섬망 심각도와 관련된 위험 요인
Risk Factors Associated with the Severity of Delirium
2
조회
0
다운로드
3
인용
0
참고문헌
초록
ObjectivesZZThe purpose of this study was to investigate the relationship between the sum of the risk factors for delirium and the severity of delirium and to identify those risk factors which increase the severity of delirium. MethodsZZThe participants were 151 patients who were consulted with a consultation-liaison psychiatrist and diagnosed using DSM-IV criteria as suffering from delirium. Sociodemographic and clinical characteristics were obtained through structured interviews and medical chart reviews. The severity of delirium symptoms was measured by the Korean version of the Delirium Rating Scale-Revised 98 (K-DRS-R98). Patients were divided into two groups : a ‘mild delirium group (MDG)’, whose total scores on the K-DRS-R98 were below 16, and a ‘severe delirium group (SDG)’ with the scores above 16. ResultsZZThere was a positive correlation between the sum of known risk factors for delirium and total scores on the K-DRS-R98 (p=0.009). The SDG showed a significantly higher incidence of abnormal potassium levels, abnormal sodium levels, old age, and polypharmacy than the MDG (p=0.010, p=0.046, p=0.042, and p=0.033 respectively). In a logistic regression model, old age, abnormal sodium and potassium levels, and polypharmacy were found to predict increased severity of the delirium (p=0.001, p=0.007, p=0.019, and p=0.005 respectively). ConclusionZZThe present findings suggested that there are certain factors which not only affect the occurrence of delirium, but also severity of delirium symptoms.
Abstract
ObjectivesZZThe purpose of this study was to investigate the relationship between the sum of the risk factors for delirium and the severity of delirium and to identify those risk factors which increase the severity of delirium. MethodsZZThe participants were 151 patients who were consulted with a consultation-liaison psychiatrist and diagnosed using DSM-IV criteria as suffering from delirium. Sociodemographic and clinical characteristics were obtained through structured interviews and medical chart reviews. The severity of delirium symptoms was measured by the Korean version of the Delirium Rating Scale-Revised 98 (K-DRS-R98). Patients were divided into two groups : a ‘mild delirium group (MDG)’, whose total scores on the K-DRS-R98 were below 16, and a ‘severe delirium group (SDG)’ with the scores above 16. ResultsZZThere was a positive correlation between the sum of known risk factors for delirium and total scores on the K-DRS-R98 (p=0.009). The SDG showed a significantly higher incidence of abnormal potassium levels, abnormal sodium levels, old age, and polypharmacy than the MDG (p=0.010, p=0.046, p=0.042, and p=0.033 respectively). In a logistic regression model, old age, abnormal sodium and potassium levels, and polypharmacy were found to predict increased severity of the delirium (p=0.001, p=0.007, p=0.019, and p=0.005 respectively). ConclusionZZThe present findings suggested that there are certain factors which not only affect the occurrence of delirium, but also severity of delirium symptoms.
참고문헌 (39)
- Lipowsky ZJ, "Delirium (acute confusional states)", JAMA, 258, pp.1789~1792 (1987)
- Mesulam M, "Attention: confusional state and neglect in Principles of Behavioral Neurology", pp.125~168 (1985), Saunders
- Yudofsky SC, "Textbook of Neuropsychiatry and Behavioral Neurosciences", pp.446~517 (2007), The American Psychiatric Publishing Inc.
- Ely EW, "The impact of delirium in the intensive care unit on hospital length of stay", Intensive Care Med, 27, pp.1892~1900 (2001)
- Lawlor PG, "Occurrence, causes and outcome of delirium in patients with advanced cancer", Arch Intern Med, 160, pp.786~794 (2000)
- Cole MG, "Prognosis of delirium in elderly hospital patients", CMAJ, 149, pp.41~46 (1993)
- Inouye SK, "Does delirium contribute to poor hospital outcome?", J Gen Intern Med, 13, pp.234~242 (1998)
- Trzepacz PT, "Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine", Semin Clin Neuropsychiatry, 5, pp.132~148 (2000)
- Goldberg E, "Lateralization of frontal lobe function and cognitive novelty", J Neuropsychiatry Clin Neurosci, 6, pp.371~378 (1998)
- Posner ML, "Components of attention", Psychol Rev, 78, pp.391~408 (1971)
- Medina JL, "Syndrome of agitated delirium and visual impairment: a manifestation of medial temporo-occipital infarction", J Neurol Neurosurg Psychiatry, 40, pp.861~864 (1977)
- Trzepacz PT, "Update on the neuropathogenesis of delirium", Dement Geriatr Gogn Disord, 10, pp.330~334 (1999)
- Inouye SK, "Precipitating factors for delirium in hospitalized elderly patients. Predictive model and interrelationships with baseline vulnerability", JAMA, 275, pp.852~857 (1996)
- Inouye SK, "A multicomponent intervention to prevent delirium in hospitalized older patients", N Engl J Med, 340, pp.669~676 (1999)
- 대한노인병학회, "노인병학", pp.68~71 (2005), 의학출판사
- Timmers JFM, "A review of assessment scales for delirium, in primary prevention of Delirium in the Elderly", pp.21~39 (2005), Academisch Proefschrift, University of Amsterdam
- 임경옥, "한국판 섬망 평가 척도-98(K-DRS-98)의 표준화 연구", 신경정신의학, 45(6), pp.518~526 (2006), 대한신경정신의학회
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies: development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- Koppie TM, "Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer", Cancer, 112, pp.2384~2292 (2008)
- Gomez JM, "What should the optimal target hemoglobin be? Kidney Int Suppl", Kidney Int Suppl, 39~43 (2002)
- Schurink CA, "Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability", Intensive Care Med, 30, pp.217~224 (2004)
- Andreoli TE, "Cecil Essentials of Medicine", pp.676~707 (2007), Saunders
- Child CG, "Surgery and portal hypertension in The liver and portal hypertension", pp.50~64 (1964), Saunders
- Adrogue HJ, "Hyponatremia", N Engl J Med, 342, pp.1581~1589 (2000)
- Adrogue HJ, "Hypernatremia", N Engl J Med, 342, pp.1493~1499 (2000)
- Andreoli TE, "Cecil Essentials of Medicine", pp.292~295 (2007), Saunders
- O’Keeffe ST, "Predicting delirium in elderly patients: development and validation of a risk-stratification model", Age Ageing, 25, pp.317~321 (1996)
- Marcatonio ER, "Reducing delirium after hip fracture: a randomized trial", J Am Geriatr Soc, 49, pp.516~522 (2001)
- Francis J, "A prospective study of delirium in hospitalized elderly", JAMA, 263, pp.1097~1101 (1990)
- Aldemir M, "Predisposing factors for delirium in the surgical intensive care unit", Crit Care, 5, pp.265~270 (2001)
- Marcantonio ER, "A clinical prediction rule for delirium after elective noncardiac surgery", JAMA, 271, pp.134~139 (1994)
- Goldenberg G, "Predicting postoperative delirium in elderly patients undergoing surgery for hip fracture", Psychogeriatrics, 6, pp.43~48 (2006)
- Brown TM, "Drug-induced delirium", Semin Clin Neuropsychiatry, 5, pp.113~124 (2000)
- Tune LE, "Anticholinergic effects of drugs commonly prescribed for the elderly: potential means for assessing risk of delirium", Am J Psychiatry, 149, pp.1393~1394 (1992)
- White S, "Enzymes of drug metabolism during delirium", Age Ageing, 34, pp.603~608 (2005)
- Fulton MM, "Polypharmacy in the elderly a literature review", J Am Acad Nurse Pract, 17, pp.123~132 (2005)
- Linjakumpu T, "Use of medications and polypharmacy are increasing among the elderly", J Clin Epidemiol, 55, pp.809~817 (2002)
- Trzepacz PT, "Low serum albumin and risk of delirium", Am J Psychiatry, 147, pp.675~ (1990)
- Kasper DL, "Harrison’s Principles of Internal Medicine", pp.1813~1816 (2004), McGraw-Hill Professional