Loge Jon Håvard, Hjermstad Marianne Jensen, Kaasa Stein
Avdeling for atferdsfag, Institutt for medisinske basalfag, Universitetet i Oslo, Postboks 1111 Blindern, 0317 Oslo.
Tidsskr Nor Laegeforen. 2006 Feb 23;126(5):616-9.
Delirium has an abrupt onset and represents an emergency. The symptoms of delirium include reduced consciousness, cognitive failure and altered psychomotor activity. In this paper, we present delirium in palliative care based on a literature review and clinical experience. Delirium is the second most common psychiatric condition in cancer patients in general. The exact prevalence in palliative care is unknown. Several factors can precipitate a delirium. The most common factors are probably opioids, dehydration and metabolic disturbances. The assessment must be balanced towards the patient's life expectancy and aims at establishing the diagnosis and identifying precipitating factors. The diagnosis of delirium is easy for those familiar with the diagnostic criteria. The abrupt change in the patients' mental status is the key to correct diagnosis. The assessment can include instruments used in semi-structured interviews. Delirium can probably be prevented. The type and amount of treatment depends upon the patient's life expectancy. Causal treatment is a goal unless the delirium is part of the dying process. Symptom control is generally achieved by haloperidol and regulation of stimuli.
谵妄起病急骤，属于急症。谵妄的症状包括意识减退、认知障碍及精神运动活动改变。在本文中，我们基于文献综述和临床经验阐述姑息治疗中的谵妄。谵妄总体上是癌症患者中第二常见的精神疾病。姑息治疗中的确切患病率尚不清楚。多种因素可促发谵妄。最常见的因素可能是阿片类药物、脱水和代谢紊乱。评估必须兼顾患者的预期寿命，旨在确立诊断并识别促发因素。对于熟悉诊断标准的人来说，谵妄的诊断并不困难。患者精神状态的突然改变是正确诊断的关键。评估可包括半结构化访谈中使用的工具。谵妄或许可以预防。治疗的类型和剂量取决于患者的预期寿命。除非谵妄是濒死过程的一部分，否则病因治疗是目标。症状控制通常通过使用氟哌啶醇和调节刺激来实现。
