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Delirium

Sist revidert:
Sist revidert av:

Definisjon:
Et syndrom karakterisert ved forstyrrelser av bevissthet, oppmerksomhet og kognisjon, med brå start, fluktuerende forløp, og utløst av en akutt medisinsk tilstand
Forekomst:
En hyppig komplikasjon til somatisk sykdom hos eldre med generelt svekka helsetilstand og blant kritisk syke i sykehus
Symptomer:
Det skilles mellom hyperaktiv, hypoaktiv og et blandet symptommønster
Funn:
Endringer i kognisjon, humør, persepsjon, aktivitetsnivå
Diagnostikk:
Tilleggsundersøkelser har som formål å identifisere underliggende sykdom
Behandling:
Det viktigste tiltaket er å forsøke å identifisere og ev. korrigere utløsende faktorer
  1. Breitbart W, Yesne A. Agitation and delirium at the end of life. JAMA 2008; 300: 2898-2910. Journal of the American Medical Association  
  2. Pisani M. Assessment of delirium. BMJ Best Practice, last updated 15 Dec, 2021.
  3. Helsedirektoratet. Nasjonalt handlingsprogram for palliasjon i kreftomsorgen. Sist faglig oppdatert: 14. oktober 2019. www.helsebiblioteket.no  
  4. van den Boogaard M, Schoonhoven L, Evers AW, et al. Delirium in critically ill patients: impact on long-term health-related quality of life and cognitive functioning. Crit Care Med. 2012;40:112-118. PubMed  
  5. Neufeld KJ, Thomas C. Delirium: definition, epidemiology, and diagnosis. J Clin Neurophysiol. 2013;30:438-442. PubMed  
  6. Marcantonio ER. Delirium in Hospitalized Older Adults. N Engl J Med 2017; 377: 1456-66. pmid:29020579 PubMed  
  7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.
  8. Duppils GS, Wikblad K. Patients’ experiences of being delirious. J Clin Nurs 2007; 16: 810 – 8. PMID: 17462032 PubMed  
  9. Tieges Z, Maclullich AMJ, Anand A, et al. Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis published online ahead of print, 2020 Nov 11. Age Ageing. 2020;afaa224. Pmid: 33196813 PubMed  
  10. 4AT – Rapid assement test for Delirium. Siden besøkt 12.02.2021 www.the4at.com  
  11. Evensen S, Forr T, Al-Fattal A, et al. Nytt verktøy for å oppdage delirium og kognitiv svikt. Tidsskr Nor Legeforen 2016; 136: 299-300. doi:10.4045/tidsskr.15.1334 DOI  
  12. Helsedirektoratet. Nasjonale faglige råd. Delirium. Psykiske lidelser hos eldre.Oslo; mai, 2019. Siden besøkt 27.09.2021 www.helsedirektoratet.no  
  13. Oh ES, Fong TG, Hshieh TT, et al. Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA. 2017 Sep 26;318(12):1161-74. PMID: 28973626 PubMed  
  14. Siddiqi N, Harrison JK, Clegg A, Teale EA, Young J, Taylor J, Simpkins SA. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD005563. DOI: 10.1002/14651858.CD005563.pub3. DOI  
  15. Neerland BE, Watne LO, Wyller TB. Delirium hos eldre pasienter. Tidsskr Nor Legeforen 2013; 133: 1596-600. doi:10.4045/tidsskr.12.1327 DOI  
  16. Neufeld KJ, Yue J, Robinson TN, et al. Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis. J Am Geriatr Soc 2016. doi:10.1111/jgs.14076 DOI  
  17. Burry L, Mehta S, Perreault MM et al. Antipsychotics for treatment of delirium in hospitalised non-ICU patients. Cochrane Database of Systematic Reviews 2018, Issue 6. Art. No.: CD005594. DOI: 10.1002/14651858.CD005594.pub3 DOI  
  18. Nikooie R, Neufeld KJ, Oh ES, et al. Antipsychotics for Treating Delirium in Hospitalized Adults: A Systematic Review. Ann Intern Med 2019. pmid:31476770 PubMed  
  19. Dalseg R, Skui H. Ad forespørsel om fortolkning av pasientrettighetsloven kapittel 4 A - psykotisk pasient med somatisk lidelse. Brev fra Helsedirektoratet 25.03.2009 helsedirektoratet.no  
  20. Hui D, Frisbee-Hume S, Wilson A, et al. Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care A Randomized Clinical Trial. JAMA 2017; 318: 1047-56. doi:10.1001/jama.2017.11468 DOI  
  21. Agar MR, et al. Efficacy of oral risperidone, haloperidol, or placebo for symptoms of delirium among patients in palliative care: A randomized clinical trial. JAMA Intern Med 2016. pmid:27918778 PubMed  
  22. Pandharipande P, Shintani A, Peterson J et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 2006; 104: 21 – 6. PMID: 16394685 PubMed  
  23. Lonergan E, Luxenberg J, Areosa Sastre A. Benzodiazepines for delirium. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006379. DOI: 10.1002/14651858.CD006379.pub3. The Cochrane Library  
  24. Al-Aama T, Brymer C, Gutmanis I et al. Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial. Int J Geriatr Psychiatry 2011; 26: 687 – 94. PMID: 20845391 PubMed  
  25. Maldonado JR, Wysong A, van der Starre PJ et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics 2009; 50: 206 – 17. PMID: 19567759 PubMed  
  26. Chen K, Lu Z, Xin YC, Cai Y, Chen Y, Pan SM. Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD010269. DOI: 10.1002/14651858.CD010269.pub2. DOI  
  27. Burry L, Hutton B, Williamson DR, et al. Pharmacological interventions for the treatment of delirium in critically ill adults. Cochrane Database Syst Rev. 2019 Sep 3;9:CD011749. doi: 10.1002/14651858.CD011749.pub2. DOI  
  28. Hshieh TT, Yue J, Oh E et al. Effectiveness of multicomponent nonpharmacological delirium interventions: a meta-analysis. JAMA Intern Med. 2015 Apr;175(4):512-20. Erratum in: JAMA Intern Med. 2015 Apr;175(4):659. PMID: 25643002 PubMed  
  29. Herling S, Greve IE, Vasilevskis EE et al. Interventions for preventing intensive care unit delirium in adults. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD009783. DOI: 10.1002/14651858.CD009783.pub2 DOI  
  30. Oh ES, Needham DM, Nikooie R, et al. Antipsychotics for Preventing Delirium in Hospitalized Adults: A Systematic Review. Ann Intern Med 2019. pmid:31476766 PubMed  
  31. O'Mahony R, Murthy L, Akunne A, et al. Synopsis of the National Institute for Health and Clinical Excellence guideline for prevention of delirium. Ann Intern Med 2011; 154: 746-51. Annals of Internal Medicine  
  32. Zenilman ME. Delirium An Important Postoperative Complication. JAMA 2017; 317(1): 77-78. pmid:28030685 PubMed  
  33. Fjerstad E, Lang N. . «Dantes Inferno» – psykologisk førstehjelp ved postoperativt delirium. Tidsskr Nor Legeforen 2013; 133: 1084-6. doi:10.4045/tidsskr.13.0202 DOI  
  34. Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia. JAMA 2010; 304: 443-51. PMID: 20664045 PubMed  
  • Silje Barlindhaug, spesialist i allmennmedisin, redaktør NEL