Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses.
Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses.
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阐明妄想的病理生理学：重点是异常压力反应的作用。
DOI：
10.1016/j.jpsychores.2008.05.019
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发表时间：
2008-09
影响因子：
4.7
通讯作者：
Cunningham, Colm
中科院分区：
文献类型：
--
作者：
MacLullich, Alasdair M. J.;Ferguson, Karen J.;Miller, Thomas;de Rooij, Sophia E. J. A.;Cunningham, Colm
谵妄是一种常见的严重急性神经精神综合征，其核心特征是注意力不集中和认知障碍，相关特征包括觉醒改变、睡眠-觉醒周期改变和其他精神状态改变。主要的危险因素是老年、认知障碍和其他合并症。虽然谵妄具有一致的核心临床特征，但其诱发因素非常广泛，包括急性疾病、手术、创伤和药物。这些诱发因素导致谵妄的分子机制在很大程度上尚不清楚。在这篇文章中，我们试图缩小一些具体的因果途径。我们提出了一个基本的病因分类：(a)直接脑损伤，(b)异常应激反应。直接脑损伤在很大程度上是不分青红皂白的，包括普遍和区域的能量剥夺(例如：缺氧、低血糖、中风)、代谢异常(如：低钠血症，高钙血症)，以及药物的作用。异常应激反应在概念上和机制上是不同的，因为它们构成了应激反应途径的不利影响，而在健康情况下，应激反应途径是适应性的。衰老和中枢神经系统疾病是谵妄的两个主要诱发因素，与压力和疾病行为反应的程度或持续时间的改变以及对这些反应影响的脆弱性增加有关。我们详细讨论了两种可能参与谵妄病理生理学的应激反应系统：炎症和疾病行为反应，以及边缘-下丘脑-垂体-肾上腺轴的活动。最后，我们讨论了对未来研究和谵妄新疗法发展的影响。
Delirium is a common and serious acute neuropsychiatric syndrome with core features of inattention and cognitive impairment, and associated features including changes in arousal, altered sleep-wake cycle, and other changes in mental status. The main risk factors are old age, cognitive impairment, and other comorbidities. Though delirium has consistent core clinical features, it has a very wide range of precipitating factors, including acute illness, surgery, trauma, and drugs. The molecular mechanisms by which these precipitating factors lead to delirium are largely obscure. In this article we attempt to narrow down some specific causal pathways. We propose a basic classification for the aetiological factors: (a) direct brain insults, and (b) aberrant stress responses. Direct brain insults are largely indiscriminate and include general and regional energy deprivation (eg. hypoxia, hypoglycaemia, stroke), metabolic abnormalities (eg. hyponatraemia, hypercalcaemia), and the effects of drugs. Aberrant stress responses are conceptually and mechanistically distinct in that they constitute adverse effects of stress-response pathways which, in health, are adaptive. Ageing and central nervous system disease, two major predisposing factors for delirium, are associated with alterations in the magnitude or duration of stress and sickness behaviour responses, and increased vulnerability to the effects of these responses. We discuss in detail two stress response systems that are likely to be involved in the pathophysiology of delirium: inflammation and the sickness behaviour response, and activity of the limbic-hypothalamic-pituitary-adrenal axis. We conclude by discussing the implications for future research and the development of new therapies for delirium.
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影响因子：
4.3
作者：
Epstein, J;Breslow, MJ
通讯作者：
Breslow, MJ
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0.8
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10.6
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Brown, ES;Woolston, DJ;Cullum, CM
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Cullum, CM
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Cunningham, C;Boche, D;Perry, VH
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Perry, VH
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Anisman, Hymie;Poulter, Michael O.;Hayley, Shawn
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Hayley, Shawn