Grassi Luigi, Caraceni Augusto, Mitchell Alex J, Nanni Maria Giulia, Berardi Maria Alejandra, Caruso Rosangela, Riba Michelle
Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Corso Giovecca 203, 44121, Ferrara, Italy,
Curr Psychiatry Rep. 2015 Mar;17(3):550. doi: 10.1007/s11920-015-0550-8.
Delirium is a complex but common disorder in palliative care with a prevalence between 13 and 88 % but a particular frequency at the end of life (terminal delirium). By reviewing the most relevant studies (MEDLINE, EMBASE, PsycLit, PsycInfo, Cochrane Library), a correct assessment to make the diagnosis (e.g., DSM-5, delirium assessment tools), the identification of the possible etiological factors, and the application of multicomponent and integrated interventions were reported as the correct steps to effectively manage delirium in palliative care. In terms of medications, both conventional (e.g., haloperidol) and atypical antipsychotics (e.g., olanzapine, risperidone, quetiapine, aripiprazole) were shown to be equally effective in the treatment of delirium. No recommendation was possible in palliative care regarding the use of other drugs (e.g., α-2 receptors agonists, psychostimulants, cholinesterase inhibitors, melatonergic drugs). Non-pharmacological interventions (e.g., behavioral and educational) were also shown to be important in the management of delirium. More research is necessary to clarify how to more thoroughly manage delirium in palliative care.
谵妄是姑息治疗中一种复杂但常见的病症，患病率在13%至88%之间，在生命终末期（终末期谵妄）出现频率尤为高。通过回顾最相关的研究（MEDLINE、EMBASE、PsycLit、PsycInfo、Cochrane图书馆），报告指出，做出诊断的正确评估（如DSM-5、谵妄评估工具）、识别可能的病因以及应用多组分和综合干预措施是在姑息治疗中有效管理谵妄的正确步骤。在药物方面，传统药物（如氟哌啶醇）和非典型抗精神病药物（如奥氮平、利培酮、喹硫平、阿立哌唑）在治疗谵妄方面显示出同等疗效。在姑息治疗中，对于使用其他药物（如α-2受体激动剂、精神兴奋剂、胆碱酯酶抑制剂、褪黑素能药物）无法给出推荐。非药物干预措施（如行为和教育干预）在谵妄管理中也很重要。需要更多研究来阐明如何在姑息治疗中更全面地管理谵妄。
