Delirium in the clinical practice of a therapist


Cite item

Full Text

Abstract

Delirium is a neuropsychiatric condition that may complicate any visceral disease. Its rate is especially high among patients with inflammatory diseases or metabolic disturbances and in the elderly. Brain injury concurrent with an abnormal stress response underlies the development of delirium. The clinical picture of delirium is characterized by clouding of consciousness accompanied by global cognitive and behavioral changes. According to the nature of changes in motor behavior, delirium is divided into hyperactive, hypoactive, and mixed subtypes. Special scales, such as Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), are used to identify delirium. Management of delirium includes specific therapy for the underlying disease and adequate care. Low-dose neuroleptics, haloperidol in particular, are recommended to correct behavioral changes.

Full Text

Делирий в клинической практике терапевта. - Аннотация. Делирий - нервно-психическое расстройство, которое может осложнять течение любого заболевания внутренних органов. Его частота особенно высока среди пациентов с воспалительными заболеваниями, метаболическими нарушениями, а также среди пожилых людей. В основе развития делирия лежит сочетание поражения головного мозга и патологической стресс-реакции. Клиническая картина делирия характеризуется помрачнением сознания, которое сопровождается глобальными когнитивными и поведенческими нарушениями. По характеру изменений двигательного поведения делирии делится на гиперактивный, гипоактивный и смешанный. Для выявления делирия используют специальные шкалы, например МОСС-ОРИТ. Лечение делирия состоит из специфической терапии основного заболевания и адекватного ухода. Для коррекции поведенческих нарушений рекомендуется использовать малые дозы нейролептиков, в частности галоперидола.
×

References

  1. O'Hanlon S., O'Regan N., Maclullich A.M. et al. Improving delirium care through early intervention: from bench to bedside to boardroom. J Neurol Neurosurg Psychiatry. Published on-line 2013 Jan 25. doi: 10.1136/jnnp-2012-304334
  2. Кутлубаев М.А., Ахмадеева Л.Р. Делирий в остром периоде церебрального инсульта. Журн неврол и психиатр 2012;8: 100-105.
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). 1994 Washington DC: APA.
  4. Maclullich A.M., Ferguson K.J., Miller T. et al. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res 2008; 65: 229-238.
  5. Trzepacz P.T., Leavitt M., Ciongoli K. An animal model for delirium. Psychosomatics 1992; 33: 404-415.
  6. Thomas C., Hestermann U., Kopitz J. et al. Serum anticholinergic activity and cerebral cholinergic dysfunction: an EEG study in frail elderly with and without delirium. BMC Neurosci 2008; 15: 86.
  7. Alagiakrishnan K., Wiens C.A. An approach to drug induced delirium in the elderly. Postgrad Med J 2004; 80: 388-393.
  8. De Rooij S.E. Melatonin Deficiency Hypothesis in Delirium. A Synthesis of Current evidence. Rejuvenation Res 2013; 16 (4): 273-278.
  9. Murray C., Sanderson D.J., Barkus C. et al. Systemic inflammation induces acute working memory deficits in the primed brain: relevance for delirium. Neurobiol Aging 2012; 33: 603-616.
  10. Khan B.A., Zawahiri M., Campbell N.L., Boustani M.A. Biomarkers for delirium - a review. J Am Geriatr Soc 2011; 59 (Suppl 2): S256-261.
  11. Hall R.J., Shenkin S.D., Maclullich A.M. A systematic literature review of cerebrospinal fluid biomarkers in delirium. Dement Geriatr Cogn Disord 2011; 32: 79-93.
  12. Jacobson S., Jerrier H. EEG in delirium. Semin Clin Neuropsychiatry 2000; 5: 86-92.
  13. Soiza R.L., Sharma V., Ferguson K. et al. Neuroimaging studies of delirium: a systematic review. J Psychosom Res 2008; 65: 239-248.
  14. Martins S., Fernandes L. Delirium in elderly people: a review. Front Neurol 2012; 3: 101.
  15. Cole M.G., You Y., McCusker J. et al. The 6 and 12 month outcomes of older medical inpatients who recover from delirium. Int J Geriatr Psychiatry 2008; 23: 301-307.
  16. Caraceni A., Grassi L. Delirium. Acute Confusional States in Palliative Medicine, 2-nd Edn. Oxford: Oxford University Press 2011.
  17. Kim P., Louis C., Muralee S., Tampi R.R. Sun downing in the elderly patient. Clin Geriat 2005; 13: 32-36.
  18. Saxena S., Lawley D. Delirium in the elderly: a clinical review. Postgrad Med J 2009; 85: 405-413.
  19. Ely E.W., Margolin R., Francis J. et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 2001; 29: 1370-1379.
  20. Попугаев К.А., Савин И.А., Горячев А.С. и др. Шкала оценки тяжести дыхательной недостаточности у нейрохирургических пациентов. Анестезиол и реаниматол 2010; 4: 42-50.
  21. http://www.mc.vanderbilt.edu/icudelirium/assessment.html#otherlanguages [Электронный ресурс]. Режим доступа: Assessment resources for ICU delirium - свободный. Загл. с экрана.
  22. NICE. (2010). Delirium: Diagnosis, Prevention and Management. (Clinical Guideline103). National Institute for Health and Clinical Excellence. Available at: www.nice.org.uk/CG103
  23. Björkelund K.B., Hommel A., Thorngren K.G. et al. Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study. Acta Anaesthesiol Scand 2010; 54: 678-688.
  24. Meagher D.J., McLoughlin L., Leonard M. et al. What Do We Really Know About the Treatment of Delirium With Antipsychotics? Ten Key Issues for Delirium Pharmacotherapy. Am J Geriatr Psychiatry 2013; 21 (12): 1223- 1238.
  25. Grover S., Mattoo S.K., Gupta N. Usefulness of atypical antipsychotics and choline esterase inhibitors in delirium: a review. Pharmacopsychiatry 2011; 44: 43-54.
  26. Carson A., Ryan T. Managing acute behavioural disturbance in a neurology ward. Pract Neurol 2010; 10 (2): 67-81.
  27. O'Malley G., Leonard M., Meagher D., O'Keeffe S.T. The delirium experience: a review. J Psychosomatic Res 2008; 65: 223-228.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2014 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

 © 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies