The delirium experience: Delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses
The delirium experience: Delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses
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DOI：
10.1176/appi.psy.43.3.183
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发表时间：
2002-05-01
期刊：
影响因子：
3.4
通讯作者：
Tremblay, A
中科院分区：
文献类型：
--
作者：
Breitbart, W;Gibson, C;Tremblay, A
我们对154例住院癌症患者的谵妄经历进行了系统的检查。所有患者均符合DSM-IV谵妄标准，并采用记忆性谵妄评估量表（Memorial Delirium Assessment Scale）评定谵妄严重程度、现象学和消退。在154名患者中，101名患者的谵妄完全消退，并接受了谵妄经历问卷（DEQ-一种评估谵妄回忆和与谵妄发作相关的痛苦的面部有效测量）。配偶/照顾者和主要护士也被管理DEQ，以评估与照顾谵妄患者有关的痛苦。54例（53.5%）患者回忆了他们的谵妄经历。Logistic回归分析显示，短期记忆障碍（OR = 38.4）、谵妄严重性知觉障碍（OR = 6.9）具有显著性（OR = 11.3），且存在谵妄回忆的p预测因子。回忆起谵妄的患者的平均谵妄相关痛苦水平（DEQ的0-4数值评定量表）为3.2，配偶/照顾者为3.75，护士为3.09。Logistic回归分析表明，妄想的存在（OR = 7.9）是最显着的预测患者的痛苦。“活动减退”谵妄患者与“活动过度”谵妄患者一样痛苦。Karnofsky行为状态（OR = 9.1）是配偶/照顾者痛苦的最重要预测因子。谵妄的严重程度（OR =5.2）和知觉障碍（OR =3.6）的存在是最显着的预测护士痛苦。总之，大多数谵妄患者回忆起他们的谵妄是非常痛苦的。谵妄也是一个非常痛苦的经验，为配偶/照顾者和护士谁是照顾谵妄患者。迅速识别和治疗谵妄是至关重要的，以减少痛苦和痛苦。
We conducted a systematic examination of the experience of delirium in a sample of 154 hospitalized patients with cancer. Patients all met DSM-IV criteria for delirium and were rated with the Memorial Delirium Assessment Scale as a measure of delirium severity, phenomenology, and resolution. Of the 154 patients assessed, 101 had complete resolution of their delirium and were administered the Delirium Experience Questionnaire (DEQ-a face-valid measure that assesses delirium recall and distress related to the delirium episode). Spouse/caregivers and primary nurses were also administered the DEQ to assess distress related to caring for a delirious patient. Fifty-four (53.5%) patients recalled their delirium experience. Logistic-regression analysis demonstrated that short-term memory impairment (odds ratio [OR] = 38.4), delirium severity perceptual disturbances (OR = 6.9) were significant (OR = 11.3), and the presence of p predictors of delirium recall. Mean delirium-related distress levels (on a 0-4 numerical rating scale of the DEQ) were 3.2 for patients who recalled delirium, 3.75 for spouses/caregivers, and 3.09 for nurses. Logistic-regression analysis demonstrated that the presence of delusions (OR = 7.9) was the most significant predictor of patient distress. Patients with "hypoactive" delirium were just as distressed as patients with "hyperactive" delirium. Karnofsky Performance Status (OR = 9.1) was the most significant predictor of spouse/caregiver distress. Delirium severity (OR =5.2) and the presence of perceptual disturbances (OR =3.6) were the most significant predictors of nurse distress. In conclusion, a majority of patients with delirium recall their delirium as highly distressing. Delirium is also a highly distressing experience for spouses/ caregivers and nurses who are caring for delirious patients. Prompt recognition and treatment of delirium is critically important to reduce suffering and distress.