Farrell K R, Ganzini L
Department of Medicine, Oregon Health Sciences University, Portland, USA.
Arch Intern Med. 1995;155(22):2459-64.
Delirium, a common and often overlooked syndrome in acutely ill elderly patients, may present with signs and symptoms of depression.
To determine (1) how often health care providers mistake delirium for a depressive disorder in older hospitalized patients referred to a psychiatric consultation service for depressive symptoms and (2) which signs and symptoms of depression and delirium characterize these patients.
Patients older than 60 years, admitted to a Veterans Affairs teaching hospital, and consecutively referred to a psychiatric consultation service for evaluation and treatment of a depressive disorder.
The diagnosis of delirium was based on two independent assessments: (1) a clinical interview by a member of the psychiatric consultation service and (2) a structured bedside evaluation performed by one of the investigators, who was not a member of the psychiatric consultation service. The investigator administered the Confusion Assessment Method Instrument, Mini-Mental State Examination, digit span forward, and months of year backward. The investigator also administered the Diagnostic Interview Schedule items for depression to elicit depressive symptoms.
Twenty-eight (41.8%) of the 67 subjects referred for evaluation or treatment of a depressive disorder were found to be delirious. Compared with nondelirious subjects, the delirious subjects were older and more impaired in activities of daily living. The delirious subjects often endorsed depressive symptoms, such as low mood (60%), worthlessness (68%), and frequent thoughts of death (52%). The referring health care provider had considered delirium in the differential diagnosis of the mood disturbance in only three subjects.
Health care providers should consider the diagnosis of delirium in hospitalized elderly patients who appear to be depressed.
谵妄是急性病老年患者中一种常见且常被忽视的综合征，可能表现出抑郁的体征和症状。
确定（1）在因抑郁症状转诊至精神科会诊服务的老年住院患者中，医护人员将谵妄误诊为抑郁症的频率有多高，以及（2）这些患者中抑郁和谵妄的哪些体征和症状具有特征性。
60岁以上的患者，入住退伍军人事务教学医院，并连续转诊至精神科会诊服务以评估和治疗抑郁症。
谵妄的诊断基于两项独立评估：（1）精神科会诊服务成员进行的临床访谈，以及（2）由一名非精神科会诊服务成员的研究人员进行的结构化床边评估。研究人员使用了混乱评估方法工具、简易精神状态检查表、顺背数字广度和倒背月份。研究人员还使用了抑郁症诊断访谈表项目来引出抑郁症状。
在转诊接受抑郁症评估或治疗的67名受试者中，有28名（41.8%）被发现患有谵妄。与无谵妄的受试者相比，谵妄受试者年龄更大，日常生活活动能力受损更严重。谵妄受试者经常认可抑郁症状，如情绪低落（60%）、无价值感（68%）和频繁的死亡念头（52%）。转诊的医护人员仅在三名受试者的情绪障碍鉴别诊断中考虑过谵妄。
医护人员应考虑对看似抑郁的住院老年患者进行谵妄诊断。
