van Velthuijsen Eveline L, Zwakhalen Sandra M G, Kempen G I J M, Verhey Frans R J
Universiteit Maastricht, Care and Public Health Research Institute (CAPHRI), afd. Health Services Research.
Contact: E.L. van Velthuijsen (
Ned Tijdschr Geneeskd. 2018 Jul 13;162:D2660.
Hypoactive delirium is common among older hospitalised patients: between 29 and 64% of all older patients in hospital develop a delirium, of which the majority is of the hypoactive subtype. Hypoactive delirium often remains undiagnosed or is only diagnosed late and prognosis is worse than for a hyperactive delirium. Psychotic symptoms, fear, and distress are as frequent in hypoactive as in hyperactive delirium. The guideline of the Dutch College of General Practitioners and the multidisciplinary guideline of the Dutch Geriatrics Society differ in their advice on the pharmacological treatment of hypoactive delirium. Research into the effectiveness of antipsychotics so far did not differentiate between the different types of delirium. In patients with hypoactive delirium, antipsychotics should only be considered after all non-pharmacological options have been tried, no obvious and solvable cause for the delirium has been found and the patient is visibly suffering from the psychotic symptoms.
住院的所有老年患者中有29%至64%会发生谵妄，其中大多数是活动减退型亚型。活动减退型谵妄往往未被诊断出来，或者仅在晚期才被诊断出来，其预后比活动亢进型谵妄更差。活动减退型谵妄中的精神病性症状、恐惧和痛苦与活动亢进型谵妄一样常见。荷兰全科医生学院的指南和荷兰老年医学协会的多学科指南在活动减退型谵妄的药物治疗建议上存在差异。迄今为止，关于抗精神病药物有效性的研究并未区分不同类型的谵妄。对于活动减退型谵妄患者，只有在尝试了所有非药物治疗选项、未发现明显且可解决的谵妄病因且患者明显因精神病性症状而痛苦时，才应考虑使用抗精神病药物。
