Subsyndromales Delir – Erfahrungen aus der Psychiatrie – Erwartungen für die postoperative Versorgung

Zusammenfassung

Das Phänomen des Delirs ist seit über 100 Jahren bekannt. Die Anästhesiologie hat erkannt, dass eine frühzeitige Aufdeckung und damit Therapie eines Delirs zu einer deutlichen Verbesserung des postoperativen klinischen Zustandes von Patienten führen kann.

Im folgenden Artikel soll es darum gehen, dass es sich lohnt, noch einen weiteren Schritt zu gehen, indem auch subsyndromaleDelire schon therapiert werden.

Da in der Anästhesiologie dazu kaum Erfahrungen vorhanden sind, soll diese Behauptung anhand der Daten aus der Psychiatrie untermauert werden.

Abstract

The phenomenon of delirium is well known since over 100 years. The anesthesiology has recognized that early detection and therapy results in significant improvement of postoperative clinical state of health of the patients.

In the following article it will be discussed that it could be profitable to make a further step: threatening the subsyndromal delirium. Because there are only few experiences in anesthesiology, this thesis will be substantiated by datas from psychiatry.

Stichworte

Subsyndromales Delir - Anästhesiologie - Intensivmedizin - Delirtestung - frühe Behandlung

Key words:

Subsyndromal delirium - anesthesiology - psychiatry - intensive care - delirium testing - early treatment

• Literatur

• 1 Gabriel A.. Phänomenologie des Delirs. Neuropsychologische und psychopathologische Differenzierung des Delirsyndroms. Saarbrücken: VDM Verlag Dr. Müller; 2008
• 2 Lütz A, Heymann A, Radtke FM, Spies CD. [If delirium is not monitored it will often be not detected]. AnasthesiolIntensivmedNotfallmedSchmerzther 2010; 45: 106-111
• 3 Schneider M. Das frühe postoperative Delirium. Vergleich des Delirium Screening Scale und der Confusion Assessment Method. Klinik für Anästhesiologie mit Schwerpunkt noperative Intensivmedizin der Medizinischen Fakultät Charité – Universitätsmedizin Berlin. 2009; 36-36
• 4 Radtke FM, Spies C. [Postoperative delirium and cognitive deficit. Just don't lose your head!]. AnasthesiolIntensivmedNotfallmedSchmerzther 2010; 45: 104-105
• 5 Heymann A, Spies C. [Postoperative delirium and cognitive deficit. Prevention and therapy]. AnasthesiolIntensivmedNotfallmedSchmerzther. 2010; 45
• 6 Pun BT, Ely EW. The importance of diagnosing and managing ICU delirium. Chest 2007; 132: 624-636
• 7 Ely EW, Shintani A, Truman B et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Jama 2004; 291: 1753-1762
• 8 Schiemann A, Hadzidiakos D, Spies C. Managing ICU delirium. CurrOpinCrit Care 2011; 17: 131-140
• 9 Martin J, Heymann A, Basell K et al. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version. Ger Med Sci 2010; 8
• 10 Girard TD, Jackson JC, Pandharipande PP et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 2010; 38: 1513-1520
• 11 Collins N, Blanchard MR, Tookman A, Sampson EL. Detection of delirium in the acute hospital. Age Ageing 2010; 39: 131-135
• 12 Judd LL, Akiskal HS, Paulus MP. The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder. J Affect Disord 2007; 42
• 13 Adam H, Gottschaldt U, Pausch NC, Ruffert H, Sipli KM. [Fulminant MH crisis during the ninth general anaesthesia]. AnasthesiolIntensivmedNotfallmedSchmerzther 2007; 42: 692-699
• 14 Voyer P, Richard S, Doucet L, Carmichael PH. Detecting delirium and subsyndromal delirium using different diagnostic criteria among demented long-term care residents. J Am Med Dir Assoc 2009; 10: 181-188
• 15 Zuliani G, Bonetti F, Magon S et al. Subsyndromal delirium and its determinants in elderly patients hospitalized for acute medical illness. J Gerontol A BiolSci Med Sci 2013; 68: 1296-1302
• 16 Hegerl U, Schonknecht P. [Subdiagnostic depression. Are there treatments with clinically relevant effects?]. Nervenarzt 2009; 80: 6-9
• 17 Radinovic K, Milan Z, Markovic-Denic L et al. Predictors of severe pain in the immediate postoperative period in elderly patients following hip fracture surgery. Injury 2014;
• 18 van Gorp S, Kessels AG, Joosten EA et al. Pain prevalence and its determinants after spinal cord injury: A systematic review. Eur J Pain 2014;
• 19 Rashiq S, Dick BD. Post-surgical pain syndromes: a review for the non-pain specialist. Can J Anaesth 2014; 61: 123-130
• 20 Goebel S, Baumann B, Steinert A, Reppenhagen S, Faller H. [Elevated postoperative pain levels following orthopedic surgery. Depression as a strong predictor]. Schmerz 2010; 24: 54-61
• 21 Kerper L, Spies C, Buspavanich P et al. Preoperative depression and hospital length of stay in surgical patients. Minerva Anestesiol 2013;
• 22 Paykel ES, Ramana R, Cooper Z, Hayhurst H, Kerr J, Barocka A. Residual symptoms after partial remission: an important outcome in depression. Psychol Med 1995; 25: 1171-1180
• 23 Katon W, Unutzer J, Russo J. Major depression: the importance of clinical characteristics and treatment response to prognosis. Depress Anxiety 2010; 27: 19-26
• 24 Sadek N, Bona J. Subsyndromal symptomatic depression: a new concept. Depress Anxiety 2000; 12: 30-39
• 25 Gazalle FK, Andreazza AC, Hallal PC et al. Bipolar depression: the importance of being on remission. Rev Bras Psiquiatr 2006; 28: 93-96
• 26 Cole MG, McCusker J, Voyer P et al. Subsyndromal delirium in older long-term care residents: incidence, risk factors, and outcomes. J Am GeriatrSoc 2011; 59: 1829-1836
• 27 Martinez Velilla N, Alonso Bouzon C et al. [Delirium and subsyndromal delirium: prevalence of a disease spectrum]. Rev EspGeriatrGerontol 2012; 47: 158-161
• 28 Martinez-Velilla N, Alonso-Bouzon C, Cambra-Contin K et al. Outcomes in complex patients with delirium and subsyndromal delirium one year after hospital discharge. IntPsychogeriatr 2013; 25: 2087-2088
• 29 Cole MG, McCusker J, Voyer P et al. The course of subsyndromal delirium in older long-term care residents. Am J Geriatr Psychiatry 2013; 21: 289-296
• 30 Heymann A, Radtke F, Schiemann A et al. Delayed treatment of delirium increases mortality rate in intensive care unit patients. J Int Med Res 2010; 38: 1584-1595
• 31 Blazer DG, van Nieuwenhuizen AO. Evidence for the diagnostic criteria of delirium: an update. CurrOpin Psychiatry 2012; 25: 239-243
• 32 Meagher D, Adamis D, Trzepacz P, Leonard M. Features of subsyndromal and persistent delirium. Br J Psychiatry 2012; 200: 37-44
• 33 Ouimet S, Riker R, Bergeron N et al. Subsyndromal delirium in the ICU: evidence for a disease spectrum. Intensive Care Med 2007; 33: 1007-1013
• 34 Judd LL, Akiskal HS, Maser JD et al. A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry 1998; 55: 694-700
• 35 Lyness JM, Heo M, Datto CJ et al. Outcomes of minor and subsyndromal depression among elderly patients in primary care settings. Ann Intern Med 2006; 144: 496-504
• 36 Lyness JM. Naturalistic outcomes of minor and subsyndromal depression in older primary care patients. Int J Geriatr Psychiatry 2008; 23: 773-781
• 37 Fogel J, Eaton WW, Ford DE. Minor depression as a predictor of the first onset of major depressive disorder over a 15-year follow-up. ActaPsychiatrScand 2006; 113: 36-43
• 38 Trzepacz PT, Franco JG, Meagher DJ et al. Phenotype of subsyndromal delirium using pooled multicultural Delirium Rating Scale--Revised-98 data. J Psychosom Res 2012; 73: 10-17
• 39 Cole M, McCusker J, Dendukuri N, Han L. The prognostic significance of subsyndromal delirium in elderly medical inpatients. J Am GeriatrSoc 2003; 51: 754-760
• 40 Hakim SM, Othman AI, Naoum DO. Early treatment with risperidone for subsyndromal delirium after on-pump cardiac surgery in the elderly: a randomized trial. Anesthesiology 2012; 116: 987-897
• 41 Grabovich A, Lu N, Tang W et al. Outcomes of subsyndromal depression in older primary care patients. Am J Geriatr Psychiatry 2010; 18: 227-235
• 42 Rapaport MH, Judd LL. Minor depressive disorder and subsyndromal depressive symptoms: functional impairment and response to treatment. J Affect Disord 1998; 48: 227-232
• 43 Cuijpers P, Smit F. Excess mortality in depression: a meta-analysis of community studies. J Affect Disord 2002; 72: 227-236
• 44 Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL. Subthreshold depression in adolescence and mental health outcomes in adulthood. Arch Gen Psychiatry 2005; 62: 66-72
• 45 Cuijpers P, Smit F, Oostenbrink J et al. Economic costs of minor depression: a population-based study. Acta PsychiatrScand 2007; 115: 229-236
• 46 Pisani MA, Kong SY, Kasl SV et al. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J RespirCrit Care Med 2009; 180: 1092-1097
• 47 Helmchen H. Was heißt “unterschwellig” psychisch krank?. In: Vollmoeller W, Hrsg. Grenzwertige psychische Störungen. Stuttgart: Thieme; 2004
• 48 Skrobik Y, Ahern S, Leblanc M et al. Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates. AnesthAnalg 2010; 111: 451-463