Langan Clare, Sarode Deep P, Russ Tom C, Shenkin Susan D, Carson Alan, Maclullich Alasdair M J
College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Psychogeriatrics. 2017 Sep;17(5):327-335. doi: 10.1111/psyg.12240. Epub 2017 Jan 27.
Delirium is an acute and usually transient severe neuropsychiatric syndrome associated with significant long-term physical morbidity. However, its chronic psychiatric sequelae remain poorly characterized. To investigate the prevalence of psychiatric symptoms, namely anxiety, depressive, and post-traumatic stress disorder (PTSD) symptoms after delirium, a systematic literature search of MEDLINE, EMBASE and PsycINFO databases was performed independently by two authors in March 2016. Bibliographies were hand-searched, and a forward- and backward-citation search using Web of Science was performed for all included studies. Of 6411 titles, we included eight prospective cohort studies, including 370 patients with delirium and 1073 without delirium. Studies were heterogeneous and mostly included older people from a range of clinical groups. Consideration of confounders was variable. The prevalence of depressive symptoms was almost three times higher in patients with delirium than in patients without delirium (22.2% vs 8.0%, risk ratio = 2.79; 95% confidence interval = 1.36-5.73). There was no statistically significant difference between the prevalence of anxiety symptoms between patients with and without delirium. The prevalence of PTSD symptoms after delirium was inconclusive: only one study investigated this and no association between PTSD symptoms after delirium was reported. There is limited published evidence of the prevalence of psychiatric symptoms after non-ICU delirium and the strongest evidence is for depressive symptoms. Further longitudinal studies are warranted to investigate the prevalence of anxiety and PTSD symptoms.
谵妄是一种急性且通常为短暂性的严重神经精神综合征，与显著的长期身体疾病相关。然而，其慢性精神后遗症的特征仍不明确。为了调查谵妄后焦虑、抑郁和创伤后应激障碍（PTSD）等精神症状的患病率，两位作者于2016年3月独立对MEDLINE、EMBASE和PsycINFO数据库进行了系统的文献检索。对手检的参考文献进行了手工检索，并对所有纳入研究使用Web of Science进行了向前和向后的引文检索。在6411篇标题中，我们纳入了8项前瞻性队列研究，包括370例谵妄患者和1073例非谵妄患者。研究具有异质性，大多纳入了来自一系列临床组的老年人。对混杂因素的考虑各不相同。谵妄患者中抑郁症状的患病率几乎是非谵妄患者的三倍（22.2%对8.0%，风险比=2.79；95%置信区间=1.36 - 5.73）。谵妄患者与非谵妄患者焦虑症状的患病率之间无统计学显著差异。谵妄后PTSD症状的患病率尚无定论：仅有一项研究对此进行了调查，且未报告谵妄后PTSD症状之间的关联。关于非ICU谵妄后精神症状患病率的已发表证据有限，最有力的证据是关于抑郁症状的。有必要进行进一步的纵向研究以调查焦虑和PTSD症状的患病率。
