Leentjens Albert F G, Schieveld Jan N M, Leonard Maeve, Lousberg Richel, Verhey Frans R J, Meagher David J
Department of Psychiatry, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
J Psychosom Res. 2008 Feb;64(2):219-23. doi: 10.1016/j.jpsychores.2007.11.003.
The phenomenology of delirium in childhood is understudied.
The objective of the study is to compare the phenomenology of delirium in children, adults and geriatric patients.
Forty-six children [mean age 8.3, S.D. 5.6, range 0-17 years (inclusive)], admitted to the pediatric intensive care unit of Maastricht University Hospital, with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) delirium, underwent assessment with the Delirium Rating Scale (DRS). The scores are compared with those of 49 adult (mean age 55.4, S.D. 7.9, range 18-65 years) and 70 geriatric patients (mean age 76.2, S.D. 6.1, range 66-91 years) with DSM-IV delirium, occurring in a palliative care unit. Score profiles across groups, as well as differences in individual item scores across groups are analysed with multiple analysis of variance, applying a Bonferroni correction.
Although the range of symptoms occurring in all three groups was similar, DRS score profiles differed significantly across the three groups (Wilks lambda=0.019, F=804.206, P<.001). On item level, childhood delirium is characterized by a more acute onset, more severe perceptual disturbances, more frequent visual hallucinations, more severe delusions, more severe lability of mood, greater agitation, less severe cognitive deficits, less severe sleep-wake cycle disturbance, and less variability of symptoms over time. Adult and geriatric delirium do not differ in their presentations, except for the presence of more severe cognitive symptoms in geriatric delirium (P=.001).
Childhood delirium has a different course and symptom profile than adult and geriatric delirium. Adult and geriatric delirium differ only in the severity of cognitive symptoms.
儿童谵妄的现象学研究不足。
本研究的目的是比较儿童、成人和老年患者谵妄的现象学。
46名儿童[平均年龄8.3岁，标准差5.6，年龄范围0 - 17岁（含）]因符合《精神疾病诊断与统计手册》第四版（DSM-IV）的谵妄诊断标准，入住马斯特里赫特大学医院儿科重症监护病房，并接受了谵妄评定量表（DRS）评估。将这些分数与49名成人（平均年龄55.4岁，标准差7.9，年龄范围18 - 65岁）和70名老年患者（平均年龄76.2岁，标准差6.1，年龄范围66 - 91岁）的分数进行比较，这些成人和老年患者的谵妄发生在姑息治疗病房。采用多因素方差分析并应用Bonferroni校正，分析各组间的得分概况以及各单项得分的差异。
尽管三组出现的症状范围相似，但三组的DRS得分概况存在显著差异（威尔克斯λ = 0.019，F = 804.206，P <.001）。在项目层面，儿童谵妄的特点是起病更急、感知障碍更严重、视幻觉更频繁、妄想更严重、情绪更不稳定、躁动更明显、认知缺陷不那么严重、睡眠 - 觉醒周期紊乱不那么严重，且症状随时间的变异性较小。成人和老年谵妄的表现没有差异，只是老年谵妄的认知症状更严重（P = 0.001）。
儿童谵妄的病程和症状特征与成人及老年谵妄不同。成人和老年谵妄仅在认知症状的严重程度上存在差异。
