Delirium.
Delirium.
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DOI：
10.1038/s41572-020-00223-4
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发表时间：
2020-11-12
影响因子：
81.5
通讯作者：
Ely, E. Wesley
中科院分区：
文献类型：
--
作者：
Wilson, Jo Ellen;Mart, Matthew F.;Cunningham, Colm;Shehabi, Yahya;Girard, Timothy D.;MacLullich, Alasdair M. J.;Slooter, Arjen J. C.;Ely, E. Wesley
谵妄是一种以注意力、意识和认知的急剧变化为特征的疾病，是由一种无法用预先存在的神经认知障碍更好解释的医学疾病引起的。已经描述了谵妄的多种诱发因素（例如，预先存在的认知障碍）和诱发因素（例如，尿路感染），大多数患者同时具有两种类型。由于谵妄的病因学涉及多种因素，因此可能有几种神经生物学过程促成谵妄的发病机制，包括神经炎症、脑血管功能障碍、脑代谢改变、神经递质失衡和神经元网络连接受损。精神疾病诊断和统计手册，第5版（DSM-5）是最常用的诊断系统，在此基础上进行参考标准诊断，尽管由于在许多情况下使用DSM-5不切实际，已经开发了许多其他谵妄筛查工具。谵妄的药物治疗（如抗精神病药物）是无效的，反映了我们对病理生理学的理解存在重大差距。目前，最好的管理策略是多领域干预，重点是治疗突发疾病，药物审查，管理痛苦，减轻并发症，并保持对环境问题的参与。谵妄检测、治疗和预防策略的有效实施仍然是全球医疗保健组织面临的主要挑战。谵妄是一种严重的神经精神综合征，其特征是注意力、意识和认知的急剧变化，由各种疾病引起。本书回顾了谵妄的流行病学、病理生理学、诊断、分类和管理方法，并讨论了谵妄研究和治疗的未来方向。
Delirium, a condition characterized by an acute change in attention, awareness and cognition, is caused by a medical condition that cannot be better explained by a pre-existing neurocognitive disorder. Multiple predisposing factors (for example, pre-existing cognitive impairment) and precipitating factors (for example, urinary tract infection) for delirium have been described, with most patients having both types. Because multiple factors are implicated in the aetiology of delirium, there are likely several neurobiological processes contributing to delirium pathogenesis, including neuroinflammation, brain vascular dysfunction, altered brain metabolism, neurotransmitter imbalance and impaired neuronal network connectivity. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) is the most commonly used diagnostic system upon which a reference standard diagnosis is made, although many other delirium screening tools have been developed owing to the impracticality of using DSM-5 in many settings. Pharmacological treatments for delirium (such as antipsychotic drugs) are not effective, reflecting substantial gaps in our understanding of pathophysiology. Currently, the best management strategies are multidomain interventions that focus on treating precipitating conditions, medication review, managing distress, mitigating complications, and maintaining engagement to environmental issues. Effective implementation of delirium detection, treatment and prevention strategies remains a major challenge for healthcare organizations globally. Delirium is a severe neuropsychiatric syndrome characterized by an acute change in attention, awareness and cognition and is caused by a various medical conditions. This Primer reviews delirium epidemiology, pathophysiology, diagnosis, classification and management approaches and discusses future directions in delirium research and treatment.
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影响因子：
34.7
作者：
Arnsten, Amy F. T.
通讯作者：
Arnsten, Amy F. T.
DOI：
10.1186/cc13084
发表时间：
2013-10-29
期刊：
Critical care (London, England)
影响因子：
--
作者：
Abelha FJ;Luís C;Veiga D;Parente D;Fernandes V;Santos P;Botelho M;Santos A;Santos C
通讯作者：
Santos C
影响因子：
4.7
作者：
Breitbart, W;Rosenfeld, B;Passik, S
通讯作者：
Passik, S
影响因子：
9
作者：
Böhner, H;Hummel, TC;Schneider, F
通讯作者：
Schneider, F
影响因子：
8.8
作者：
Balas MC;Vasilevskis EE;Olsen KM;Schmid KK;Shostrom V;Cohen MZ;Peitz G;Gannon DE;Sisson J;Sullivan J;Stothert JC;Lazure J;Nuss SL;Jawa RS;Freihaut F;Ely EW;Burke WJ
通讯作者：
Burke WJ