Ätiologie und Therapie des Delirs

Zusammenfassung

Der Begriff Delir wurde operationalisiert und ersetzt diverse Befunde und Diagnosen wie Durchgangssyndrom oder hirnorganisches Psychosyndrom. Dies führte in den letzten Jahren zu wesentlichen neuen Erkenntnissen: Die Diagnose bedarf einer strukturierten Befunderhebung. Ein Delir ist im Krankenhaus sehr häufig. Es betrifft nicht nur alte Patienten, Intensivpatienten oder frisch Operierte. Ein Delir ist verknüpft mit einer länger notwendigen Behandlung auf Intensivstationen und im Krankenhaus; mit einer erhöhten kurz- und langfristigen Mortalität; mit einem erhöhten Risiko zur Entwicklung bzw. zur Beschleunigung eines kognitiven Abbaus. Durch frühzeitige Identifizierung von Risikopatienten kann einem Progress in ein Delir effizient vorgebeugt werden. Das gelingt in einem Drittel der Fälle durch eine Multikomponentenintervention, die allgemeinmedizinische Maßnahmen, Pharmakohygiene und zum Teil personalintensive Umgebungsmaßnahmen beinhaltet. Die medikamentöse Behandlung eines eingetretenen Delirs wird entsprechend des Transmitter-Modells bei Delir primär mit typischen oder auch atypischen Neuroleptika geführt, ergänzt durch Sedativa. Dies hat nur Einfluss auf die Symptomausprägung, nicht auf die ungünstige Prognose.

Abstract

Today, the term delirium has been operationalized and a set of distinct diagnostic criteria is available that enables making diagnosis of delirium, replacing traditional but unspecific diagnoses. This has led to great progress in our understanding of delirium. It is by far more frequent than formerly thought. It is not only a problem of older patients, of critically ill or of post-surgery patients; the diagnosis is associated with a higher in-house and long-term mortality. Delirium facilitates and accelerates cognitive decline. Early recognition of patients at risk makes efficient prevention possible by a multicomponent intervention. If these measures do not suffice, medication with haloperidol or atypical neuroleptics is necessary depending on the biology of delirium, possibly supplemented by sedatives. However, these drugs will only relieve the intensity of delirium, but have no influence on the poorer outcome of patients with delirium.

Schlüsselwörter

Delirrisiko - Delirtests - Multikomponentenintervention - Delirbehandlung

Keywords

etiology of delirium - confusion assessment - multicomponent intervention - drugs for delirium

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