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[精神科会诊服务中的谵妄]

[Delirium in psychiatric consultation services].

作者信息

Ahlers Eike

机构信息

Johanniter-Krankenhaus Treuenbrietzen, Johanniter-Straße 1, 14929, Treuenbrietzen, Deutschland.

Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Berlin, Deutschland.

出版信息

Nervenarzt. 2025 Jul;96(4):342-347. doi: 10.1007/s00115-025-01836-4. Epub 2025 May 30.

DOI:10.1007/s00115-025-01836-4
PMID:40445308
Abstract

BACKGROUND

Inquiries about delirium are a very common request in psychiatric consultation and liaison services (CL).

OBJECTIVES

What practical procedures can be derived from current recommendations?

METHODS

Evaluation of current guidelines and literature recommendations, as well as of the experiences in interdisciplinary planning of delirium management at various hospitals and of comments of participants in the author's workshops.

RESULTS

Delirium is seen as a major burden in the treatment of seriously ill patients across all medical disciplines. There are national and international medical guideline recommendations that unanimously recommend institutional delirium management, which follows a standardized approach for the respective department to minimize risk and prevent delirium. Cognitive deficits can follow delirium, especially in old age. Pathophysiological models can support the indication for treatment. Nonpharmacological techniques are effective; pharmacological steps should be carefully considered. Communication with those affected and their relatives and the transition upon discharge or transfer should be explicitly included.

CONCLUSIONS

The CL can support steps and department-specific optimization of multiprofessional and delirium management, especially differential psychopharmacotherapy. Further efforts in the implementation of effective delirium management are also possible institutionally in order to improve the prognosis and quality of life of those affected.

摘要

背景

在精神科会诊-联络服务(CL)中,关于谵妄的咨询是非常常见的需求。

目的

从当前建议中可以得出哪些实用程序?

方法

评估当前指南和文献建议,以及各医院谵妄管理跨学科规划的经验和作者研讨班参与者的意见。

结果

谵妄被视为所有医学学科中重症患者治疗的主要负担。有国家和国际医学指南建议一致推荐机构性谵妄管理,各科室应遵循标准化方法以尽量降低风险并预防谵妄。谵妄后可能出现认知缺陷,尤其是在老年患者中。病理生理模型可支持治疗指征。非药物技术有效;药物治疗步骤应谨慎考虑。应明确包括与患者及其亲属的沟通以及出院或转院时的过渡。

结论

CL可支持多专业和谵妄管理的步骤及科室特定优化,尤其是差异心理药物治疗。为改善患者预后和生活质量,各机构在实施有效的谵妄管理方面也可进一步努力。

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本文引用的文献

1
Psychiatric Etiologies and Approaches in Altered Mental Status Presentations: Insights from Consultation Liaison Psychiatry.精神科病因学与改变精神状态表现的方法:从联络会诊精神病学到的见解。
Semin Neurol. 2024 Dec;44(6):606-620. doi: 10.1055/s-0044-1791226. Epub 2024 Oct 3.
2
Infection, delirium, and risk of dementia in patients with and without white matter disease on previous brain imaging: a population-based study.既往脑影像学检查存在脑白质疾病与无脑白质疾病患者的感染、谵妄与痴呆风险:一项基于人群的研究。
Lancet Healthy Longev. 2024 Feb;5(2):e131-e140. doi: 10.1016/S2666-7568(23)00266-0.
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Enhancing European Management of Analgesia, Sedation, and Delirium: A Multinational, Prospective, Interventional Before-After Trial.
强化欧洲镇痛、镇静和谵妄管理:一项多中心、前瞻性、干预前后试验。
Neurocrit Care. 2024 Jun;40(3):898-908. doi: 10.1007/s12028-023-01837-8. Epub 2023 Sep 11.
4
Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients.欧洲麻醉学会和重症监护医学学会关于成人术后谵妄的循证和共识指南更新。
Eur J Anaesthesiol. 2024 Feb 1;41(2):81-108. doi: 10.1097/EJA.0000000000001876. Epub 2023 Aug 30.
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Structured Delirium Management in the Hospital.结构化谵妄管理在医院。
Dtsch Arztebl Int. 2022 Mar 18;119(11):188-194. doi: 10.3238/arztebl.m2022.0131.
6
Acute Confusional States in Hospital.医院中的急性意识混乱状态。
Dtsch Arztebl Int. 2019 Feb 15;116(7):101-106. doi: 10.3238/arztebl.2019.0101.
7
[Acute and long-term cognitive consequences of treatment on intensive care units].[重症监护病房治疗的急性和长期认知后果]
Nervenarzt. 2016 Mar;87(3):246-52. doi: 10.1007/s00115-016-0078-0.
8
Pharmacological treatments of non-substance-withdrawal delirium: a systematic review of prospective trials.非物质戒断性谵妄的药物治疗:前瞻性试验的系统评价。
Am J Psychiatry. 2014 Feb;171(2):151-9. doi: 10.1176/appi.ajp.2013.13040458.
9
Neuropathogenesis of delirium: review of current etiologic theories and common pathways.谵妄的神经发病机制:当前病因理论和常见途径综述。
Am J Geriatr Psychiatry. 2013 Dec;21(12):1190-222. doi: 10.1016/j.jagp.2013.09.005.
10
What do we really know about the treatment of delirium with antipsychotics? Ten key issues for delirium pharmacotherapy.我们对使用抗精神病药治疗谵妄究竟了解多少?谵妄药物治疗的 10 个关键问题。
Am J Geriatr Psychiatry. 2013 Dec;21(12):1223-38. doi: 10.1016/j.jagp.2012.09.008. Epub 2013 Mar 25.