Dtsch Med Wochenschr 2019; 144(23): 1619-1628
DOI: 10.1055/a-0767-9764
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© Georg Thieme Verlag KG Stuttgart · New York

Delir erkennen in 3 Schritten

Vom Screening über die Diagnosesicherung zur UrsachenklärungDetection of delirium in three stepsFrom Screening to Verification to Etiology
Rebecca von Haken
,
Hans-Christian Hansen
Further Information

Publication History

Publication Date:
21 November 2019 (online)

Abstract

Background Clinicians are commonly confronted with the differential diagnosis of altered mental status, impaired cognition and altered level of consciousness in hospitalized patients including those admitted to medical, geriatric, emergency, intensive and post-operative care units. Although delirium is the most common acute neuropsychiatric condition in the acute hospital setting this diagnosis is commonly delayed, made too late or missed altogether.

Difficulties and importance of timely diagnosis The causes of delirious states are manifold. Both, direct damage to the brain tissue as well as encephalopathy as a result of other medical diseases, can be the cause of delirium. Depending on the predisposition delirious syndromes can be provoked by minor medical interventions. Clinical presentation is very variable, but remains largely independent of the triggering mechanisms. Purely catatonic, hypoactive, hyperactive and excitatory types as well as mixed forms can be distinguished.

Immediate diagnosis of a delirious syndrome and rapid elucidation of its causes are keys for the implementation of curative therapy. There is a need to act fast because delirious phases are associated with significantly longer hospital stay and increased morbidity as a result of long-term cognitive deficits as well as increased mortality. As negative outcome is closely linked to the duration of a delirious episode, early diagnosis and rapid termination of the delirium constitute a significant positive predictor of outcome. In this respect, delirium represents an emergency, with or without concomitant cerebral or extracerebral symptoms.

Klinikärzte werden mit der Fragestellung einer unklaren „Wesensänderung/Bewusstseinsstörung/Delir“ in allen operativen und nicht operativen Krankenhausabteilungen konfrontiert – vor allem bei geriatrischen, intensivmedizinischen und kritisch kranken Patienten in der Notaufnahme [1]. Obwohl es das häufigste akute neuropsychiatrische Krankheitsbild im Akutkrankenhaus ist, wird das Delir häufig nicht oder zu spät erkannt.