DELIRIUM 中國醫藥大學附設醫院

蘇 冠 賓 E-mail: [email protected]

診治一般醫療中之

常見精神疾病 Common psychiatric disorders in general medical practice • DELIRIUM, DEMENTIA, DEPRESSION • MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION

Delir Demen Depr, SuKP

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Concept of Delirium … Brain function is … profoundly influenced … by organic factors Delir Demen Depr, SuKP

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Features of Delirium • Altered consciousness • Altered attention • Cognitive dysfunctions, disorientation, decreased memory

• Rapid onset, usually hours to days • Brief duration, usually days to weeks • Fluctuations, worse at night (sundowning) Delir Demen Depr, SuKP

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Etiology of Delirium • Delirium is due to – General medical condition or – Substance – Implicating brain involvement

• Delirium is usually contributed by multiple factors – Elderly, multiple illness, electrolytes...

• The core syndrome is the same, regardless of etiology Delir Demen Depr, SuKP

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-- Brown TM et al, BMJ 2002; 325: 644 Delir Demen Depr, SuKP

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Treatment of Delirium • The primary treatment is to identify and ameliorate any contributing medical condition – E.g. treating brain disease, collecting electrolytes, minimized sedatives and BZDs – The exception is delirium due to sedative-hypnotic or alcohol withdrawal

• Supportive physical care • Quiet environment • Frequent cues to orientation Delir Demen Depr, SuKP

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Treatment of Delirium • Agitated Delirium: physical restraints: transient when necessary high-potency, lowdose antipsychotics (orally or parenterally) • Hypoactive delirium: no specific pharmacotherapy required • Low-potency antipsychotics, benzodiazepines, and other sedatives (antihistamines, barbiturates) should generally be avoided Delir Demen Depr, SuKP

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Treatment of Alcohol Withdrawal Symptoms and Delirium • Prevention is the best policy!! • ANS hyperarousalÆpsychoticÆseizure attackÆdelirium (30% mortality) • Medication: – full-dose lorazepam for 3 days, gradually tapering in one week – Thiamine – Propranolol, antipsychotics, if needed Delir Demen Depr, SuKP

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-- Brown TM et al, BMJ 2002; 325: 644 Delir Demen Depr, SuKP

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Etiology of Dementia • Frontal lobe dementia: – Changes in personality and behavior – Less language deficit, apraxis, and agnosis in early stage

• Cortical dementia • Subcortical dementia • Vascular dementia – Vascular dementia: more commonly associated with multiple infarctions – Single infarction: discrete loss of function Delir Demen Depr, SuKP

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Treatment of Delirium • Agitated Delirium: physical restraints: transient when necessary high-potency, lowdose antipsychotics (orally or parenterally) • Hypoactive delirium: no specific pharmacotherapy required • Low-potency antipsychotics, benzodiazepines, and other sedatives (antihistamines, barbiturates) should generally be avoided Delir Demen Depr, SuKP

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delirium

The primary treatment is to identify and ameliorate any contributing medical condition. – E.g. treating brain disease, collecting electrolytes, minimized sedatives and BZDs. – The exception is delirium due to sedative-hypnotic or alcohol withdrawal. • Supportive physical care. • Quiet environment. • Frequent cues to orientation.

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