Delirium in AIDS patients: recognition and medication factors

The purpose of this study is to determine the frequency of delirium in AIDS patients residing at a skilled nursing facility and to identify factors and outcomes associated with delirium episodes. Medical records were reviewed for 137 patients discharged from or dying at the facility in 1994. Presence or absence of delirium was determined using the Confusion Assessment Method. Patients with delirium were compared to those without delirium regarding demographics, medical conditions, and medication exposure using Mann-Whitney U, chi-square, and two-tailed t-tests. A model for delirium based on medication exposure was determined using multiple logistic regression. Forty-six percent of patients (n = 63) were determined to have at least one delirium episode; only one episode was diagnosed at the time of occurrence. Associated medical conditions included medication changes (44%), fever (38%), and infection (26%). Narcotics, benzodiazepines, anticholinergic/antihistaminic, and steroid medications each contributed significantly to the model for delirium (chi 2 = 60.19; df = 4; p = 0.0000). The authors concluded that delirium is a common yet underidentified condition in AIDS patients, and that patterns of medication use contribute to a large number of delirium episodes.