Gagnon Pierre R
Laval University, Department of Psychiatry, Centre Hospitalier Universitaire de Québec (CHUQ), Québec, Canada.
Curr Opin Support Palliat Care. 2008 Mar;2(1):60-6. doi: 10.1097/SPC.0b013e3282f4ce05.
The past few years have witnessed increased research into delirium treatment and related issues, leading to better management (e.g. improved detection) and better understanding of phenomenology and pathophysiology. Many treatment and prevention trials have been conducted.
Delirium phenomenology studies revealed that even subsyndromal presentations may bear a poor prognosis. Varied pathophysiology may lead to different delirium subtypes with implications for treatment, especially the hypoactive subtype, for which systematic neuroleptic treatment remains controversial. The high prevalence of delirium has led to improved use of validated instruments and better trials. Nonpharmacological interventions remain an essential step in delirium management and have yielded positive results, especially in prevention. Two trials of haloperidol prophylaxis identified reduced severity and duration of delirium in one and reduced incidence in the other. Trials comparing haloperidol with atypical antipsychotics, mainly risperidone and olanzapine, found equal efficacy but more side effects with haloperidol.
Use of validated detection instruments is now standard procedure in both specialized clinical practice and research. Although haloperidol remains the mainstay of treatment, recent trials have begun to discriminate between the use of different agents and pharmacological approaches.
在过去几年中，对谵妄治疗及相关问题的研究不断增加，从而实现了更好的管理（如改进检测方法），并对其现象学和病理生理学有了更深入的了解。已经开展了许多治疗和预防试验。
谵妄现象学研究表明，即使是亚综合征表现也可能预后不良。不同的病理生理学可能导致不同的谵妄亚型，这对治疗有影响，尤其是活动减退型谵妄，对此系统性使用抗精神病药物治疗仍存在争议。谵妄的高患病率促使人们更好地使用经过验证的工具并开展更完善的试验。非药物干预仍然是谵妄管理的重要环节，并已取得积极成果，尤其是在预防方面。两项关于氟哌啶醇预防的试验，一项发现谵妄的严重程度和持续时间降低，另一项发现发病率降低。比较氟哌啶醇与非典型抗精神病药物（主要是利培酮和奥氮平）的试验发现，二者疗效相当，但氟哌啶醇的副作用更多。
在专业临床实践和研究中，使用经过验证的检测工具现已成为标准程序。尽管氟哌啶醇仍然是治疗的主要药物，但最近的试验已开始区分不同药物和药理学方法的使用。
