Improving the Diagnosis and Treatment of Mood Disorders in a Delirium Clinic

Introduction

Evidence suggests a significant relationship between delirium and mood disorders. Pre-existing depression is a risk factor for delirium, and depressive symptoms frequently emerge as a sequela of an acute episode. Despite considerable symptom overlap, these conditions are distinct and require targeted management. This audit evaluated whether the introduction of formal mood assessment tools improves the detection and early treatment of mood disorders in a delirium follow-up setting.

Methods

A two-cycle clinical audit was conducted at a specialist delirium follow-up clinic. In Cycle 1, we retrospectively reviewed the records of 56 new patients to establish baseline rates of mood disorder diagnosis based on standard clinical evaluation. In Cycle 2, we implemented the systematic use of objective screening tools and analysed a further 23 patients to assess the impact on diagnosis and treatment initiation.

Results

In the initial cohort (n=56), 27% (15/56) of patients had evidence of a current mood disorder, with depression being the most prevalent (60%, 9/15). A prior history of mood disorder was noted in 32% (18/56). Following the introduction of objective assessment tools (n=23), the detection rate of current mood disorders increased significantly to 52% (12/23), with 48% (11/23) having a documented prior history. Regarding management in the intervention group, treatment was initiated directly in clinic for 8% (1/12), while the majority (58%, 7/12) received treatment recommendations forwarded to their GP. Notably, no patients in the second phase required onward referral to secondary psychiatry services.

Conclusion

Patients following an episode of delirium exhibit high rates of both prior and current mood disorders. The implementation of objective mood assessment tools significantly improved detection rates compared to clinical evaluation alone. These findings suggest that screening facilitates earlier intervention and potentially reduces the need for specialist psychiatric referral through coordination with primary care.