IJSR - INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH 381 Volume : 2 | Issue : 12 | December 2013 • ISSN No 2277 - 8179 Research Paper Medical Science Dr. Raheel Mushtaq MBBS, MD, Senior resident, Post Graduate Department of Psychiatry, Government Medical College, Srinagar. Dr. Sheikh Shoib MBBS, MD, Senior resident, Post Graduate Department of Psychiatry, Government Medical College, Srinagar. Dr. Tabindah Shah MBBS, Government Medical College, Srinagar. Dr.Rajesh Kumar Chandel MBBS, MD, Senior resident, Post Graduate Department of Psychiatry, Government Medical College, Srinagar. Dr. Mohammad Maqbool Dar MBBS, MD, Associate professor and HOD, Post Graduate Department of Psychiatry, Government Medical College, Srinagar. Sahil Mushtaq MBBS, ASCOMS, JAMMU ABSTRACT Background: Delirium is an etiologically non-specific syndrome, characterised by disturbance in cognition with fluctuation consciousness. The interrelationship of delirium and their Attributable risk factors with psy- chopathological factors have been studied in west. However no comprehensive study has been published from this part of world. Aims and objectives: To assess Attributable risk factors and psychopathological factors in hyperactive and hypoactive delirium. Material and methods: 40 DSM IV TR cases of Delirium including Hypoactive and Hyperactive Delirium and 40 other patients (includ- ing psychiatric patients) were studied as controls. Checklist of etiological factors (CLEF), which was specifically designed for the study were administered to the patients and Memorial Delirium Assessment Scale were administered to each patient. Categorical param- eters were evaluated by means of chi square and Fischer’s test as applicable Results: The mean age of study and control group was 27.85 and 33.10 respectively. 70% patients had hyperactive delirium while 30% was having hypoactive delirium. Pattern of attributing factors appear to be quiet different in both the groups. Impaired liver function test (89%) and ICU environment (58%) were the main attributing factors in hyperactive and hypoactive delirium respectively. Out of 40 controls there were 31 were psychiatric patients. Psychotic symptoms were the majority (30%). formed the bulk. Delusions were found more in the control group ( 60% vs. 35% ). Study group had more illusions (33% vs 10%) Visual hallucination 75% vs. 63% and auditory hallucinations (83% vs 57%). w Delirium with psychosis had more cognitive impairment in comparison to delirium without psychosis.(p<0.001). Conclusion: Hyperactive and hypoactive delirium appears to be two distinct subtypes with different pattern of psychopathology and attributable risk factors. Etiological Risk factors , Psycho pathological symptoms and Sleep disturbances in Hyperactive and Hypoactive Delirium- An Original Research KEYWORDS : Hyperactive and hypoac- tive delirium,attributable risk factors INTRODUCTION : Delirium is an acute confustional state caused due to various direct or indirect cerebral insults. Delirium is currently conceptualized both as a disease and a syndrome . 1 Two types of delirium have been identified: Hyperactive delir- ium is characterized as agitation, increased speech, irritability and hyperactivity whereas hypoactive delirium is characterized by withdrawal, lethargy and reduced arousal. 2 The pathophysi- ology is poorly understood. 3 Multiple aetiologies for delirium may funnel into final common neural pathway. Alteration in the phenomenological presentation of delirium in the elderly is not well studied. 4 The hyperactive and hypoactive delirium have different precipitant causes 5 . The incidence of delirium varies with hospital setting, age, disease, psychosocial variables. The incidence could be as high as 50% . Francis (1999) et al report- ed an incidence of 12-14 % . 6 Trazepacz and Meager (2005 )et al summarized the psychotic symptoms in form of perceptual disturbances , delusions, and thought disorders . 7 Sleep wake disturbances that include fragment sleep, reversal of normal cycle and sleeplessness, psychomotor behaviour in the form of hypoactive and hyperactive and mixed behaviour. However no comprehensive studies about this common condition have been carried out in India. In view of the above a comprehensive study to investigate the etiological underpinnings as well as psy- chopathological manifestations has been undertaken. To study psychopathological symptoms and to assess the etiological con- tributions of underlying systemic disturbances in delirium in a general hospital setting. MATERIALS AND METHOD The study was conducted at Shri Maharaja Singh Hospital . 40DSM-IV TR (9) identified cases of delirium drawn from vari- ous departments of the hospital formed the study group and Equal number of patients (including psychiatric patients) with- out delirium formed the control. INCLUSION CRITERIA • Patients 18 years and above. • Any sex. • Any educational status. • Consent to participate in the study. • Permission by the primary medical caregiver. EXCLUSION CRITERIA • Patient is too incapacitated to participate in the study due to poor medical status. • Grossly disturbed and excited patients Detailed mental status evaluation was carried out to establish the diagnosis of the delirium. Patients characterised by restless- ness, hypervigilance, rapid speech, irritability and combative- ness were diagnosed as hyperactive delirium. Whereas patients characterised by psychomotor retardation and apathy were diagnosed as hypoactive delirium. Cogniyive status estimation test (CSET) and checklist of etiological factors (CLEF), which were specifically designed for the studywere administered to the patients. Memorial Delirium Assesment Scale (MDAS) was also administered to each patient. All assessment were carried out three times in 24 hour cycle of day and night. STATISTICAL EVALUATION All continuous variables were subjected to tests of significance as appropriate. Correlation between cognitive variables and symptomatology were assessed by means of linear correlations (Pearson’s Product Moment Correlation). Categorical param-