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Delirium in Neurocritical Care: Uncovering Undisclosed Psychotropic Substance and Medication Use and Stress Exposure by Hair Analysis.
Bögli, Stefan Yu; Capone, Crescenzo; Baumgartner, Markus R; Quednow, Boris B; Kraemer, Thomas; Keller, Emanuela; Binz, Tina Maria.
Afiliación
  • Bögli SY; Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. stefanyu.boegli@usz.ch.
  • Capone C; Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University Zurich, Frauenklinikstrasse 26, 8091, Zurich, Switzerland. stefanyu.boegli@usz.ch.
  • Baumgartner MR; Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
  • Quednow BB; Center for Forensic Hair Analytics, Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.
  • Kraemer T; Experimental and Clinical Pharmacopsychology, Department of Adult Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland.
  • Keller E; Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland.
  • Binz TM; Neurocritical Care Unit, Institute for Intensive Care Medicine and Department of Neurosurgery, University Hospital Zurich, University Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Neurocrit Care ; 2024 Jul 16.
Article en En | MEDLINE | ID: mdl-39009940
ABSTRACT

OBJECTIVE:

In intensive care, delirium is frequent, prolongs the stay, increases health care costs, and worsens patient outcome. Several substances and medications as well as stress can impact the risk of delirium; however, assessment of previous exposure to psychotropic agents and stress by self-reports or third-party information is not always reliable. Hair analysis can be used to objectively assess medication and substance use (including chronic alcohol consumption), and allows for the determination of stress-related long-term changes in steroid hormones and endocannabinoids.

METHODS:

Consecutive adult patients with acute brain injury admitted to the neurocritical care unit were included. Delirium was diagnosed using the Confusion Assessment Method for the Intensive Care Unit. Liquid chromatography coupled with tandem mass spectrometry was used to investigate psychoactive substances and medications, ethyl glucuronide, steroid hormones, and endocannabinoids in hair samples. Univariable and multivariable analyses were used to reveal any associations with the occurrence of delirium.

RESULTS:

Of 50 consecutive patients, 21 (42%) were diagnosed with delirium. Detection of antipsychotics or antidepressants in hair was more frequent in patients with delirium (antidepressants 43% vs. 14%, p = 0.040; antipsychotics 29% vs. 0%, p = 0.021). These patients also displayed higher ethyl glucuronide levels (p = 0.049). Anandamide (AEA) concentrations were higher in patients with delirium (p = 0.005), whereas oleoylethanolamide (p = 0.045) and palmitoylethanolamide (PEA) (p = 0.017) concentrations were lower in patients with delirium. Backward stepwise logistic regression analysis revealed antidepressants and AEA/PEA to be independent relevant predictors of delirium.

CONCLUSIONS:

Hair analysis provides crucial and otherwise unattainable information regarding chronic stress and the use of psychotropic substances and medications. Undisclosed antidepressant/antipsychotic use or intense chronic alcohol consumption is susceptible to treatment (continuation of medication or provision of low-dose benzodiazepines in case of alcohol). Chronic stress can be evaluated using stress markers and endocannabinoids in hair, potentially allowing for personalized delirium risk stratification and preventive measures.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Neurocrit Care Asunto de la revista: NEUROLOGIA / TERAPIA INTENSIVA Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Neurocrit Care Asunto de la revista: NEUROLOGIA / TERAPIA INTENSIVA Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos