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DOI: 10.1055/s-2008-1040331
© Georg Thieme Verlag Stuttgart · New York
Notsituation akute Verwirrtheit - Anamnese und Untersuchung unter Beachtung der Risikofaktoren
Emergency situation: Acute delirium - anamnesis and examination while taking risk factors into accountPublication History
Publication Date:
21 January 2008 (online)
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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
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Korrespondenz
Prof. Dr. med. Hagen Sandholzer
Selbständige Abteilung für Allgemeinmedizin Universität Leipzig
Philipp-Rosenthal-Straße 55
04103 Leipzig
Email: haeb@medizin.uni-leipzig.de