Psychiatrische Erkrankungen auf der Intensivstation - Teil I - Das Delir

Till Krauseneck; Florian Seemüller; Olivia Krähenmann; Gustav Schelling; Frank Padberg

doi:10.1055/s-2006-958843

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2006; 41(11): 720-726
DOI: 10.1055/s-2006-958843

Fachwissen: Intensivmedizin

Psychiatrische Erkrankungen auf der Intensivstation - Teil I - Das Delir

Psychiatry on ICU - The DeliriumTill Krauseneck, Florian Seemüller, Olivia Krähenmann, Gustav Schelling, Frank Padberg

Abstract

Zusammenfassung

Das Delir ist die häufigste psychiatrische Erkrankung auf Intensivstationen. Unbehandelt kann es zu Stupor, Koma oder zum Tod des Patienten führen. Durch die Zusammenarbeit von Intensivmedizinern und Psychiatern werden eine schnelle Diagnose und eine effektive Behandlung der Erkrankung ermöglicht. Im folgenden Artikel werden die verschiedenen Formen des Delirs und deren Ursachen sowie Therapiemaßnahmen beschrieben. Weiterhin wird darauf eingegangen wie man durch Veränderungen im Umfeld des Patienten, den Verlauf des Delirs positiv beeinflussen kann.

Summary

Delirium is the most common psychiatric disorder on ICU. Without sufficient treatment there can be stupor, koma or exitus of the patient. Close collaboration of ICU physicians and Psychiatrists leads to quick diagnosis and effective treatment. This article reviews the different forms of delirium, its causes and therapy strategies. Also changes of the ICU environment to prevent patients from delirium are mentioned.

Schlagwörter:

Delir - Verwirrtheit - Intensivstation - Behandlung - Entzugsdelir - Psychiatrie

Keywords:

delirium - icu psychosis - confusional state - withdrawal - psychiatric disorder

Full Text

References

Literaturverzeichnis

1 Ely EW. et al. . Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004; 291 1753-62
2 Thomason JW. et al. . Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care. 2005; 9 R375-R381
3 Kapfhammer HP. et al. . Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome. Am J Psychiatry. 2004; 161 45-52
4 Krauseneck T. et al. . PTSD in somatic disease. Fortschr.Neurol.Psychiatr. 2005; 73 206-17
5 Schelling G. et al. . Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-ife outcomes after cardiac surgery. Crit Care Med. 2003; 31 1971-80
6 Ampelas JF, Pochard F, Consoli SM. Psychiatric disorders in intensive care units. Encephale. 2002; 28 191-99
7 Chick J. Delirium tremens. BMJ. 1989; 298 3-4
8 Möller HJ, Laux G, Kapfhammer HP. Psychiatrie und Psychotherapie 2002
9 Liptzin B, Levkoff SE. An empirical study of delirium subtypes. Br J Psychiatry. 1992; 161 843-45
10 Pfitzer F, Schuchardt V, Heitmann R. Treatment of severe alcoholic delirium. Nervenarzt. 1988; 59 229-36
11 Feuerlein W. New experiences of the alcohol-delirium investigation. Nervenarzt. 1967; 38 492-500
12 Peterson JF. et al. . Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc. 2006; 54 479-84
13 Trzepacz PT. et al. . Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. J Neuropsychiatry Clin Neurosci. 2001; 13 229-42
14 Ely EW. et al. . Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001; 286 2703-10
15 Benkert and Hippius . Kompendium der psychiatrischen Pharmakotherapie. 2005; 5
16 Amann BL. et al. . EEG abnormalities associated with antipsychotics: a comparison of quetiapine, olanzapine, haloperidol and healthy subjects. Hum Psychopharmacol. 2003; 18 641-46
17 McCusker J. et al. . Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study. CMAJ. 2001; 165 575-83
18 O'Keeffe S, Lavan J. „The prognostic significance of delirium in older hospital patients.” J Am Geriatr Soc. 1997; 45 174-78
19 Cole MG, Primeau FJ. „Prognosis of delirium in elderly hospital patients.” CMAJ. 1993; 149 41-46
20 Rommelspacher H, Schmidt LG, Helmchen H. Pathobiochemistry and pharmacotherapy of alcohol withdrawal delirium. Nervenarzt. 1991; 62 649-57
21 American Psychiatric Association . Practice guideline for the treatment of patients with delirium. Am J Psychiatry. 1999; 156 1-20