Notsituation akute Verwirrtheit - Anamnese und Untersuchung unter Beachtung der Risikofaktoren

Unter einem akuten Verwirrtheitszustand versteht man eine meist akut auftretende, organische Psychose oft auf dem Boden einer Demenz. Im Gegensatz zu dieser sind öfters reversible Faktoren relevant, die einer speziellen Behandlung bedürfen. Dabei ist besonders auf Arzneimittelnebenwirkungen zu achten, die das cholinerge Defizit im Gehirn verstärken. Selbst die Verordnung von Antibiotika kann infolge von Wechselwirkungen und Interaktionen gravierende Folgen haben. Im Notdienst muss mit präklinischen Mitteln versucht werden, die Ursache zu finden. Für einen Arzt, der den Patienten nicht kennt, ist oft eine Einweisung nicht zu vermeiden. Nach Ausschluss organischer reversibler Ursachen ist Haloperidol das Mittel der Wahl. Eine wichtige Präventionsmöglichkeit besteht darin, Demenzkranken möglichst wenige Arzneimittel zu verordnen.

An acute condition of delirium is defined as a mostly acute organic psychosis frequently based on dementia. In such cases, acute delirium is often relevantly due to reversible factors while the dementia remains. This acute condition requires specific attention to be focussed on side effects of drugs if these enhance cholinergic deficiency in the brain. Even antibiotics may trigger severe effects due to interaction. Hence, emergency service personnel must try to detect the causes using pre-clinical measures. Haloperidol is the drug of choice after having excluded organic reversible causes. An important preventive step may be to prescribe only a minimum of drugs to patients suffering from dementia.

Key words

Acute delirium - dementia - side effects of drugs - medical emergency service

Literatur

• 1 Rahkonen T, Makela H, Paanila S. et al. . Delirium in elderly people without severe predisposing disorders: etiology and 1-year prognosis after discharge.  Int Psychogeriatr. 2000;  12 473-481
• 2 Marcantonio ER, Simon SE, Bergmann MA. et al. . Delirium symptoms in post-acute care: prevalent, persistent and associated with poor functional recovery.  J Am Geriatr Soc. 2003;  51 4-9
• 3 Cole MG, McCusker J, Dendukuri N, Han L.. Symptoms of delirium in elderly medical patients with or without dementia.  J Neuropsychiatry Clin Neurosci. 2002;  14 167-175
• 4 Ely EW, Stephens RK, Jackson JC. et al. . Current opinions regarding the importance, diagnosis and management of delirium in the intensive care unit: a survey of 912 healthcare professionals.  Crit Care Med. 2004;  32 106-112
• 5 Schuurmans MJ, Deschamps PI, Markham SW. et al. . The measurement of delirium: review of rating scales.  Res Theory Nurs Pract. 2003;  17 207-224
• 6 Inouye SK, Dyck CHV, Alessi CA. et al. . Clarifying confusion: the Confusion Assessment Method.  Ann Intern Med. 1990;  113 941-948
• 7 Marcantonio ER, Goldman L, Orav EJ. et al. . The association of intraoperative factors with the development of postoperative delirium.  Am J Med. 1998;  105 380-384
• 8 Litaker D, Locala J, Franco K. et al. . Preoperative risk factors for delirium.  Evidence Based Mental Health. 2002;  5 27; 
• 9 Rahkonen T, Luukainen-Markkula R, Paanila S. et al. . Delirium episode as a sign of undetected dementia among community dwelling elderly subjects: a 2 year follow up study.  J Neurol Neurosurg Psychiatry. 2000;  69 519-521
• 10 Han L, McCusker J, Cole M. et al. . Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients.  Arch Intern Med. 2001;  161 1099-1105
• 11 Zakriya KJ, Christmas C, Wenz Sr JF. et al. . Preoperative factors associated with postoperative change in confusion assessment method score in hip fracture patients.  Anesth Analg. 2002;  94 1628-1632
• 12 Inouye SK.. Predisposing and precipitating factors for delirium in hospitalized older patients.  Dement Geriatr Cogn Disord. 1999;  10 393-400
• 13 American Psychiatric Association. . Practice guidelines for the treatment of patients with delirium.  Am J Psychiatry. 1999;  5 1-20
• 14 Han CS, Kim YK.. A double-blind trial of risperidone and haloperidol for the treatment of delirium.  Psychosomatics. 2004;  45 297-301
• 15 The Parkinson Study Group. . Low-dose clozapine for drug-induced psychosis in Parkinson's disease.  N Engl J Med. 1999;  340 757-763
• 16 The French Clozapine Parkinson Study Group. . Clozapine in drug-induced psychosis in Parkinson's disease.  Lancet. 1999;  353 2041-2042
• 17 Inouye SK, Bogardus ST, Charpentier PA. et al. . A multicomponent intervention to prevent delirium in hospitalized older patients.  N Engl J Med. 1999;  340 669-676
• 18 Marcantonio ER, Flacker JM, Wright RJ, Resnick NM.. Reducing delirium after hip fracture: a randomized trial.  J Am Geriatr Soc. 2001;  49 516-522
• 19 Lundström M, Edlund A, Lundstrom G, Gustavson Y.. Reorganization of nursing and medical care to reduce the incidence of postoperative delirium and improve rehabilitation outcome in elderly patients treated for femoral neck fractures.  Scand J Caring Sci. 1999;  13 193-200
• 20 Cole MG, Primeau FJ, Bailey al RF et. Systematic intervention for elderly inpatients with delirium: a randomized trial.  CMAJ. 1994;  151 965-970
• 21 Britton A, Russel R.. Multidisciplinary team interventions for delirium in patients with chronic cognitive impairment. Cochrane Database of Systematic Reviews 2004
• 22 Cole MG, McCusker J, Bellavance F. et al. . Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial.  CMAJ. 2002;  167 763-764

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