老年与非老年的谵妄患者比较分析

目的:探讨老年与非老年谵妄患者的临床特征及谵妄的影响因素。方法:以谵妄量表为工具,调查我院2005年全年精神科会诊的50例谵妄患者,非老年组29例,老年组21例,均符合中国精神障碍分类与诊断标准第3版和美国精神障碍诊断与统计手册第4版谵妄诊断标准,进行回顾性分析。结果:非老年组谵妄由脑外伤、中毒与成瘾物质戒断引起者显著较老年组为多,而老年组由脑卒中、痴呆、心血管疾病、呼吸系统疾病引起者显著较非老年组为多,差异显著。白细胞和中性粒细胞数增多、高红细胞压积、低血钾、血氧分压降低、高尿素氮、住院时间延长与谵妄程度有关。结论:老年与非老年的谵妄病因有所不同,老年人意识障碍较重,病情波动大。感染、内环境失衡与谵妄程度有关。     

综合科老年期谵妄临床观察

目的；探讨综合医院各科病人中老年期谵妄的发生及其相关因素。方法：对符合CCMD-2-R以及DSM-IV诊断标准的老年期谵妄病人的临床特征进行分析，并对有关因素进行分析。结果：综合医院各科病人老年期谵妄的发生与躯体疾病及年龄等诸多因素密切相关，尤其与感染、发热，神经系统疾病等相关。结论：老年期谵妄与诸多因素相关，应提高对它的认识和处理能力。     

奥氮平治疗谵妄48例临床分析

研究奥氮平治疗谵妄的疗效与安全性。对象入组标准:符合中国精神疾病分类方案与诊断标准第3版(CCMD-3)和美国精神障碍诊断和统计手册第4版(DSM-Ⅳ)谵妄的诊断标准;简明精神病量表(BPRS)总分≥18分;临床疗效总评量表严重程度(CGI-SI)≥3分;病前无精神病史;未使用过任何抗精神病药物;排除重性精神疾病或精神活性物质所致精神障碍。共48例,男27例,女21例;年龄(52.2±20.7)岁;起病时间(4.2±6.3)天。住院时间(21.7±15.1)天;病因为颅脑疾病23例,术后谵妄7例,尿毒症3例,肺性脑病2例,肺癌2例,急性心肌梗死2例,直肠癌2例,重症肝炎、急性出血…     

老年性谵妄临床特征及相关因素分析

目的　以谵妄量表 (DSS)为工具测评老年性谵妄临床特征 ,并从社会、心理、生物学角度分析老年性谵妄发生的相关因素。方法　对研究期间的住院患者进行前瞻性观察 ,选择谵妄患者 ,收集其临床资料 ,并与对照组相对照。结果　共完成 82例 ,其中谵妄病人 41例 ,对照组 41例。谵妄的症状主要是注意力障碍 ,思维障碍 ,意识障碍 ,定向力障碍 ,睡眠 觉醒周期障碍 (DSS评分分别为 0 2± 0 5 ,0 2± 0 5 ,0 3± 0 5 ,0 3± 0 6,0 3± 0 8)等。谵妄组患者氧分压、血氧饱和度均低于对照组患者 (P <0 0 5 )。内向性格 ,人际关系紧张 ,生活事件刺激 ,男性 ,急性起病 ,白蛋白降低 ,肌酐、尿素氮水平增高 ,肺部感染 ,颅脑CT异常与谵妄发生有关。结论　年龄大、急性起病、躯体疾病、脑部器质性病变、应激与谵妄发生有关。氧分压与血氧饱和度降低是预示谵妄的敏感指标。     

精神科病人谵妄状态的临床分析

目的　研究精神科谵妄病人的临床特征以及诱发谵妄的危险因素 ,旨在为谵妄的早期发现、早期诊断和治疗提供参考依据。方法　分析 30例符合DSM Ⅳ谵妄诊断标准的精神科病人临床资料 ,以DSS为入组筛选工具和谵妄临床特征及其演变过程的再评估工具 ,并与同年龄、同性别、同诊断的 30例同期住院的非谵妄病人进行比较。结果　谵妄组患者注意力障碍、行为障碍、精神运动性兴奋、定向力障碍、认知障碍的DSS评分为 0的百分比分别为 1 0 0 %、90 %、86 7%、86 2 %及 76 6%。谵妄组患者在白细胞增高、中性粒细胞分类增高、HCT增高、血肌酐增高、血钾降低方面与对照组相比有显著性差异 (P <0 0 5 )。结论　精神科病人谵妄的核心症状是注意力障碍、行为障碍、精神运动性兴奋、定向力障碍、认知障碍。感染、红细胞压积 (HCT)增高、血肌酐增高、血钾降低为谵妄发生的危险因素。     

精神科病房常见谵妄状态的临床分析

谵妄状态是精神科病房常见的综合征。由于其病情重,合并症多。且极易误诊,具有一定的危险性,所以应予以注意。为此。本文对其临床特征及病因进行了以下分析。     

首发与复发老年抑郁症患者的临床特征分析

目的 分析首发与复发老年抑郁症患者的临床特征异同点.方法 应用自制量表调查109例老年期首发抑郁症患者(老年首发组)与89例老年期复发抑郁症患者(老年复发组)的临床特征并进行比较.结果 老年首发组患者的激越、疑病症状、躯体症状和记忆减退,均显著高于复发组,差异均有统计学意义(P<0.05);老年首发组躯体症状中的心血管系统症状显著高于对照组,差异有统计学意义(P<0.05).结论 老年首发抑郁症不同于老年复发抑郁症,激越、疑病、躯体症状和记忆障碍等较为突出.     

综合医院精神科会诊患者谵妄的临床特点

目的:探讨综合性医院精神科会诊中的谵妄与精神病专科医院中的谵妄的临床特点。方法:对综合性医院中精神科会诊中的58例谵妄患者(会诊组)与同期在精神病院的54例患者(非会诊组)的临床资料进行对照分析,并使用谵妄评分量表中文修订版(CAM-CR)测评。结果:会诊组中的谵妄患者年龄偏大,病因复杂,内科疾病以呼吸系统感染、脑卒中、心血管疾患多见,外科疾病以脑外伤、手术后、骨折多见,其中多系统疾病引起谵妄的几率最高,CAM-CR精神运动性抑制因子分显著高于非会诊组;非会诊组相对年龄偏小,病因简单,以精神活性物质依赖戒断、老年痴呆、抗精神病药应用不当多见,CAM-CR总分及意识水平的改变、知觉障碍、精神运动性兴奋因子分均显著高于会诊组。结论:综合性医院中的谵妄患者年龄大,病因症状复杂,误诊率高,预后差。会诊联络亟待加强。     

Early assessment of delirium in elderly patients after hip surgery

Objective

This study is intended to identify predictive factors of delirium, including risk factors and prodromal symptoms.

Methods

This study included sixty-five patients aged 65 years or older who had undergone hip surgery. Baseline assessments included age; gender; admission type (acute/elective); reason for surgery (fracture/replacement); C-reactive protein (CRP); Acute Physiology, Age, Chronic Health Evaluation (APACHE III); and the Mini-Mental State Examination (MMSE). The Korean version of the Delirium Rating Scale-Revised-98 (K-DRS-98) was used to assess prodromal symptoms daily before the onset of delirium.

Results

Almost 28% (n=18) of the 65 patients developed delirium after surgery. Delirium in elderly patients after hip surgery was observed more often in older patients and those with acute admission, hip fracture, higher APACHE III score, lower MMSE score, and higher CRP levels within early days after the operation. Sleep-wake cycle disturbances, thought process abnormalities, orientation, and long-term memory in symptom items of K-DRS-98 were showed significant difference on 4 days before delirium, lability of affect on 3 days before, perceptual disturbances and hallucination, and visuo-spatial ability on 2 days before, and delusion, motor agitation, and short-term memory on the day before the occurrence of delirium. CRP levels within 24 hours and 72 hours after hospitalization were significantly higher in the delirium group.

Conclusion

Medical professionals must pay attention to behavioral, cognitive changes and risk factors in elderly patients undergoing hip surgery and to the prodromal phase of delirium. K-DRS-98 may help in identifying the prodromal symptoms of delirium in elderly patients after hip surgery.     

精神病院中谵妄病人的临床分析

目的：探讨谵妄的病因和临床特点。方法：对符合ＣＣＭＤ－２－Ｒ意识障碍和ＤＳＭ－Ⅳ谵妄诊断标准１２１例患者的临床资料进行回顾性分析。结果：引起谵妄的病因很多,以颅脑疾病为最常见,其次是综合因素。临床表现以意识障碍伴有思维不连贯,遗忘,视幼觉和行为紊乱等为主。结论：引起谵妄的病因很多,往往是多种原因作用的结果。谵妄的临床特点是急性起病,以意识障碍伴全面认识功能障碍,症状节律变化为主的临床症状群。     

89例首发住院老年期抑郁症的临床特征分析

目的　研究首发住院老年期抑郁症的临床特征。方法　应用自编一般资料调查表 ,回顾 1994～ 2 0 0 1年 89例住院首发老年期抑郁症患者的临床特征 ,并与同期住院的 2 4 9例非老年期首发抑郁症比较。结果　老年期组男性有自杀观念者多于女性 ,并发躯体疾病者少于女性 (P <0 0 0 5 ) ;老年期组并发躯体疾病多于非老年期组 ,精神焦虑比青年组多 ,自杀观念和自杀行为比老年前期少 ,较多单一使用麦普替林 (P <0 0 5 ) ;临床疗效和非老年期无显著差异。结论　老年期抑郁症有较多的精神性焦虑。充分的治疗可以取得满意的疗效     

Designing clinical trials for the treatment of delirium

There is a large body of empirical evidence for the usefulness of pharmacological treatment of delirium though there is a relative dearth of double-blind randomized clinical trials and few that are placebo controlled. There are no registration quality double-blind, randomized, placebo-controlled trials that evaluate efficacy and safety, nor is there a regulatory body in any country that has approved a drug with an indication to treat delirium. Reasons include inadequate training for design and implementation of clinical trials, too few patients at a given research site to adequately power a study, confounding variables such as dementia, multifactorial underlying etiologies that are difficult to control, inadequate understanding of the neuropathophysiology of delirium that could theoretically guide a choice of drugs, referral populations where the primary physician may not be the one interested in pursuing the research, confounding factors for attribution of safety signals, and lack of funding for an adequately powered trial outside of the pharmaceutical industry. This article provides basic information aimed at educating physicians and other clinicians about design and implementation considerations to conduct an adequately powered double-blind, randomized placebo-controlled clinical trial to evaluate a drug's efficacy in delirium.     

Efficacy of risperidone in the treatment of delirium in elderly patients

Background:  Despite increasing recognition of delirium as a serious complication of physical illness, little has been reported in this area. Interest has been raised in treatment options other than haloperidol, such as atypical antipsychotic agents.
Methods:  A 2-week open-label trial of risperidone for the treatment of delirium was conducted to assess the efficacy and tolerance of this medication in elderly patients. Twenty-two patients with DSM-IV-defined delirium were investigated. All patients had the hyperactive–hyperalert variant of delirium. Patients received a fixed dose of risperidone (mean 1.5 ± 0.7 mg; range 0.5–3 mg). Delirium was assessed using the Delirium Rating Scale (DRS) at baseline and on Days 1, 3, 5, 7, and 14 after the initiation of risperidone treatment. Clinical and demographic data, as well as risperidone therapy related information, were collected.
Results:  Delirium resolved in all patients over the course of treatment. The mean period over which delirium resolved was 4.0 ± 2.9 days. The mean DRS score at baseline was 20.7 ± 3.0. The DRS score improved from baseline to Day 1 of treatment and continued to improve until the study end-point. Mild side-effects were present in 27.3% of patients. Stepwise logistic regression identified a decrease of 2 points or higher on the DRS on Day 1 associated with side-effects. There were no significant differences in the response to treatment with the different doses of risperidone used.
Conclusion:  Our findings indicate that low-dose risperidone (0.5–3.0 mg/day) is effective and safe for the treatment of delirium in elderly patients, and that an early response on Day 1 of treatment may be associated with side-effects in these patients.     

The prevalence and recognition rate of delirium in hospitalized elderly patients in Turkey

Objective. Delirium is frequently observed, but generally under recognized in elderly hospitalized patients. The aims of this study were to determine the prevalence of delirium in elderly patients hospitalized at a university hospital, and to determine the recognition rate by hospital staff during hospitalization. Methods. The study included 108 consecutive patients aged ≥ 65 years that were hospitalized in the medical and surgical inpatient departments at Ba?kent University Hospital, Ankara, Turkey. All the patients were evaluated using the Mini Mental State Examination (MMSE) upon admission and Confusion Assessment Method (CAM) on a daily basis during hospitalization. Written documents and consultation requests from psychiatry and/or neurology departments were reviewed for recognition of delirium by hospital staff. Results. Among the 108 patients in the study, delirium was noted in 18 (16.7%) during their hospital stay. Consultation from psychiatry or neurology departments was requested for 5 of the 18 patients, only 1 with a delirium diagnosis, indicating that 17 of the cases (94.4%) were not recognized by their primary physicians. Conclusions. The delirium non-recognition rate in elderly hospitalized patients was very high. We think that hospital staff must be trained to recognize the symptoms of delirium and identify high-risk patients.     

托吡酯多中心开放性治疗老年癫痫的临床观察

目的 研究单用或加用托吡酯治疗老年癫痫患者的疗效和不良事件.方法 在一项托吡酯治疗癫痫的多中心开放实验中.对全国52家医院门诊病例的119例60岁以上的老年癫痫患者疗效进行分析.剂量采用8周加量期到200 mg/d,接着是12周的稳定期,治疗期间每月随访一次.结果 稳定期结束后,119例患者中有106例(89.1%)发作减少超过50%.119例患者中65例单用托吡酯治疗.有效率为93.8%,54例合并用药,有效率为83.8%.各种类型癫痫患者单用或加用托吡酯治疗后,发作完全控制的患者的例数均超过50%.单用或加用托吡酯治疗病程分别为小于1年、1～3年、4～6年、大于6年的患者的发作减少频数分别为92.86%、91.67%、100%、94.44%和80.00%、85.71%、70.00%、86.36%.合并用卡马西平、丙戊酸钠、苯妥英钠、苯巴比妥、安定的患者总有效率分别为:79.41%、87.50%、85.71%、0%、80%.单用托吡酯治疗老年患者副作用程度较轻.结论 托吡酯无论单用或加用治疗老年癫痫患者,在稳定期结束后发作次数均明显减少,单用副作用程度较轻.不同的发作类型、基础病程、加用药物对疗效无明显影响.     

Cytokines and acute phase response in delirium

OBJECTIVE: This study aimed to examine the expression patterns of pro- and anti-inflammatory cytokines in elderly patients with and without delirium who were acutely admitted to the hospital. METHODS: All consecutive patients aged 65 years and older, who were acutely admitted to the Department of Internal Medicine of the Academic Medical Center, Amsterdam, a tertiary university teaching hospital, were invited. Members of the geriatric consultation team completed a multidisciplinary evaluation for all study participants within 48 h after admission, including cognitive and functional examination by validated measures of delirium, memory, and executive function. C-reactive protein and cytokines (IL-1beta, IL-6, TNF-alpha, IL-8, and IL-10) were determined within 3 days after admission. RESULTS: In total, 185 patients were included; mean age was 79 years; 42% were male; and 34.6% developed delirium within 48 h after admission. Compared to patients without delirium, patients with delirium were older and had experienced preexistent cognitive impairment more often. In patients with delirium, significantly more IL-6 levels (53% vs. 31%) and IL-8 levels (45% vs. 22%) were above the detection limit as compared with patients who did not have delirium. After adjusting for infection, age, and cognitive impairment, these differences were still significant. CONCLUSIONS: Proinflammatory cytokines may contribute to the pathogenesis of delirium in acutely admitted elderly patients.     

老年椎管内脊膜瘤患者的临床特点及手术治疗

目的探讨脊膜瘤老年患者的临床和病理特点及显微手术技巧。方法回顾性分析2001年3月至2011年10月显微手术治疗的56例经病理学检查证实的脊膜瘤老年患者(年龄60~84岁)的临床资料;按McCormick神经功能分级,56例患者中术前McCormickⅠ级6例,Ⅱ级11例,Ⅲ级22例,Ⅳ级14例,Ⅴ级3例。结果肿瘤位于硬膜下髓外55例(98.2%),完全位于硬膜外1例(1.8%);56例患者中38例(67.9%)肿瘤位于胸段。55例(98.2%)肿瘤全切除,1例大部分切除。无手术死亡病例。术后、McCormick分级改善者31例(55.4%),不变者19例(33.9%),恶化者6例(10.7%)。术后随访3个月至7年,肿瘤无复发。结论老年脊膜瘤患者中女性发病率明显高于男性。老年患者术前脊膜瘤误诊率高,术前大多数患者有中、重度神经功能障碍。肿瘤多位于胸段及脊髓腹侧及腹外侧,且部分质地坚硬,显微手术应精细操作,尽量避免脊髓及神经损伤。