Mental Health Division and Health Services Research and Development Program, Portland Veterans Affairs Medical Center, Portland, Oregon 97207, USA.
J Pain Symptom Manage. 2011 Feb;41(2):394-401. doi: 10.1016/j.jpainsymman.2010.04.015. Epub 2010 Sep 25.
Prospective studies are needed to adequately describe the overall impact of neuropsychiatric syndromes on the course of hospice enrollment in outpatient settings.
To determine the prevalence and natural history of delirium, cognitive impairment, alcohol abuse, anxiety, depression, and suicidal ideation (SI) in community-dwelling veteran hospice patients.
Home hospice patients were visited regularly from enrollment until their deaths, study withdrawal, or discharge from hospice. Family caregivers gave consent for those with Mini-Mental State Examination (MMSE) scores less than or equal to 23. Measures included the Structured Clinical Interview for DSM-IV for depression (past and current) and alcohol abuse; the Hospital Anxiety and Depression Scale; MMSE; and Confusion Assessment Method (CAM). A clinician-rated CAM item documented sleep disturbance, and participants were asked about SI at each visit.
The median length of hospice enrollment was 81 days. Of 88 participants, 77 (88%) experienced at least one neuropsychiatric syndrome. Cognitive impairment was prevalent, with 60 (68%) registering MMSE less than or equal to 23 at least once. More than half of the participants developed delirium; the proportion with delirium, any cognitive impairment, sleep disturbance, or any neuropsychiatric syndrome increased significantly from first to last study visit. Twelve (14%) participants had SI during the study, and 30 (34%) participants were affected by depression overall. Sixteen patients who were not depressed on admission subsequently developed depression. Anxiety was present in 14 (16%) on at least one study visit. Active alcohol abuse remained relatively stable (8%) across visits.
Psychiatric syndromes are highly prevalent in hospice patients. Systematic case finding of psychiatric disorders may be necessary to improve quality of life in the last months of life.
需要前瞻性研究充分描述神经精神综合征对门诊临终关怀登记过程的总体影响。
确定在社区居住的退伍军人临终关怀患者中谵妄、认知障碍、酒精滥用、焦虑、抑郁和自杀意念（SI）的患病率和自然史。
从临终关怀登记开始，定期家访临终关怀患者，直至患者死亡、退出研究或从临终关怀中出院。对于 Mini-Mental State Examination（MMSE）评分低于或等于 23 的患者，征得家属同意。评估措施包括DSM-IV 结构性临床访谈用于评估抑郁（过去和现在）和酒精滥用；医院焦虑和抑郁量表；MMSE；和混乱评估方法（CAM）。临床医生评估的 CAM 项目记录睡眠障碍，每次就诊时询问参与者关于 SI 的情况。
中位临终关怀登记时间为 81 天。88 名参与者中，77 名（88%）至少经历过一种神经精神综合征。认知障碍很常见，有 60 名（68%）至少有一次 MMSE 评分低于或等于 23。超过一半的参与者出现谵妄；从第一次到最后一次研究访问，患有谵妄、任何认知障碍、睡眠障碍或任何神经精神综合征的比例显著增加。在研究期间，有 12 名（14%）参与者有 SI，30 名（34%）参与者总体上患有抑郁症。16 名入院时无抑郁的患者随后发展为抑郁症。至少有一次研究访问中 14 名（16%）患者存在焦虑。在整个访视过程中，活跃的酒精滥用相对稳定（8%）。
精神科综合征在临终关怀患者中非常普遍。可能需要系统地发现精神障碍，以提高生命最后几个月的生活质量。
