A comparison of the phenomenology of pediatric, adult, and geriatric delirium Albert F.G. Leentjens a, ⁎ , Jan N.M. Schieveld a , Maeve Leonard b,c , Richel Lousberg a , Frans R.J. Verhey a , David J. Meagher b,c a Department of Psychiatry, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands b Department of Adult Psychiatry, Limerick Regional Hospital, Ireland c University of Limerick Medical School, Castletroy, Limerick, Ireland Received 21 June 2007; received in revised form 25 October 2007; accepted 6 November 2007 Abstract Background: The phenomenology of delirium in childhood is understudied. Objective: The objective of the study is to compare the phenomenology of delirium in children, adults and geriatric patients. Population and Methods: Forty-six children [mean age 8.3, S.D. 5.6, range 0–17 years (inclusive)], admitted to the pediatric intensive care unit of Maastricht University Hospital, with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) delirium, underwent assessment with the Delirium Rating Scale (DRS). The scores are compared with those of 49 adult (mean age 55.4, S.D. 7.9, range 18–65 years) and 70 geriatric patients (mean age 76.2, S.D. 6.1, range 66–91 years) with DSM-IV delirium, occurring in a palliative care unit. Score profiles across groups, as well as differences in individual item scores across groups are analysed with multiple analysis of variance, applying a Bonferroni correction. Results: Although the range of symptoms occurring in all three groups was similar, DRS score profiles differed significantly across the three groups (Wilks lambda=0.019, F=804.206, Pb.001). On item level, childhood delirium is characterized by a more acute onset, more severe perceptual disturbances, more frequent visual hallucinations, more severe delusions, more severe lability of mood, greater agitation, less severe cognitive deficits, less severe sleep-wake cycle disturbance, and less variability of symptoms over time. Adult and geriatric delirium do not differ in their presentations, except for the presence of more severe cognitive symptoms in geriatric delirium (P =.001). Conclusion: Childhood delirium has a different course and symptom profile than adult and geriatric delirium. Adult and geriatric delirium differ only in the severity of cognitive symptoms. © 2008 Elsevier Inc. All rights reserved. Keywords: Delirium; Childhood delirium; Phenomenology; Delirium Rating Scale (DRS); Pediatric intensive care unit (PICU) Introduction Delirium is a complex neuropsychiatric syndrome that fre- quently complicates physical illness and negatively impacts upon prognosis. It is associated with longer hospital stay, poorer functional outcome, and cognitive decline [1,2] in addition to an elevated morbidity and mortality that is at least in part independent of underlying medical morbidity and premorbid cognitive status [3–5]. Moreover, delirium is recognized as a source of considerable patient and family distress [6,7]. Even though the importance of adequate detection and management of delirium in hospitals is increasingly recognized, studies of phenomenology, etiol- ogy, and treatment of delirium are still scarce. Delirium in children remains a particularly neglected area [8], even though childhood delirium also appears associated with longer hospital stay and higher mortality [9]. While some studies have described the symptomatic presentation of delirium in children, to date, the phenomenological profile in children and adults has not been directly compared. The Journal of Psychosomatic Research 64 (2008) 219 – 223 ⁎ Corresponding author. Tel.: +31 43 3877443; fax: +31 43 3875444. E-mail address: a.leentjens@np.unimaas.nl (A.F.G. Leentjens). 0022-3999/08/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2007.11.003