Bhat Ravi, Rockwood Kenneth
Goulburn Valley Area Mental Health Service, University of Melbourne, Shepparton, Victoria, Australia.
J Neurol Neurosurg Psychiatry. 2007 Nov;78(11):1167-70. doi: 10.1136/jnnp.2007.115998. Epub 2007 May 8.
Delirium is a common clinical phenomenon, often described as a disorder of consciousness. Delirium is commonly under recognised. The usual response to under recognition is to exhort practitioners to do a better job, but perhaps under recognition should instead be seen as a daily pragmatic challenge to how delirium is conceptualised. Here we retain the view that delirium is a disorder of consciousness, but propose a more multidimensional approach to this key feature. We argue that delirium can be recognised through evaluating arousal, attention and temporal orientation. We suggest that this approach can be validated by testing whether it leads to better delirium identification, accounts for the characteristic clinical disturbances, explains why delirium is common in the extreme age groups and why in later life its boundaries often blend with dementia.
谵妄是一种常见的临床现象，常被描述为意识障碍。谵妄常常未得到充分认识。对于认识不足的通常应对方式是告诫从业者要做得更好，但或许认识不足反而应被视为对谵妄概念化方式的日常实际挑战。在此，我们坚持谵妄是一种意识障碍的观点，但针对这一关键特征提出一种更具多维度的方法。我们认为，谵妄可通过评估觉醒、注意力和时间定向来识别。我们建议，通过测试这种方法是否能带来更好的谵妄识别、解释特征性临床紊乱、说明谵妄在极端年龄组中为何常见以及为何在晚年其界限常与痴呆症相融合，可对该方法进行验证。
