participaron en el estudio 42 personas, 32 mujeres y 10 hombres, 21 en puestos técnicos y 21 auxiliares de enfermería. Se empleó una entrevista semi-estructurada, de la cual se analizaron las respuestas a dos preguntas planteadas frente a la siguiente situación: Una persona con demencia de la residencia insiste en que tiene que irse a casa ya que su madre le está esperando. (1) ¿Qué se tendría que hacer en una situación así? (2) ¿Qué es lo que en general harían sus compañeros? Las respuestas obtenidas fueron examinadas mediante un análisis temático. Las estrategias más frecuentemente señaladas por los participantes para enfrentar la sintomatología delirante fueron “mentir” y “distraer” en prácticas comunes tanto por técnicos como por gerocultores. Para buenas prácticas el 42.9% de participantes no sabían cómo responder al cuestionamiento. Estos resultados enfatizan la importancia de disponer de lineamientos organizacionales y del desarrollo del personal en el manejo de los síntomas delirantes en personas adultas mayores con diagnóstico de demencia que viven en residencias., [eng] The presence of delusions is a frequent symptom in cases of dementia, and its non-pharmacological approach is particularly challenging for professionals, especially due to its ethical implications. This research aims to explore the usual practices and the perception of good practices for managing situations involving delusions in people with dementia in residential centers. The study involved 42 people, 32 women and 10 men, 21 in technical positions and 21 nursing assistants. A semi-structured interview was used, from which the answers to two questions posed in the following situation were analyzed: A person with dementia in the residence insists that he has to go home since his mother is waiting for him. (1) What should be done in such a situation? (2) What would your classmates generally do? The answers obtained were examined through a thematic analysis. The strategies most frequently indicated by the participants to deal with delusional symptomatology were "lying" and "distracting" in common practices by both technicians and geriatricians. For good practices, 42.9% of participants did not know how to answer the question. These results emphasize the importance of having organizational guidelines and staff development in the management of delusional symptoms in older adults with a diagnosis of dementia living in nursing homes.

Background: The ABCDE bundle is a set of evidence-based practices to systematically reduce the risks of sedation, delirium, and immobility in intensive care patients. Implementing the bundle improves clinical outcome. Aims and Objectives: To investigate the association between patient outcomes and compliance with bundle components ABC (analgosedation algorithms), D (delirium protocol), and E (early mobilization protocol). Design: A Spanish multicentre cohort study of adult patients receiving invasive mechanical ventilation (IMV) for ≥48 h until extubation. Methods: The primary outcome was pain level, cooperation to permit Medical Research Council Scale administration, patient days of delirium, and mobility. The secondary outcome was cumulative drug dosing by IMV days. Tertiary outcomes (ICU days, IMV days, bed rest days, ICU mortality, ICUAW) and independent variables (analgosedation, delirium, early mobilization protocols) were also studied. Results: Data were collected from 605 patients in 80 ICUs and 5214 patient days with IMV. Two-thirds of the ICUs studied applied no protocols. Pain was not assessed on 83.6% of patient days. Patient cooperation made scale administration feasible on 20.7% of days. Delirium and immobility were found on 4.2% and 69.9% of days, respectively. Patients had shorter stays in ICUs with bundle protocols and fewer days of IMV in ICUs with delirium and mobilization bundle components (P = 0.006 and P = 0.03, respectively). Analgosedation protocols were associated with more opioid dosing (P = 0.02), and delirium and early mobilization protocols with more propofol (P = 0.001), dexmedetomidine (P = 0.001), and lower benzodiazepine dosing (P = 0.008). Conclusions: The implementation rate of ABCDE bundle components was very low in our Spanish setting, but when implemented, patients had a shorter ICU stay, more analgesia dosing, and lighter sedation. Relevance to clinical practice: Applying some but not all the bundle components, there is increased analgesia and light sedation drug use, decreased benzodiazepines, and increased patient cooperation and mobility, resulting in a shorter ICU stay and fewer days of IMV.

Objectives: To investigate the association between anticholinergic drug burden (ADB), measured with anticholinergic drug scales, and delirium and delirium severity. Design: Systematic review. Setting and Participants: All available studies. Methods: A systematic literature search was performed in Medline, Embase, PsycINFO, Web of Science, CINAHL, Cochrane library, and Google Scholar. Studies evaluating the association between ADB (measured as a total score) and delirium or delirium severity, published in English, were eligible for inclusion. Results: Sixteen studies, including 148,756 persons, were included. Fifteen studies investigated delirium. ADB was measured with the Anticholinergic Risk Scale (ARS, n 1⁄4 5), the Anticholinergic Cognitive Burden Scale (ACB, n 1⁄4 6), the list of Chew (n 1⁄4 1), the Anticholinergic Drug Scale (ADS, n 1⁄4 5), a modified version of the ARS (n 1⁄4 1), and a modified version of the ACB (n 1⁄4 1). A high ADB, measured with the ARS, was associated with delirium (5/5). Also with the modified version of the ARS and ACB, an asso- ciation was found between a high ADB and delirium during 3-month (1/1) and 1-year follow-up (1/1), respectively. When ADB was assessed with other scales, the results were inconclusive, with only 1 positive association for the ACB (1/6) and ADS (1/5) each. The possible association between ADB and delirium severity has also been investigated (ADS n 1⁄4 2, Summers Drug Risk Number n 1⁄4 1). One study found an association between a high ADB, measured with the ADS, and an increase in severity of delirium. Conclusions and Implications: ADB assessed with the ARS is consistently associated with delirium. The association found between the modified versions of the ARS and ACB and delirium needs confirmation. When ADB was assessed with other scales, the findings were inconclusive. The current findings suggest that the ARS might be a useful tool to identify patients at increased risk for delirium.

Introduction: Cognitive biases are key factors in the development and persistence of delusions in psychosis. The Cognitive Biases Questionnaire for Psychosis (CBQp) is a new self-reported questionnaire of 30 relevant situations to evaluate five types of cognitive biases in psychosis. In the context of the validation of the Spanish version of the CBQp, our objectives were to (1) analyze the factorial structure of the questionnaire with a confirmatory factor analysis (CFA), (2) relate cognitive biases with a widely used scale in the field of delusion cognitive therapies for assessing metacognition, specifically, Beck's Cognitive Insight Scale (BCIS) (1), and, finally, (3) associate cognitive biases with delusional experiences, evaluated with the Peters Delusions Inventory (PDI) (2).Materials and Methods: An authorized Spanish version of the CBQp, by a translation and back-translation procedure, was obtained. A sample of 171 patients with different diagnoses of psychoses was included. A CFA was used to test three different construct models. Associations between CBQp biases, the BCIS, and the PDI were made by correlation and mean differences. Comparisons of the CBQp scores between a control group and patients with psychosis were analyzed.Results: The CFA showed comparative fit index (CFI) values of 0.94 and 0.95 for the models with one, two, and five factors, with root mean square error of approximation values of 0.031 and 0.029. The CBQp reliability was 0.87. Associations between cognitive biases, self-certainty, and cognitive insight subscales of the BCIS were found. Similarly, associations between total punctuation, conviction, distress, and concern subscales of the PDI were also found. When compared with the group of healthy subjects, patients with psychoses scored significantly higher in several cognitive biases.Conclusion: Given the correlation between biases, a one-factor model might be more appropriate to explain the scale's underlying construct. Biases were associated with a greater frequency of delusions, distress, conviction, and concern as well as worse cognitive insight in patients with psychosis.

Treballs Finals de Grau d'Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Curs: 2019-2020, Tutor: Javier Colina Torralva, Introducción. El delirium es un trastorno caracterizado por una alteración de la conciencia y de la atención, de comienzo agudo y curso fluctuante. Se considera el segundo síndrome psiquiátrico más frecuente dentro del ámbito hospitalario, y lo padecen entre el 20% y 40% de pacientes ancianos ingresados. Además, su desarrollo aumenta la estancia hospitalaria y la mortalidad. Objetivos. El objetivo general es describir las intervenciones enfermeras en relación a la prevención y manejo del delirium en pacientes ingresados en unidades de cuidados intensivos. Metodología. Se ha realizado la revisión bibliográfica de un total de 15 artículos, publicados entre los años 2015 y 2019, utilizando las siguientes bases de datos: PubMed, CINHAL y SciELO. Resultados. Se identificaron los siguientes artículos: 2 revisiones sistemáticas, 1 guía de práctica clínica, 1 estudio cuantitativo, 1 cohorte prospectivo, 2 encuestas, 1 investigación de acción, 1 cohorte intervencionista controlado, 1 estudio de tipo antes y después, 3 revisiones bibliográficas, 1 estudio observacional y 1 estudio cualitativo. Conclusiones. La prevención es el mejor método para tratar el delirium, y las estrategias no farmacológicas son las más utilizadas. También se encuentran protocolos de actuación, escalas y la participación de la familia. En el caso de que el delirium ya se haya instalado, optar por tratamiento farmacológico ayuda en la disminución de su duración y gravedad, a la vez que combate su sintomatología. Por último, es importante aumentar los conocimientos de los profesionales enfermeros.

DOI: 10.1016/j.dadm.2016.11.002 URL: http://www.sciencedirect.com/science/article/pii/S2352872916300586 Filiació URV: SI Inclòs a la memòria: SI Introduction Subsyndromal delirium (SSD) complicates diagnosis of delirium and dementia, although there is little research comparing their symptom profiles. Methods Cross-sectional study of 400 elderly patients’ admission to a general hospital or nursing home diagnosed with delirium, SSD, dementia, or no-delirium/no-dementia (NDND). Symptom profiles were assessed using the Delirium Rating Scale-Revised-98 (DRS-R98). Results Twenty percent patients had delirium, 19.3% had SSD, 29.8% had dementia-only, and 31% had NDND. Eighty-one percent of subsyndromal and 76% of delirium groups had comorbid dementia. DRS-R98 scores showed ascending severity from NDND < dementia-only < SSD < delirium. DRS-R98 scores for items evaluating the three core symptom domains (cognitive, higher-order thinking, and circadian) distinguished SSD from delirium and both from nondelirium groups. DRS-R98 profiles were essentially the same in delirium and SSD subgroups with or without dementia, although total scale scores were generally higher when in comorbid subgroups. Discussion SSD shared characteristic core domain symptoms with delirium, which distinguished each from nondelirium groups, although severity was intermediate in the subsyndromal group. Delirium core symptoms overshadowed the dementia phenotype when comorbid. Milder disturbances of delirium core domain symptoms are highly suggestive of SSD.

Aims and objectives: to evaluate the usefulness of comprehensive nursing assessment as a strategy for determining the risk of delirium in older in-patients from a model of care needs based on variables easily measured by nurses. Background: there are many scales of assessment and prediction of risk of delirium, but they are little known and infrequently used by professionals. Recognition of delirium by doctors and nurses continues to be limited. Design and methods: a case-control study. A specific form of data collection was designed to include the risk factors for delirium commonly identified in the literature and the care needs evaluated from the comprehensive nursing assessment based on the Virginia Henderson model of care needs. We studied 454 in-patient units in a basic general hospital. Data were collected from a review of the records of patients' electronic clinical history. Results: the areas of care that were significant in patients with delirium were dyspnoea, problems with nutrition, elimination, mobility, rest and sleep, self-care, physical safety, communication and relationships. The specific risk factors identified as independent predictors were as follows: age, urinary incontinence, urinary catheter, alcohol abuse, previous history of dementia, being able to get out of bed/not being at rest, habitual insomnia and history of social risk. Conclusions: comprehensive nursing assessment is a valid and consistent strategy with a multifactorial model of delirium, which enables the personalised risk assessment necessary to define a plan of care with specific interventions for each patient to be made. Relevance to clinical practice: the identification of the risk of delirium is particularly important in the context of prevention. In a model of care based on needs, nursing assessment is a useful component in the risk assessment of delirium and one that is necessary for developing an individualised care regime.

The Australian philosopher Philip Gerrans ambitiously tries to provide a general theory about the formation of delusions that should enclose neuronal, cognitive and phenomenological levels of description. His theory is defined as narrative and it is grounded on the so called “default thoughts”, that consist in simulations, autobiographical narrative fragments produced by the Default Mode Network (DMN). The DMN is a powerful simulation system that evolved to allow humans to simulate and imagine experiences in the absence of an eliciting stimulus. Such imaginative/simulative process is precariously disciplined by the Self’s demands of narrative coherence. The Author’s aim is to waive the notion of belief and the causal role played by the impairments of fixation-beliefs system in the onset of delusions, as predicted by the principle doxastic theories. Il filosofo australiano Philip Gerrans ha l’ambizione di fornire una teoria generale della formazione dei deliri che integri livelli di descrizione neurali, cognitivi e fenomenologici. Si tratta di una teoria narrativa basata sui cosiddetti “default thoughts”, blocchi elementari di pensiero prodotti dal Default Mode Network (DMN), inteso come un potente sistema immaginativo evolutosi per permettere agli uomini di simulare esperienze. I default thoughts sono simulazioni, frammenti di narrazioni autobiografiche, e l’attività del DMN consisterebbe in un processo immaginativo disciplinato dalla richiesta da parte del Sé di coerenza narrativa. L’originalità della proposta teorica di Gerrans consiste nel tentativo di scalzare la nozione di credenza e il ruolo causale giocato, nell’insorgenza dei deliri, dalla compromissione del sistema di fissazione delle credenze, come previsto dalle principali teorie doxastiche.

In this paper we illustrate the potential of the repertory grid technique as an instrument for case formulation and understanding of the personal perception and meanings of people with a diagnosis of psychotic disorders. For this purpose, the case of James is presented: A young man diagnosed with schizophrenia and personality disorder, with severe persecutory delusions and other positive symptoms that have not responded to antipsychotic medication, as well with depressive symptomatology. His case was selected because of the way his symptoms are reflected in his personal perception of self and others, including his main persecutory figure, in the different measures that result from the analysis of his repertory grid. Some key clinical hypotheses and possible targets for therapy are discussed.

DOI: 10.1186/s12888-016-0878-6 URL: http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0878-6 Background: Information on validity and reliability of delirium criteria is necessary for clinicians, researchers, and further developments of DSM or ICD. We compare four DSM and ICD delirium diagnostic criteria versions, which were developed by consensus of experts, with a phenomenology-based natural diagnosis delineated using cluster analysis of delirium features in a sample with a high prevalence of dementia. We also measured inter-rater reliability of each system when applied by two evaluators from distinct disciplines. Methods: Cross-sectional analysis of 200 consecutive patients admitted to a skilled nursing facility, independently assessed within 24-48 h after admission with the Delirium Rating Scale-Revised-98 (DRS-R98) and for DSM-III-R, DSM-IV, DSM-5, and ICD-10 criteria for delirium. Cluster analysis (CA) delineated natural delirium and nondelirium reference groups using DRS-R98 items and then diagnostic systems' performance were evaluated against the CA-defined groups using logistic regression and crosstabs for discriminant analysis (sensitivity, specificity, percentage of subjects correctly classified by each diagnostic system and their individual criteria, and performance for each system when excluding each individual criterion are reported). Kappa Index (K) was used to report inter-rater reliability for delirium diagnostic systems and their individual criteria. Results: 117 (58.5 %) patients had preexisting dementia according to the Informant Questionnaire on Cognitive Decline in the Elderly. CA delineated 49 delirium subjects and 151 nondelirium. Against these CA groups, delirium diagnosis accuracy was highest using DSM-III-R (87.5 %) followed cl

This analysis inquires about the pertinence of classifying denominations that havebeen used for Thomas Ligotti’s works (philosophical, metaphysical or nihilistic terror).The question of wether these are appropriate and useful for the author’s textsor work only as a marketing strategy is developed in this article. For that purpose,some of Ligotti’s most representative tales are analyzed, in these, the themes of thedream, the unreality and the hallucinations are all present. The goal is to portray onevoyage from the conscience to the unconscious that pretends to explain the work ofthis writer using the theory of the fantastic., El presente trabajo parte de la pregunta por la pertinencia de las denominaciones que se han utilizado para clasificar la obra de Thomas Ligotti (terror filosófico, metafísico o nihilista); si estas son apropiadas para dar cuenta del trabajo de este autor o si sólo forman parte de estrategias de mercadotecnia. Para ello, partiendo del análisis de algunos de sus cuentos más representativos, en los que se presentan constantes de su obra como el sueño, la irrealidad y a las alucinaciones, se plantea un trayecto que va de lo consciente a lo inconsciente que busca explicar por medio de las teorías de lo fantástico el trabajo de este autor.

Màster en Lideratge i Gestió d'Infermeria, Universitat de Barcelona. Escola Universitària d'Infermeria, curs: 2012-2013, Director: Ma. Teresa Lluch Canut, A les unitats de cures intensives, el deliri es relaciona amb una major mortalitat, una prolongada estada, i una major atenció de la salut amb costos més elevats. Objectiu: Valorar la incidència de Deliri en la unitat de Reanimació de l’Hospital Universitari Germans Trias i Pujol (HUGTiP). Àmbit de l’estudi: L’estudi es realitzarà a la Unitat de reanimació Postquirúrgica HUGTiP de Badalona que consta de 12 llits. Disseny : Estudi descriptiu, prospectiu i observacional. Durant un període de 3 mesos s’inclouran el total de malalts ingressats a la unitat que acompleixin els criteris d’inclusió. Per a realitzar la recollida de dades de cada malalt s’ha dissenyat una Graella d’avaluació del malat on seran recollides les dades què inclou l’ICDSC: test (eina de detecció del deliri), edat, sexe, motiu de ingrés, especialitat quirúrgica i APACHE II

Los libros David Curto son una sarcástica extensión de sus propuestas donde confluyen su crítica al sistema global y una depurada presentación gráfica. Este artículo analiza el libro "Une mauvaise semanine", de clara referencia a "Une semaine de bonté" de Max Ernst. Curto actualiza las propuestas apropiacionistas de Ernst y las enmarca en una delirante escenografía que pone en entredicho los "complacientes" valores de nuestra clase política, eclesiástica y financiera enmarcada en el omnipresente capitalismo. Palabras clave: apropiacionismo / delírio / realidad y ficción. Els llibres David Curto són una sarcàstica extensió de les seves propostes on conflueixen la seva crítica al sistema global i una depurada presentació gràfica. Aquest article analitza el llibre 'Uneix mauvaise semanine', de clara referència a 'Uneix semaine de bonté' de Max Ernst. Curto actualitza les propostes apropiacionistes d'Ernst i les emmarca en una delirant escenografia que posa en dubte els 'complaents' valors de la nostra classe política, eclesiàstica i financera emmarcada en l'omnipresent capitalisme. Paraules clau: apropiacionisme / Delírio / realitat i ficció

El deliri és un trastorn neuropsiquiàtric que poden patir els pacients greus a les unitats de cures intensives. La seva aparició s’associa amb un augment de la morbimortalitat. La seva incidència varia entre el 20-80% segons els mètodes diagnòstics i la situació clínica del pacient. L’objectiu principal del estudi fou avaluar la incidència de delirium en la Unitat de Reanimació de l’Hospital Universitari Germans Trias i Pujol mitjançant el test ICDSC i associar el delirium amb la edat, severitat del pacient, urgència de la cirurgia, especialitat quirúrgica i opinió del equip d‘infermeria sobre el test. Durant 3 mesos es van incloure 50 pacients que van ser avaluats amb el ICDSC dues vegades al dia, durant 5 dies. La incidència de delirium a la unitat fou del 18%. Es va trobar una associació estadísticament significativa entre delirium i la edat i el APACHE II score al ingrés. És recomanable monitoritzar diàriament el delirium i tractar-lo com a un signe vital més. El test ICDSC és un test senzill i fàcil que ens ajuda a no infravalorar el delirium del pacient crític. El delirium es un trastorno neuropsiquiátrico que suelen padecer los pacientes graves en unidades de cuidados intensivos. Su aparición se asocia a un aumento de la morbimortalidad. Su incidencia varía entre el 20-80% según los métodos diagnósticos y la situación clínica del paciente. El objetivo principal del estudio fue evaluar la incidencia de delirium en la Unidad de Reanimación del Hospital Universitari Germans Trias i Pujol utilizando el test ICDSC y asociar el delirium con la edad, gravedad del paciente, urgencia de la cirugía, especialidad quirúrgica y analizar la opinión de enfermería sobre dicho test. Durante 3 meses se incluyeron 50 pacientes que fueron evaluados con el ICDSC dos veces al día, durante 5 días. La incidencia de delirium en nuestra unidad fue del 18%. Se encontró una asociación estadísticamente significativa entre delirium y la edad y el APACHE II score al ingreso. Es recomendable monitorizar diariamente el delirium y tratarlo como un signo vital más. El test ICDSC es un herramienta diagnóstica sencilla y fácil que ayuda a no infravalorar el delirium del paciente crítico.

Demència; Prevalença; Factors de risc Demencia; Prevalencia; Factores de riesgo Dementia; Prevalence; Risc factors There are many studies on delirium in clinical populations and nursing home patients but not in community populations. This study has aimed to know the prevalence of delirium in a community population and to know the survival rate during a five-year period. Method. Case-control and survival study based on data from an epidemiological study to measure the prevalence and incidence of dementia in eight rural villages in Girona. According to the Diagnostic and Statistical Manual of Mental Disorders, delirium was identified for the prevalence study using the information obtained from the Cambridge Mental Disorders of the Elderly Examination. A hypothesis contrast method was used in order to compare all clinical features of the subjects according the presence or the absence of delirium. The Kaplan-Meier technique was used to estimate survival of the subjects, and a multivariate Cox regression analysis was done to know the effect of delirium on mortality over the five-year period. Results. 1,460 subjects older than 69 participated in the study. A prevalence of 0.96% (95% confidence interval [CI]: 0.43-1.49) was detected (14 cases of delirium). Mean survival for subjects with delirium was 3.0 years (CI 95%: 1.9-4.1) and it was slightly lower than for healthy controls. The presence of delirium increased the risk of death in five years by 2.65. Conclusion. The prevalence of delirium in community populations is low and most of the times it is superimposed on dementia. Patients with delirium have a higher risk of mortality at the end of a five-year period Fundació de Recerca Sanitària (FIS: 90-0797 i 94-1799)

Se presentan 3 casos de somatoparafrenia reunidos en el curso de 30 años. Se trata de adultos con lesiones vasculares extensas del hemisferio derecho, con hemiplejia, heminanestesia y heminanopsia. Todos tuvieron la convicción delirante de que su brazo paralizado pertenecía a un familiar próximo. Se señala la variabilidad de los síntomas (somatoparafrenia, personificación, misoplejia), la relación de estos con la anosodiaforia más que con la anosognosia y con lesiones del hemisferio derecho. Se concluye que, a semejanza de los problemas en el reconocimiento de rostros o del entorno, es necesario distinguir entre el nivel de la percepción y el nivel de la interpretación como propio o como familiar

Se presentan 3 casos de somatoparafrenia reunidos en el curso de 30 años. Se trata de adultos con lesiones vasculares extensas del hemisferio derecho, con hemiplejia, heminanestesia y heminanopsia. Todos tuvieron la convicción delirante de que su brazo paralizado pertenecía a un familiar próximo. Se señala la variabilidad de los síntomas (somatoparafrenia, personificación, misoplejia), la relación de estos con la anosodiaforia más que con la anosognosia y con lesiones del hemisferio derecho. Se concluye que, a semejanza de los problemas en el reconocimiento de rostros o del entorno, es necesario distinguir entre el nivel de la percepción y el nivel de la interpretación como propio o como familiar We present three patients with somatoparaphrenia collected along 30 years. They were seniors who had suffered an extended right-sided cerebrovascular injury in territory of the middle cerebral artery, with left sided hemiplegia, hemianesthesia and hemianopia. All of them suffered delusions believing that their left arm belonged to another family member. The fluctuations of their symptoms (somatoparaphrenia, misoplegia, personification), the association with anosodiaphoria (more than with anosognosia) and to right sided lesions are remarked. Such as in cases of altered recognition of faces or place, these patients show that in a paralysed arm's recognition two aspects are involved: perception and recognition of familiarity

El delirium o síndrome confusional agudo es un trastorno que se sitúa en la interfase entre la Psiquiatría y el resto de especialidades médicas. Se define como un síndrome caracterizado por alteraciones de las funciones cognoscitivas superiores de inicio agudo y curso fluctuante. Es un síndrome de etiología compleja y a menudo multifactorial, que se presenta con alta frecuencia en los pacientes ingresados en un hospital general, afectando especialmente a los pacientes de edad avanzada. Supone una importante complicación que implica una elevada mortalidad y un aumento de la estancia media. El delirium habitualmente se infradiagnostica o recibe un abordaje terapéutico inapropiado o tardío.El objeto de la presente introducción es examinar las últimas investigaciones sobre los procedimientos más eficientes para detectar eficazmente el delirium en el ámbito clínico y hacer posible su tratamiento inmediato y específico. Con esta finalidad se ha efectuado una búsqueda sistemática de publicaciones en la base datos bibliográficos Medline entre 1990 y 2003, usando las siguientes palabras claves: delirium síndrome mental agudo, síndrome confusional agudo y síndrome mental orgánico. También se han valorado algunos trabajos anteriores al año 1990 por su particular interés. Los artículos se seleccionaron según la relevancia de sus aportaciones y de su calidad metodológica.