Skip to main content
Erschienen in: Der Nervenarzt 5/2016

01.12.2015 | Übersichten

Das nichtentzugsbedingte Delir

Evidenz zu Prävention und Therapie

verfasst von: Dr. R. Haussmann, M. Bauer, M. Donix

Erschienen in: Der Nervenarzt | Ausgabe 5/2016

Einloggen, um Zugang zu erhalten

Zusammenfassung

Das Delir ist im klinischen Alltag häufig, aber unterdiagnostiziert. Die Behandlung des oft multifaktoriell bedingten schweren Krankheitsbildes, welches mit hoher Mortalität und immensen Kosten für das Gesundheitssystem einhergeht, erfolgt oft spät und beschränkt sich meist auf pharmakologische Maßnahmen. Wir geben einen Überblick zu Kernsymptomen und Risikofaktoren des Delirs, medikamentösen und nichtmedikamentösen Behandlungsstrategien und Möglichkeiten der Delirprävention.
Literatur
1.
Zurück zum Zitat Dilling DMW, Schmidt MH (2011) Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel F0. Klinisch-diagnostische Leitlinien, 8. Aufl. Hogrefe, Bern Dilling DMW, Schmidt MH (2011) Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel F0. Klinisch-diagnostische Leitlinien, 8. Aufl. Hogrefe, Bern
3.
Zurück zum Zitat Hatta K et al (2014) Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA Psychiatry 71(4):397–403CrossRefPubMed Hatta K et al (2014) Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA Psychiatry 71(4):397–403CrossRefPubMed
5.
Zurück zum Zitat Hüfner K, Sperner-Unterweger B (2014) Delir in der Neurologie - Diagnose, Behandlung und Prognose. Nervenarzt 85:427–436CrossRefPubMed Hüfner K, Sperner-Unterweger B (2014) Delir in der Neurologie - Diagnose, Behandlung und Prognose. Nervenarzt 85:427–436CrossRefPubMed
7.
Zurück zum Zitat Ahmed S, Leurent B, Sampson EL (2014) Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age Ageing 43(3):326–333CrossRefPubMedPubMedCentral Ahmed S, Leurent B, Sampson EL (2014) Risk factors for incident delirium among older people in acute hospital medical units: a systematic review and meta-analysis. Age Ageing 43(3):326–333CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat van Meenen LC et al (2014) Risk prediction models for postoperative delirium: a systematic review and meta-analysis. J Am Geriatr Soc 62(12):2383–2390CrossRefPubMed van Meenen LC et al (2014) Risk prediction models for postoperative delirium: a systematic review and meta-analysis. J Am Geriatr Soc 62(12):2383–2390CrossRefPubMed
9.
Zurück zum Zitat Shi Q et al (2012) Delirium in acute stroke: a systematic review and meta-analysis. Stroke 43(3):645–649CrossRefPubMed Shi Q et al (2012) Delirium in acute stroke: a systematic review and meta-analysis. Stroke 43(3):645–649CrossRefPubMed
10.
Zurück zum Zitat Witlox J, Eurelings L, de Jonghe JEA (2010) Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 304:443–451CrossRefPubMed Witlox J, Eurelings L, de Jonghe JEA (2010) Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 304:443–451CrossRefPubMed
11.
Zurück zum Zitat Mach JR Jr. et al (1995) Serum anticholinergic activity in hospitalized older persons with delirium: a preliminary study. J Am Geriatr Soc 43(5):491–495CrossRefPubMed Mach JR Jr. et al (1995) Serum anticholinergic activity in hospitalized older persons with delirium: a preliminary study. J Am Geriatr Soc 43(5):491–495CrossRefPubMed
12.
Zurück zum Zitat Campbell N et al (2009) The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging 4:225–233PubMedPubMedCentral Campbell N et al (2009) The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging 4:225–233PubMedPubMedCentral
13.
Zurück zum Zitat Trzepacz PT (1994) The neuropathogenesis of delirium. A need to focus our research. Psychosomatics 35(4):374–391CrossRefPubMed Trzepacz PT (1994) The neuropathogenesis of delirium. A need to focus our research. Psychosomatics 35(4):374–391CrossRefPubMed
14.
Zurück zum Zitat Trzepacz P (2000) Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 5:132–148PubMed Trzepacz P (2000) Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 5:132–148PubMed
15.
Zurück zum Zitat Cerejeira J, Lagarto L, Mukaetova-Ladinska EB (2014) The immunology of delirium. Neuroimmunomodulation 21(2–3):72–78PubMed Cerejeira J, Lagarto L, Mukaetova-Ladinska EB (2014) The immunology of delirium. Neuroimmunomodulation 21(2–3):72–78PubMed
16.
Zurück zum Zitat Androsova G et al (2015) Biomarkers of postoperative delirium and cognitive dysfunction. Front Aging Neurosci 7:1–16CrossRef Androsova G et al (2015) Biomarkers of postoperative delirium and cognitive dysfunction. Front Aging Neurosci 7:1–16CrossRef
17.
Zurück zum Zitat Downing J, Miyan J (2000) Neural immunoregulation: emerging roles for nerves in immune homeostasis and disease. Immunol Today 21:281–289CrossRefPubMed Downing J, Miyan J (2000) Neural immunoregulation: emerging roles for nerves in immune homeostasis and disease. Immunol Today 21:281–289CrossRefPubMed
18.
Zurück zum Zitat D’Mello C, Le T, Swain M (2009) Cerebral microglia recruit monocytes into the brain in response to tumor necrosis factor-alpha signaling during peripheral organ inflammation. Neuroscience 29(7):2089–2102PubMed D’Mello C, Le T, Swain M (2009) Cerebral microglia recruit monocytes into the brain in response to tumor necrosis factor-alpha signaling during peripheral organ inflammation. Neuroscience 29(7):2089–2102PubMed
19.
Zurück zum Zitat Steiner LA (2011) Postoperative delirium. Part 1: pathophysiology and risk factors. Eur J Anaesthesiol 28(9):628–636CrossRefPubMed Steiner LA (2011) Postoperative delirium. Part 1: pathophysiology and risk factors. Eur J Anaesthesiol 28(9):628–636CrossRefPubMed
20.
Zurück zum Zitat Cerejeira J et al (2012) The cholinergic system and inflammation: common pathways in delirium pathophysiology. J Am Geriatr Soc 60(4):669–675CrossRefPubMed Cerejeira J et al (2012) The cholinergic system and inflammation: common pathways in delirium pathophysiology. J Am Geriatr Soc 60(4):669–675CrossRefPubMed
22.
Zurück zum Zitat Tune L (2002) The role of antipsychotics in treating delirium. Curr Psychiatry Rep 4(3):209–212CrossRefPubMed Tune L (2002) The role of antipsychotics in treating delirium. Curr Psychiatry Rep 4(3):209–212CrossRefPubMed
23.
Zurück zum Zitat Inouye SK et al (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 113(12):941–948CrossRefPubMed Inouye SK et al (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 113(12):941–948CrossRefPubMed
24.
Zurück zum Zitat Trzepacz PT (1999) The delirium rating scale. its use in consultation-liaison research. Psychosomatics 40(3):193–204CrossRefPubMed Trzepacz PT (1999) The delirium rating scale. its use in consultation-liaison research. Psychosomatics 40(3):193–204CrossRefPubMed
25.
26.
Zurück zum Zitat Wong CL et al (2010) Does this patient have delirium? Value of bedside instruments. JAMA 304:779–786CrossRefPubMed Wong CL et al (2010) Does this patient have delirium? Value of bedside instruments. JAMA 304:779–786CrossRefPubMed
27.
Zurück zum Zitat Lai MM, Wong Tin Niam DM (2012) Intracranial cause of delirium: computed tomography yield and predictive factors. Intern Med J 42(4):422–427CrossRefPubMed Lai MM, Wong Tin Niam DM (2012) Intracranial cause of delirium: computed tomography yield and predictive factors. Intern Med J 42(4):422–427CrossRefPubMed
28.
Zurück zum Zitat Jacobson S, Jerrier H (2000) EEG in delirium. Semin Clin Neuropsychiatry 5(2):86–92PubMed Jacobson S, Jerrier H (2000) EEG in delirium. Semin Clin Neuropsychiatry 5(2):86–92PubMed
29.
Zurück zum Zitat Jenssen S (2005) Electroencephalogram in the dementia workup. Am J Alzheimers Dis Other Demen 20(3):159–166CrossRefPubMed Jenssen S (2005) Electroencephalogram in the dementia workup. Am J Alzheimers Dis Other Demen 20(3):159–166CrossRefPubMed
30.
Zurück zum Zitat Rivosecchi RM et al (2015) Nonpharmacological interventions to prevent delirium: an evidence-based systematic review. Crit Care Nurse 35(1):39–50CrossRefPubMed Rivosecchi RM et al (2015) Nonpharmacological interventions to prevent delirium: an evidence-based systematic review. Crit Care Nurse 35(1):39–50CrossRefPubMed
31.
Zurück zum Zitat Caplan GA, Harper EL (2007) Recruitment of volunteers to improve vitality in the elderly: the REVIVE study. Intern Med J 37(2):95–100CrossRefPubMed Caplan GA, Harper EL (2007) Recruitment of volunteers to improve vitality in the elderly: the REVIVE study. Intern Med J 37(2):95–100CrossRefPubMed
32.
Zurück zum Zitat Colombo R et al (2012) A reorientation strategy for reducing delirium in the critically ill. Results of an interventional study. Minerva Anestesiol 78(9):1026–1033PubMed Colombo R et al (2012) A reorientation strategy for reducing delirium in the critically ill. Results of an interventional study. Minerva Anestesiol 78(9):1026–1033PubMed
33.
Zurück zum Zitat Tabet N et al (2005) An educational intervention can prevent delirium on acute medical wards. Age Ageing 34(2):152–156CrossRefPubMed Tabet N et al (2005) An educational intervention can prevent delirium on acute medical wards. Age Ageing 34(2):152–156CrossRefPubMed
34.
Zurück zum Zitat Lundstrom M et al (2005) A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc 53(4):622–628CrossRefPubMed Lundstrom M et al (2005) A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc 53(4):622–628CrossRefPubMed
35.
Zurück zum Zitat de Jonghe A et al (2014) Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial. CMAJ 186:E547–E556CrossRefPubMedPubMedCentral de Jonghe A et al (2014) Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial. CMAJ 186:E547–E556CrossRefPubMedPubMedCentral
36.
Zurück zum Zitat Al-Aama T et al (2011) Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial. Int J Geriatr Psychiatry 26(7):687–694CrossRefPubMed Al-Aama T et al (2011) Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial. Int J Geriatr Psychiatry 26(7):687–694CrossRefPubMed
37.
Zurück zum Zitat Chen S et al (2015) Exogenous Melatonin for delirium prevention: a meta-analysis of randomized controlled trials. Mol Neurobiol. doi: 10.1007/s12035-015-9350-8 Chen S et al (2015) Exogenous Melatonin for delirium prevention: a meta-analysis of randomized controlled trials. Mol Neurobiol. doi: 10.1007/s12035-015-9350-8
38.
Zurück zum Zitat Kalisvaart KJ et al (2005) Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc 53(10):1658–1666CrossRefPubMed Kalisvaart KJ et al (2005) Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc 53(10):1658–1666CrossRefPubMed
39.
Zurück zum Zitat Larsen KA et al (2010) Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics 51(5):409–418CrossRefPubMed Larsen KA et al (2010) Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics 51(5):409–418CrossRefPubMed
40.
Zurück zum Zitat Prakanrattana U, Prapaitrakool S (2007) Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care 35(5):714–719PubMed Prakanrattana U, Prapaitrakool S (2007) Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery. Anaesth Intensive Care 35(5):714–719PubMed
41.
Zurück zum Zitat Wang W et al (2012) Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial. Crit Care Med 40(3):731–739CrossRefPubMed Wang W et al (2012) Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial. Crit Care Med 40(3):731–739CrossRefPubMed
42.
Zurück zum Zitat Fok MC et al (2015) Do antipsychotics prevent postoperative delirium? A systematic review and meta-analysis. Int J Geriatr Psychiatry 30(4):333–344CrossRefPubMed Fok MC et al (2015) Do antipsychotics prevent postoperative delirium? A systematic review and meta-analysis. Int J Geriatr Psychiatry 30(4):333–344CrossRefPubMed
43.
Zurück zum Zitat Gilmore ML, Wolfe DJ (2013) Antipsychotic prophylaxis in surgical patients modestly decreases delirium incidence – but not duration – in high-incidence samples: a meta-analysis. Gen Hosp Psychiatry 35(4):370–375CrossRefPubMed Gilmore ML, Wolfe DJ (2013) Antipsychotic prophylaxis in surgical patients modestly decreases delirium incidence – but not duration – in high-incidence samples: a meta-analysis. Gen Hosp Psychiatry 35(4):370–375CrossRefPubMed
44.
Zurück zum Zitat Ford AH, Almeida OP (2015) Pharmacological interventions for preventing delirium in the elderly. Maturitas 81:287–292CrossRefPubMed Ford AH, Almeida OP (2015) Pharmacological interventions for preventing delirium in the elderly. Maturitas 81:287–292CrossRefPubMed
45.
Zurück zum Zitat Maust DT et al (2015) Antipsychotics, other Psychotropics, and the risk of death in patients with dementia number needed to harm. JAMA Psychiatry 72:438–445CrossRefPubMedPubMedCentral Maust DT et al (2015) Antipsychotics, other Psychotropics, and the risk of death in patients with dementia number needed to harm. JAMA Psychiatry 72:438–445CrossRefPubMedPubMedCentral
46.
Zurück zum Zitat Frölich L, Hausner L (2015) Therapie mit Antipsychotika und Antidepressiva bei Demenzen. Nervenarzt 86:461–467CrossRefPubMed Frölich L, Hausner L (2015) Therapie mit Antipsychotika und Antidepressiva bei Demenzen. Nervenarzt 86:461–467CrossRefPubMed
47.
Zurück zum Zitat Lonergan E et al (2007) Antipsychotics for delirium. Cochrane Database Syst Rev 2:CD005594PubMed Lonergan E et al (2007) Antipsychotics for delirium. Cochrane Database Syst Rev 2:CD005594PubMed
48.
Zurück zum Zitat Han CS, Kim YK (2004) A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics 45(4):297–301CrossRefPubMed Han CS, Kim YK (2004) A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics 45(4):297–301CrossRefPubMed
49.
Zurück zum Zitat Hu HDW, Yang H (2004) A prospective random control study comparison of olanzapine and haloperidol in senile delirium. Chongging Med J 8:1234–1237 Hu HDW, Yang H (2004) A prospective random control study comparison of olanzapine and haloperidol in senile delirium. Chongging Med J 8:1234–1237
50.
Zurück zum Zitat Skrobik YK1, Bergeron N, Dumont M, Gottfried SB (2004) Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med 30(3):444–449CrossRefPubMed Skrobik YK1, Bergeron N, Dumont M, Gottfried SB (2004) Olanzapine vs haloperidol: treating delirium in a critical care setting. Intensive Care Med 30(3):444–449CrossRefPubMed
51.
Zurück zum Zitat Tahir TA et al (2010) A randomized controlled trial of quetiapine versus placebo in the treatment of delirium. J Psychosom Res 69(5):485–490CrossRefPubMed Tahir TA et al (2010) A randomized controlled trial of quetiapine versus placebo in the treatment of delirium. J Psychosom Res 69(5):485–490CrossRefPubMed
52.
Zurück zum Zitat Devlin JW et al (2010) Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med 38(2):419–427CrossRefPubMed Devlin JW et al (2010) Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med 38(2):419–427CrossRefPubMed
53.
Zurück zum Zitat Maneeton B et al (2013) Quetiapine versus haloperidol in the treatment of delirium: a double-blind, randomized, controlled trial. Drug Des Devel Ther 7:657–667CrossRefPubMedPubMedCentral Maneeton B et al (2013) Quetiapine versus haloperidol in the treatment of delirium: a double-blind, randomized, controlled trial. Drug Des Devel Ther 7:657–667CrossRefPubMedPubMedCentral
54.
Zurück zum Zitat Tanimukai H et al (2014) Novel therapeutic strategies for delirium in patients with cancer: a preliminary study. Am J Hosp Palliat Care. doi:10.1177/1049909II4565019. (Epub ahead of print)PubMed Tanimukai H et al (2014) Novel therapeutic strategies for delirium in patients with cancer: a preliminary study. Am J Hosp Palliat Care. doi:10.1177/1049909II4565019. (Epub ahead of print)PubMed
55.
Zurück zum Zitat Kirino E (2015) Use of aripiprazole for delirium in the elderly: a short review. Psychogeriatrics 15(1):75–84CrossRefPubMed Kirino E (2015) Use of aripiprazole for delirium in the elderly: a short review. Psychogeriatrics 15(1):75–84CrossRefPubMed
56.
Zurück zum Zitat Hale GM et al (2015) An evaluation of adverse drug reactions associated with Antipsychotic use for the treatment of delirium in the intensive care unit. J Pharm Pract. doi:10.1177/0897190014566313. (Epub ahead of print)PubMed Hale GM et al (2015) An evaluation of adverse drug reactions associated with Antipsychotic use for the treatment of delirium in the intensive care unit. J Pharm Pract. doi:10.1177/0897190014566313. (Epub ahead of print)PubMed
57.
Zurück zum Zitat Lonergan E et al (2009) Benzodiazepines for delirium. Cochrane Database Syst Rev 1:CD006379PubMed Lonergan E et al (2009) Benzodiazepines for delirium. Cochrane Database Syst Rev 1:CD006379PubMed
Metadaten
Titel
Das nichtentzugsbedingte Delir
Evidenz zu Prävention und Therapie
verfasst von
Dr. R. Haussmann
M. Bauer
M. Donix
Publikationsdatum
01.12.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Der Nervenarzt / Ausgabe 5/2016
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI
https://doi.org/10.1007/s00115-015-0027-3

Weitere Artikel der Ausgabe 5/2016

Der Nervenarzt 5/2016 Zur Ausgabe

Mitteilungen der DGPPN

Mitteilungen der DGPPN 5/2016

Neu in den Fachgebieten Neurologie und Psychiatrie