Oldham Mark A, Flanagan Nina M, Khan Ariba, Boukrina Olga, Marcantonio Edward R
From the Department of Psychiatry, Yale School of Medicine, New Haven, Conn. (MO); the Decker School of Nursing, Binghamton University, Binghamton, N.Y. (NAF); Aurora Health Care, University of Wisconsin School of Medicine and Pubic Health, Milwaukee, Wisc. (AK); Stroke Rehabilitation Research, Kessler Foundation, West Orange, N.J. (OB); and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (ERM).
J Neuropsychiatry Clin Neurosci. 2018 Winter;30(1):51-57. doi: 10.1176/appi.neuropsych.17030065. Epub 2017 Sep 6.
Delirium (acute confusion) is a serious, common health condition, and it predicts poor outcomes, including greater rates of mortality, institutionalization, prolonged hospitalization, and cognitive impairment. Expedient diagnosis and management are critical to address modifiable delirium causes and improve both quality of care and outcomes. Moreover, more than a third of delirium is preventable. Despite the clear significance of delirium and our increasingly sophisticated understanding of the condition, the gap between evidence and practice persists. The authors provide an educational review of 10 prevalent misconceptions of delirium pertaining to recognition, etiology, natural history, and best management. The authors respond to each with best evidence. Several themes emerge, chief among which is that casual observation is seldom sufficient to detect delirium. Use of open-ended questions, regular neurocognitive testing, and validated delirium screening instruments will aid in accurately identifying cases of delirium. Delirium is typically multifactorial, with several physiological and/or pharmacological contributors. Because of its multidetermined nature and its relationship with cognitive vulnerability, delirium can persist for days to months after acute causes have resolved. Furthermore, patients often have long-term cognitive impairment after delirium rather than returning to their predelirium cognitive baseline. Finally, nonpharmacological management of delirium is first-line, both for prevention and treatment. Psychotropic drugs such as neuroleptics are not recommended for routine use in delirium. They are best reserved for treating dangerous or distressing symptoms, including severe agitation, psychosis, or emotional lability. Challenging these 10 misconceptions stands to improve patient care, quality of life, and clinical outcomes substantially.
谵妄（急性意识错乱）是一种严重且常见的健康状况，它预示着不良后果，包括更高的死亡率、入住养老院、住院时间延长以及认知障碍。迅速进行诊断和管理对于解决可改变的谵妄病因以及改善护理质量和预后至关重要。此外，超过三分之一的谵妄是可以预防的。尽管谵妄具有明显的重要性，而且我们对该病症的理解日益深入，但证据与实践之间的差距依然存在。作者对有关谵妄的识别、病因、自然病程和最佳管理的10个普遍误解进行了教育性综述。作者以最佳证据对每个误解进行了回应。出现了几个主题，其中最主要的是，随意观察很少足以检测出谵妄。使用开放式问题、定期进行神经认知测试以及经过验证的谵妄筛查工具将有助于准确识别谵妄病例。谵妄通常是多因素的，有多种生理和/或药理学因素。由于其多因素性质以及与认知易损性的关系，谵妄在急性病因解决后可能会持续数天至数月。此外，谵妄患者在谵妄后往往会有长期的认知障碍，而不是恢复到谵妄前的认知基线。最后，谵妄的非药物管理无论是对于预防还是治疗都是一线方法。不建议将抗精神病药物等精神药物常规用于谵妄治疗。它们最好保留用于治疗危险或令人痛苦的症状，包括严重躁动、精神病或情绪不稳定。挑战这10个误解有望大幅改善患者护理、生活质量和临床结局。
