[Psychiatric hospitalization for delirium in Israel]

Despite growing recognition that patients in delirium merit the full facilities of general hospitals, they still continue to be admitted to psychiatric hospitals. The Israel national psychiatric case register data of psychiatric in-patients with delirium was examined. During 1984-1993, 805 patients with a diagnosis of delirium were admitted to psychiatric hospitals, constituting 0.86% of total psychiatric admissions. 4 major categories were identified: dementia with delirium (33.4%) delirium tremens (DT; 26.9%), drug-induced delirium (10.0%) and acute and, subacute delirium (29.5%). About half were under 65 years of age. Clinical variables associated with emergency psychiatric hospitalization were not found in most cases. Average in-patient stay for dementia with delirium was longer than the national average for active psychiatric hospitalization. A significant proportion of patients in all categories were hospitalized longer than a month. In dementia with delirium, there were both high rates of death (18.1%) and of referrals to general hospitals (20.8%). The referral rate of cases of acute and subacute delirium to general hospitals was also high (16.2%). These outcome variables were much lower in DT and drug-induced delirium. The issue of "justification" of psychiatric hospitalization of cases of delirium is discussed. More accurate screening is suggested, as well as wider collaboration with other facilities responsible for the management of delirious patients.