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The dataset generation failed because of a cast error
Error code: DatasetGenerationCastError
Exception: DatasetGenerationCastError
Message: An error occurred while generating the dataset
All the data files must have the same columns, but at some point there are 1 new columns ({'Korean Paragraph'}) and 1 missing columns ({'English Paragraph'}).
This happened while the csv dataset builder was generating data using
hf://datasets/gykwak03/KISS_delirium_papaers/ko_data.csv (at revision e88901ea314d4b2a890cdfd68da5c5c864d38f60)
Please either edit the data files to have matching columns, or separate them into different configurations (see docs at https://hf.co/docs/hub/datasets-manual-configuration#multiple-configurations)
Traceback: Traceback (most recent call last):
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 2011, in _prepare_split_single
writer.write_table(table)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/arrow_writer.py", line 585, in write_table
pa_table = table_cast(pa_table, self._schema)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2302, in table_cast
return cast_table_to_schema(table, schema)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/table.py", line 2256, in cast_table_to_schema
raise CastError(
datasets.table.CastError: Couldn't cast
Title: string
Korean Paragraph: string
-- schema metadata --
pandas: '{"index_columns": [{"kind": "range", "name": null, "start": 0, "' + 503
to
{'Title': Value(dtype='string', id=None), 'English Paragraph': Value(dtype='string', id=None)}
because column names don't match
During handling of the above exception, another exception occurred:
Traceback (most recent call last):
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 1532, in compute_config_parquet_and_info_response
parquet_operations = convert_to_parquet(builder)
File "/src/services/worker/src/worker/job_runners/config/parquet_and_info.py", line 1155, in convert_to_parquet
builder.download_and_prepare(
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1027, in download_and_prepare
self._download_and_prepare(
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1122, in _download_and_prepare
self._prepare_split(split_generator, **prepare_split_kwargs)
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 1882, in _prepare_split
for job_id, done, content in self._prepare_split_single(
File "/src/services/worker/.venv/lib/python3.9/site-packages/datasets/builder.py", line 2013, in _prepare_split_single
raise DatasetGenerationCastError.from_cast_error(
datasets.exceptions.DatasetGenerationCastError: An error occurred while generating the dataset
All the data files must have the same columns, but at some point there are 1 new columns ({'Korean Paragraph'}) and 1 missing columns ({'English Paragraph'}).
This happened while the csv dataset builder was generating data using
hf://datasets/gykwak03/KISS_delirium_papaers/ko_data.csv (at revision e88901ea314d4b2a890cdfd68da5c5c864d38f60)
Please either edit the data files to have matching columns, or separate them into different configurations (see docs at https://hf.co/docs/hub/datasets-manual-configuration#multiple-configurations)Need help to make the dataset viewer work? Make sure to review how to configure the dataset viewer, and open a discussion for direct support.
Title
string | English Paragraph
string |
|---|---|
응급실 노인환자의 섬망 유발에 대한 위험인자 조사 | Purpose: Delirium is a common and worrisome problem among elder hospitalized patients. Many studies have sought to evaluate the risk factors of delirium. Most of these studies have dealt with the intensive care unit, with virtually nothing known about the emergency room. Our study was designated to evaluate the risk factors in an emergency department. Methods: We retrospectively reviewed 414 cases of elder patients admitted to the general ward of internal medicine via the emergency room between January 2009 and December 2009. We divided these patients into a delirium group and non-delirium group. We statistically evaluated 31 known risk factors of delirium in these two groups. Results: Using chi-square test, 14 of 31 known risk factors of delirium were proven as risk factors of delirium in an emergency room. Using logistic regression, three of the 14 proven risk factors were revealed as prior factors. Conclusion: A variety of factors of delirium are risk factors of delirium in an emergency room. A few important known risk factors are failed to pass statistically evaluation. These results are influenced by cultural pecularities of South Korea. Also, the small sample size limited conclusive evaluation. Nonetheless, the importance of patients` past medical history, laboratory results, and choice of medication when treating elder hospitalized patients to prevent delirium is likely important in reducing mortality and morbidity. |
진전섬망 환자에 대한 임상적 고찰 | Purpose: We performed this study to identify the clinical characteristics of delirium tremens in Korea. Methods: We reviewed the charts of patients suffering from delirium tremens who visited the Emergency Department of Keimyung University Hospital during |
소아중환자실 간호사를 위한 다면적 소아 섬망 교육프로그램이 섬망 지식, 섬망 간호에 대한 자신감, 섬망 사정 정확도에 미치는 효과: 단일군 전후설계 | Purpose : This study aimed to identify the effects of a multifaceted pediatric delirium education program for pediatric intensive care unit (PICU) nurses on their delirium knowledge, confidence in delirium nursing, and delirium evaluation accuracy. Methods : This study used a one-group pretest-posttest design. The participants were 50 nurses in two units of the PICU at S General Hospital in Seoul. All participants took a 1-hour lecture with case-based practice for the first two weeks, and received feedback as they applied the program to clinical practice over the next two weeks. Test measures were completed before and after the four week intervention period for all participants. The delirium evaluation accuracy was measured using the Korean version of the Cornell Assessment of Pediatric Delirium. Data were analyzed using the chi-square and paired t-tests. Results : After the Pediatric Delirium Education Program, nurses' delirium knowledge (x2=11.65, p =.001), confidence in delirium nursing (t=9.71, p<.001), and delirium evaluation accuracy (t=6.07, p<.001) improved significantly. Conclusions : Pediatric delirium education programs for PICU nurses were effective. For active application of the program in clinical practice in the future, various cases of childhood delirium and specific strategies for each subject must be developed. To achieve this, long-term intervention and research for multiple organizations are required. |
일 종합병원 중환자실의 섬망 발생 및 중재 현황과 의료진의 섬망 인식 조사 | Purpose : This study aims to investigate the status of delirium intervention in adult intensive care unit (ICU) patients and the perception of this delirium by medical staff. Methods : This retrospective study involves 185 patients, whereas, a descriptive survey is conducted with 197 medical staff members. Results : The delirium group includes 100 patients (54.1%). The incidence of delirium is 64.9% in the medical ICU, 65.9% in the surgical ICU, 42.4% in the neuro ICU, and 46.5% in the cardiac ICU. The percentages of delirium prevention intervention differs between the two groups: 65.0% in the delirium group and 95.3% in the non-delirium group. The medical staff recognize that delirium is a common problem in the ICU (100.0%) and requires active medical intervention (98.5%). Conclusion : The length of stay at the ICU is longer in the delirium group than in the non-delirium group. It is necessary to standardize delirium prevention and treatment protocols to be equally applicable to all ICU patients. |
한국형 성인 환자 섬망 선별 도구 개발 | Purpose: The purpose of this study was to develop a Korean Adult Patients Delirium Screening Tool (K-APDS) for those admitted to general wards, and to verify its reliability and validity. Methods: For the development of the tool, 12 items were derived through the results of literature review and focus group interviews with general ward nurses, and the content validity was confirmed by experts. To verify the reliability and validity of the developed tool, 317 adult patients who were admitted to general wards of three tertiary general hospitals from October to November 2022 were evaluated by the attending nurse and data were collected. Results: After factor analysis for construct validity verification, two factors were extracted, which explained 60.1% of the total variance. After the validation of the control group, the difference in the delirium incidence scores calculated using the K-APDS between the delirium group and non-delirium group was very significant (Z=-10.82, p<.001). To verify the criterion validity, K-APDS, Delirium Observation Screening, and Pearson's correlation coefficient were checked and found to be .94 (p<.001). The predictive validity test reported that the sensitivity was 91.1%, specificity was 82.4%, positive predictive value was 52.6%, and negative predictive value was 97.8%. The reliability of K-APDS was found to be high with Cronbach’s α=.91. Conclusion: K-APDS can screen for delirium with 2 or more points, excellent validity and reliability have been verified. Therefore, this tool could be applied immediately in the clinical field, and will contribute to the early detection of delirium, enabling rapid interventions. |
급성기 병원 간호사를 위한 섬망 교육 프로그램의 효과: 체계적 문헌고찰 및 메타분석 | Purpose: This study aimed to review the effectiveness of delirium education programs for nurses in acute hospitals. Methods: The inclusion criteria were studies on delirium education programs for nurses published in English and Korean from 2012 to 2022. A literature search was conducted in the RISS, KISS, DBpia, PubMed, CINAHL, PsycINFO, and Web of Science databases using the key words of "delirium", "nurse", and "education". Qualitative appraisal of studies was conducted using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool translated by National Evidence-based Healthcare Collaborating Agency (NECA). For meta-analysis, the effect size of the intervention was calculated as standardized mean difference. Results: Eighteen studies were selected for the systematic review. While the contents of the education programs were similar, the teaching methods were different. Interventions implemented included traditional learning, e-learning, and blended learning. Teaching methods of delirium education programs for nurses included lecture, discussion, practice, simulation, role-play, and coaching. The systematic review found that delirium education programs for nurses effectively increased post-intervention outcomes in 17 studies. Delirium education programs for nurses have benefits regarding delirium knowledge and performance. In four studies, delirium education program interventions improved delirium nursing performance (95% CI: 0.48~2.44, p=.003). Conclusion: These results demonstrate the need for a standardized delirium education program. It is recommended that further studies evaluating the patient outcome effects of delirium education programs should be conducted. |
전신마취 수술 후 노인 환자의 회복실 섬망 발생 및 위험요인 | Purpose: This study is a prospective observational study that analyzes the factors affecting and the incidence of postoperative delirium in elderly patients under general anesthesia. Methods: The study enrolled 193 elderly patients who entered the recovery room after surgery under general anesthesia in a certified tertiary hospital. Data were measured twice-first, before surgery and, second, 30 minutes after the patient entered the recovery room-using the Korean Nursing Delirium Screening Scale. The data were analyzed using χ2 tests, the independent t-test, and logistic regression from SPSS 22.0. Results: The incidence of delirium in elderly patients after surgery under general anesthesia was 13.0% (25 of 193 patients). The incidence of delirium was a significant in the following cases: elderly patient, patients who performed physical activity with assistance at pre-operation, those with lower body mass index, those with lower body weight, those with long operative times, and those with high preoperative pain scores. The occurrence of delirium was 16.57 times higher in the presence of comorbidities, 5.74 times higher when hospitalization occurred through the emergency room, and 3.99 times higher when the number of catheters was high. Conclusion: Screening for early delirium in the recovery room is important, and it can provide basic data for early nursing intervention in patients suffering from postoperative delirium. |
외과계 병동 노인 수술 환자의 섬망 발생률과 위험요인 | Purpose: This retrospective chart review study was conducted to examine the frequency of delirium and to identify the risk factors of delirium in elderly surgical patients. Methods: The subjects of this study were 394 patients aged 65 years or older who underwent surgery. The diagnosis of delirium was based on the nursing assessment records with scores from the day of surgery to the 4th day after surgery. The collected data were analyzed by binary logistic regression analysis. Results: The incidence of delirium was 4.3%, and delirium occurred most frequently on the first day of surgery and lasted for 2.16 days on average. Of delirium patients, 76.5% underwent gastrointestinal surgery, and the most common delirium pattern was disorientation. In terms of the characteristics of the subjects, the occurrence of delirium was statistically different by age (x2=10.79, p=.005), systemic-specific disease (x2=9.63, p=.047), use of delirium-inducing drug(benzodiazepine) before surgery (x2=15.90, p<.001), walking ability before surgery (x2=7.65, p=.006), history of delirium (x2=35.92, p<.001), and emergency surgery (x2=16.40, p<.001). As risk factors of delirium, gastrointestinal surgery was found to increase the risk of delirium by 12.57 times (95% CI=2.45~64.46, p=.002), and the use of benzodiazepines before surgery was shown to increase delirium by 10.07 times (95% CI=2.21~45.87, p=.003). Conclusion: It is necessary for nurses to actively evaluate delirium using screening tools for early detection and prevention of delirium in elderly surgical patients with delirium risk factors. |
일 상급종합병원 병동간호사의 수술 후 섬망 사례를 이용한 섬망 선별과 섬망 지식 및 섬망 간호 | Purpose: The purpose of this study was to investigate hospital nurses’ delirium screening for postoperative delirium, delirium knowledge, and delirium care using case scenarios at a tertiary hospital in Seoul. Methods: A total of 235 nurses working at surgical units participated in this questionnaire-based study. Five cases scenarios were developed based on diagnosed postoperative delirium cases. Data were collected from April 1 to May 1, 2021. Results: The delirium screening score was 4.20±1.17 out of 5. The delirium knowledge score was 34.35±4.57 out of 47. The delirium care score was 67.61±9.26 out of 92. The correlation between the delirium screening and delirium knowledge was statistically significant (r=.18, p=.005). The correlation between the delirium knowledge and delirium care was statistically significant (r=.25, p<.001). Conclusion: The findings showed that the continuing educations of delirium for hospital nurses and the development of a delirium education programs were important to improve delirium screening and care. |
간호이론 기반 입원 환자의 섬망 연구에 대한 체계적 문헌고찰 | Purpose: This systematic review aimed to synthesize nursing theory-based delirium studies. Methods: Six electronic databases were searched via combinations of the key terms “delirium”, “nursing theory”, “hospital”, and “patient”. In total, 338 articles were found, and 87 duplicates were removed. Three independent reviewers screened and read the remaining articles and selected 12 articles. Characteristics of the included studies and theory application related information were extracted. Keywords of the studies were classified and analyzed based on the nursing meta-paradigm. Results: Studies on delirium utilized various theories that included grand (n=4), middle-range (n=4), and situation specific theories (n=4). Regarding theory application, eight studies used nursing theory as a conceptual framework, three studies developed new nursing theories on delirium, and one evaluated an existing theory. In three studies out of four RCTs (Randomized controlled trials), theory-based delirium interventions proved effective in reducing the incidence, duration, and severity of delirium. Nursing theories also helped explain nurses’ clinical reasoning and caregiver engagement in delirium. Keyword analysis results showed that elderly and intensive care unit patients are high risk groups. Conclusion: Nursing theories could be applied to various study designs; however, the number of nursing theory-based literature is limited. Further application in practice, research, and education should be promoted continuously. |
중환자실 환자의 섬망 경험 | Purpose: The study aimed to understand the delirium experience of intensive care unit (ICU) patients. Methods: We performed a qualitative study using Colaizzi's phenomenological method. Eleven patients, who experienced delirium according to the Confusion Assessment Method for ICU, participated after transferring to general wards from the ICU. Individual in-depth semi-structured interviews ranging from 30 minutes to 2 hours in length were conducted between November 2018 and August 2019. Results: Nine themes and four theme clusters emerged. The four theme clusters were: 1) 'Overwhelmed by fear,' which describes the experience of a patient close to death and the feeling of difficulty in understanding disorganized thinking; 2) 'Anxious about not understanding the situation,' which means that patients' sense of time and space were disordered in the ICU; 3) 'Being deserted,' which indicates the feeling of being separated from others and yourself; and 4) 'Resistance to protect my dignity,' which indicates that the dignity and autonomy of an individual in the patient's position at the ICU, are ignored. Conclusion: Nursing interventions are needed that would enable patients to maintain orientation and self-esteem in the ICU. In addition, healthcare providers need to provide information about the unfamiliar environment in the ICU in advance. |
국내 중환자실 섬망 예방 중재에 관한 체계적 고찰 및 메타분석 | Purpose : This study aimed to systematically review the preventive interventions for delirium in Korean intensive care unit (ICU) patients and evaluate their efficacy. Methods : For this systematic review and meta-analysis, we searched the literature and selected studies from data sources that included the RISS, KISS, National Central Library, National Assembly Library, DBpia, Science on, MEDLINE, and Cochrane Library. We used Cochrane's revised tool for risk of bias in randomized trials and non-randomized studies of intervention tools to assess the quality of the selected studies. The effect size of the intervention was calculated as odds ratio (OR) and standardized mean difference (SMD). Results : Preventive interventions reported in 23 studies with a total of 4,799 ICU patients were effective in reducing the occurrence of delirium (OR=0.64, 95% CI : 0.49~0.91, p=.011), but not the duration (SMD=-0.22, 95% CI : -0.51~0.08, p=.148). As a result of a subgroup analysis, non-pharmacological interventions were effective in reducing the occurrence of delirium (OR=0.66, 95% CI : 0.47~0.94, p=.020), while pharmacological interventions had no effect (OR=0.68, 95% CI : 0.33~1.40, p=.295). Among the non-pharmacological interventions, multi-component intervention had the largest effect size (OR=0.38, 95% CI : 0.26~0.55, p<.001). Conclusion : Non-pharmacological interventions were effective in reducing the occurrence of delirium. We recommend the development and application of multi-component interventions to prevent delirium in the Korean ICU patients. |
일 종합병원 외과 중환자실 환자의 섬망 아형별 관련 요인 | Purpose: The purpose of this study was to investigate the motor subtypes of delirium in patients in a Surgical Intensive Care Unit (SICU), and identify the factors related to the characteristics of patients according to the motor subtypes of delirium. Methods: Data were collected in the SICU of a tertiary hospital in * city from October 2018 to June 2019. Delirium was detected using the Confusion Assessment Method for the ICU (CAM-ICU) and motor subtypes of delirium were measured with the Delirium Motor Subtype Scale (DMSS)-4. Patients’ characteristics were obtained by using the electronic medical records. Descriptive statistics were used to analyze the data. Results: Among 1,112 patients, 172 patients showed delirium (15.5%). After excluding dementia patients and patients refusing to participate in the study, 126 patients included in the final analysis. Delirium patients were classified as hyperactive delirium (32.5%), hypoactive delirium (42.9%), mixed delirium (11.9%), and non-motor subtype delirium (12.7%). Conclusion: The study results suggest that hypoactive delirium is the most prevalent motor subtype of delirium in SICU. More application of ventilators, more administration of sedatives, more use of catheters, and higher nursing severity were reported for hypoactive delirium cases than hyperactive ones. Therefore, it is necessary to assess early the motor subtypes of delirium using structured tools and develop appropriate nursing interventions suitable for each subtype of delirium. |
수술 전 동영상 교육이 전신마취수술 노인환자의 섬망과 불안에 미치는 효과 | Purpose: This study aimed to verify the effects of preoperative video education on delirium and anxiety in elderly patients with general anesthesia. Methods: This study used quasi-experimental research with a non-equivalent control group non-synchronized design. Participants were 70 elderly patients who had undergone of surgery under general anesthesia (35 in the experimental group and 35 in the control group). Preoperative video education was given to the experimental group. Subjective anxiety, blood pressure, pulse and delirium were measured. Data were analyzed using descriptive statistics, test of homogeneity in pretest, independent t-tests, and two-way repeated measures ANOVA with the SPSS/Win 22.0 program. Results: Delirium of the experimental group was significantly lower than that of the control group. Subjective anxiety measured using visual analogue scale was not significantly different between the two groups. However, there was a significant difference in the interaction between the group and time. There was no significant difference in physiological anxiety measured using systolic blood pressure, diastolic blood pressure and pulse between the two groups. Conclusion: The findings suggest that preoperative video education may contribute to reducing delirium and subjective anxiety for elderly patients after surgery. |
한국어판 Cornell Assessment of Pediatric Delirium 소아 섬망 사정 도구의 검증 | Purpose: This study was to examine the reliability and validity of the Korean version of the Cornell Assessment of Pediatric Delirium (CAPD). Methods: For testing the reliability of the Korean version of the CAPD, this study calculated the internal consistency (Cronbach's α) and the Interrater Correlation Coefficient (ICC) by comparing the independent assessment results of three nurses in Pediatric Intensive Care Unit (PICU). For testing the validity of the Korean version of the CAPD, the assessment result of the Korean version of the CAPD compared with that of the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V). Receiver Operating Characteristics (ROC) analysis was used for measuring sensitivity and specificity. Results: Overall interrater reliability of the Korean version of the CAPD, ICC was .98 (95% CI .96~.99). Cronbach's α was .91 for eight items. The concordance between the Korean version of the CAPD and psychiatrist’s diagnosis was 90.0%. When the Korean version of the CAPD has the cut point of 9, sensitivity was 93.8%, and specificity was 75.0%. The area under the curve indicated by the ROC analysis was .88. Conclusion: The Korean version of the CAPD showed good reliability and validity. This tool will be useful for pediatric delirium screening and management in Korean PICU. |
간호사의 섬망간호 수행에 영향을 미치는 요인 | Purpose : The aim of this study was to identify the factors influencing nursing performance in caring for patients with delirium. Methods: This study included 166 nurses who worked for more than 6 months at 4 general hospitals in Jeju Province, South Korea. Patients were administered a self-reported questionnaire. The study was carried out from May 20, 2014, to June 19, 2014. Data analyses were conducted using stepwise multiple regression, Pearson's correlation coefficients, t-test, and analysis of variance using the SAS WIN 9.2 program (SAS Institute, Cary, NC, USA). Results: The factors associated with nurses' performance in delirium care were work position (${\beta}=.22$, t=2.58, p <.001) and having received education on delirium care (${\beta}=.16$, t=2.24, p=.026). Conclusion: The results showed that the nurses' work position and having received education on delirium care affected nursing performance in delirium care. In order to improve nurses' performance in delirium care, hospitals should provide a delirium education program for nurses and establish standard guidelines on delirium care. |
섬망이 중환자실 환자결과에 미치는 영향: 경로 분석 | Purpose: This study was conducted to investigate relationship between delirium, risk factors on delirium, and patient prognosis based on Donabedian's structure-process-outcome model. Methods: This study utilized a path analysis design. We extracted data from the electronic medical records containing delirium screening data. Each five hundred data in a delirium and a non-delirium group were randomly selected from electronic medical records of medical and surgical intensive care patients. Data were analyzed using SPSS 20 and AMOS 24. Results: In the final model, admission via emergency department (Β=.06, p=.019), age over 65 years (Β=.11, p=.001), unconsciousness (Β=.18, p=.001), dependent activities (Β=.12, p=.001), abnormal vital signs (Β=.12, p=.001), pressure ulcer risk (Β=.12, p=.001), enteral nutrition (Β=.12, p=.001), and use of restraint (Β=.30, p=.001) directly affecting delirium accounted for 56.0% of delirium cases. Delirium had a direct effect on hospital mortality (Β=.06, p=.038), hospital length of stay (Β=5.06, p=.010), and discharge to another facility (not home) (Β=.12, p=.001), also risk factors on delirium indirectly affected patient prognosis through delirium. Conclusion: The use of interventions to reduce delirium may improve patient prognosis. To improve the dependency activities and risk of pressure ulcers that directly affect delirium, early ambulation is encouraged, and treatment and nursing interventions to remove the ventilator and drainage tube quickly must be provided to minimize the application of restraint. Further, delirium can be prevented and patient prognosis improved through continuous intervention to stimulate cognitive awareness and monitoring of the onset of delirium. This study also discussed the effects of delirium intervention on the prognosis of patients with delirium and future research in this area. |
중환자실 노인 환자에서 주관적 · 객관적 섬망 평가의 불일치에 영향을 미치는 요인: 환자와 간호사 특성과 섬망지식 | Purpose: The purpose of this study was to identify the rate of discrepancy between nurses’ subjective and objective assessment of delirium in elderly patients in intensive care units (ICUs) and to explore factors influencing the discrepancy. Methods: Using a survey design, a total of 91 elderly patients and 47 nurses were recruited from three ICUs in C Hospital. While ICU nurses subjectively assessed prevalence of delirium in their patients, the researcher used the Confusion Assessment Method in the ICU (CAM-ICU) tool at the same time. Medical records were reviewed for participants’ demographic and disease-related characteristics. The nurses’ level of knowledge about delirium assessment was examined. Results: Twenty-seven percent of patients had delirium according to CAM-ICU assessment and the discrepancy rate between CAM-ICU and subjective assessments was 18.7% (x2=21.648, p<.001): 2.2% for false positives, and 16.5% for false negatives. Patient factors influencing the discrepancy between delirium assessment methods were using restraints, as well as lower Glasgow Coma Scale (GCS) scores and Richmond Agitation and Sedation Scale (RASS) scores, while a nurse factor was shorter length of time working in an ICU. Conclusion: The discrepancy rate was 18.7% with 16.5% for false negatives. An education program is necessary for nurses to improve their knowledge of symptom assessment for delirium and to receive training in the use of objective tools for delirium assessment. |
일 종합병원 외과계 중환자실 환자의 섬망 발생 요인 | Purpose : This study examined the prevalence of delirium-related factors in a surgical intensive care unit (SICU). Methods : This retrospective study enrolled 73 patients who were admitted to an SICU from October 1, 2016 to March 20, 2017 and who had been hospitalized for more than 72 hours. Data was collected by reviewing electronic medical records. Results : Delirium occurred in 46 (63.0%) patients. Its related factors were age, education, mechanical ventilator, sleep, narcotics, physical restraint, and central line catheters. Conclusion : The results indicate that sleep and physical restraint are significant factors related to delirium occurrence. The results of this study can help in developing guidelines for the prevention of delirium. |
중환자 섬망 선별도구 개발 | Purpose: This study was done to develop of the Korean intensive care delirium screening tool (KICDST). Methods: The KICDST was developed in 5 steps: Configuration of conceptual frame, development of preliminary tool, pilot study, reliability and validity test, development of final KICDST. Reliability tests were done using degree of agreement between evaluators and internal consistency. For validity tests, CVI (Content Validity Index), ROC (Receiver Operating Characteristics) analysis, known group technique and factor analysis were used. Results: In the reliability test, the degree of agreement between evaluators showed .80~1.00 and the internal consistency was KR-20=.84. The CVI was .83~1.00. In ROC analysis, the AUC (Area Under the ROC Curve) was .98. Assessment score was 4 points. The values for sensitivity, specificity, correct classification rate, positive predictive value, and negative predictive value were found to be 95.0%, 93.7%, 94.4%, 95.0% and 93.7%, respectively. In the known group technique, the average delirium screening tool score of the non-delirium group was $1.25{\pm}0.99$ while that of delirium group was $5.07{\pm}1.89$ (t= - 16.33, p <.001). The factors were classified into 3 factors (cognitive change, symptom fluctuation, psychomotor retardation), which explained 67.4% of total variance. Conclusion: Findings show that the KICDST has high sensitivity and specificity. Therefore, this screening tool is recommended for early identification of delirium in intensive care patients. |
노인환자의 수술 후 섬망에 대한 회복실 간호사의 간호수행과 영향요인 | Purpose: The purpose of this study was to identify factors associated with performance of nursing care for postoperative delirium of elderly patients among recovery room nurses. Methods: The research was a cross-sectional, descriptive design using questionnaires. The participants were 99 nurses from five urban recovery rooms. Data were analyzed using descriptive statistics, t-test, ANOVA and multiple regression with SPSS WIN 21.0. Results: The performance level of delirium nursing care was low because its mean score was 3.80 out of 5. Performance of nursing care was significantly positively correlated with the importance of nursing care and self-efficacy. Stepwise multiple regression analysis for performance of nursing care revealed that the most powerful predictor was the importance of nursing care. The importance of nursing care and self-efficacy explained 32.3% of the variance. Conclusion: The results indicate a need to enhance the performance of nursing care for postoperative delirium of elderly patients among recovery room nurses. The findings also suggest that consideration be given to strategies for improving the importance of nursing care and self-efficacy in developing programs to enhance the performance level of nursing care for elderly patients with postoperative delirium. |
섬망사정도구를 사용하는 중환자실 간호사의 섬망인식, 섬망사정의 장애요인 및 섬망사정 수행의 중요도 | Purpose: This study was conducted to identify the perception, barriers, and importance of delirium assessment of intensive care unit nurses utilizing a tool for delirium assessment. Methods: The subjects were 150 intensive care unit nurses who routinely use the CAM-ICU to screen delirium. Data were collected using self-report questionnaires and analyzed using descriptive statistics and ranking. Results: Most intensive care unit nurses had experience of education about delirium and delirium assessment, and had assessed over once in a shift. However, a small number of nurses recognized utilizing their assessment result and the effect on higher mortality and underdiagnosed and preventable problem. The first rank of barriers was being too busy to assess patients and the second was difficulty of interpreting intubated patients. The importance of delirium assessment was considered lower than assessing catheter placement and level of pain. Conclusion: The study identified intensive care unit nurses' use of a delirium assessment tool, and the perception, barriers, and importance of delirium assessment. Furthermore, it is necessary to develop education programs to improve the early recognition of delirium by intensive care unit nurses. |
중환자실 환자의 통증, 진정 및 섬망 관리 | Pain, agitation and delirium (PAD) occur frequently in mechanically ventilated patients in the intensive care unit (ICU). Consequently, analgesics and sedatives are frequently administered to critically ill patients with the aim of treating PAD, decreasing the physiological stress response, and improving synchrony with mechanical ventilation. However, many of the analgesics and sedatives in current use can lead to adverse outcomes, including longer durations of mechanical ventilation, prolonged ICU stays, delirium, and an increased risk of death, particularly when these agents are administered at excessive doses for prolonged periods. The purpose of this review is to provide an overview of the initial evaluation and monitoring of, and the medications commonly prescribed for, PAD. Moreover, we highlight the major recommendations of the recent guidelines published by the Korean Society of Critical Care Medicine and American College of Critical Care Medicine. (Korean J Med 2014;86:546-556) |
CAM-ICU로 평가한 중환자실의 섬망 발생률과 섬망 발생 위험요인 | Purpose: Screening of delirium using delirium assessment tools could promote delirium detection, however,there is lack of report about regular delirium assessment in Korea. This study was intended to describe theprevalence and related risk factors of delirium in intensive care unit (ICU). Methods: The Confusion AssessmentMethod for the ICU (CAM-ICU) data which were evaluated by nurses in ICUs was obtained through retrospectivechart review. Data were analyzed using descriptive statistics, Chi-square test, t-test, Mann-Whitney U test, andstepwise logistic regression. Results: Delirium was evaluated in 125 patients. The incidence rate of delirium was27.2% with a high prevalence of hypoactive delirium compared to hyperactive delirium (61.8 vs. 38.2%). Thosewith delirium were older, had hypertension, stayed longer in hospital, receiving ventilator support, had morenumber of catheters, had low serum protein and albumin level. Delirium incidence also varied according todiagnosis. Age, diagnosis of gastrointestinal disease, and application of ventilator were the significant risk factorsfor the incidence of delirium. Conclusion: Routine delirium screening is important for early detection ofdelirium. Identification of high-risk group and running delirium prevention programs could improve earlyrecognition of delirium in ICU. |
회복실에 대한 사전 정보제공과 보호자 상주 중재가 수술 직후 각성 시 소아 청소년 환아의 불안, 섬망 및 통증에 미치는 효과 | Purpose: The purpose of this study was to test whether pre-operative visual information and parental presence had positive effects on anxiety, delirium, and pain in pediatric patients who awoke from general anesthesia in a post-surgical stage. Methods: This study used a non equivalent control-group post test design (n=76). Independent variables were provision of pre-operative visual information and parental presence for post-surgical pediatric patients in PACU (post anesthesia care unit). Dependent variables were anxiety, delirium, and pain in the pediatric patients measured three times at 10 minute intervals after extubation in the PACU. Measurements included Numerical Rating Scale for assessing state anxiety, Pediatric Anesthesia Emergence Delirium Scale by Sikich & Lerman (2004) for delirium, and Objective Pain Scale by Broadman, Rice & Hannallah (1988) for pain. Results: Experimental group showed significantly decreased state anxiety at time points-10, 20, and 30 minutes after extubation. Delirium was significantly lower at 10 minutes and 30 minutes after extubation in the experimental group. Pain was significantly lower at 10 minutes after extubation in the experimental group. Conclusion: The results of this study suggest that this intervention can be a safe pre-operative nursing intervention for post-surgical pediatric patients at PACU. |
한국어판 간호 섬망 선별 도구 개발 및 검증 | Purpose: The aims of this study were to develop and test the validity of the Korean Nursing Delirium Scale (Nu-DESC) for older patients in hospital. Methods: The Korean Nu-DESC was developed based on the Nu-DESC (Gaudreau, 2005), and revised according to nursing records related to signs and symptoms of older patients with delirium (n=361) and the results of a pilot study (n=42) in one general hospital. To test the validity of the Korean Nu-DESC, 75 older patients whom nurses suspected of delirium from 731 older patients from 12 nursing units were assessed by bedside nurses using the Korean Nu-DESC. A Receiver Operating Characteristic Curve of the Korean Nu-DESC was constructed with an accompanying Area Under the Curve (AUC). Results: Specific examples such as irritable, kidding, sleeping tendency, which were observed by bedside nurses in Korea, were identified in the five features of signs and symptoms of delirium in the instrument. The Korean Nu-DESC was psycho-metrically valid and had a sensitivity and specificity of .81-.76 and .97-.73, respectively. The AUC were .89, .74. Conclusion: Results of this study indicate that the Korean Nu-DESC is well-suited for widespread clinical use in busy inpatients settings and shows promise as a research instrument. |
외과계 중환자실의 섬망 발생 위험요인 조사연구 | Purpose: The purpose of this study was to examine the frequency and the course of delirium, and identify risk factors for the development of delirium in surgical intensive care unit (SICU). Methods: Subjects older than 19 years admitted to the SICU were recruited. After informed written consent, enrolled subjects had baseline cognitive and functional assessments. Subjects were assessed daily for delirium using the Confusion Assessment Method-ICU (CAM-ICU). Results: During the study period, 110 patients were enrolled. The overall incidence of delirium was 20% (22/110). The average time to onset of delirium was 3.04(${\pm}1.25$) days. Several variables were associated with an increased risk of delirium including older age (p<.05), higher admission APACHE II score (p<.001), use of opioid and analgesics (p<.01), using physical restraints (p<.001), and intraoperative hypotension (p<.05). In a multivariate logistic regression model, using physical restraints (p<.001), intraoperative hypotension (p<.05), and older age (p<.05) remained significant predictors of the delirium development. Conclusion: Using physical restraints, intraoperative hypotension and older age was strongly associated with development of delirium in the SICU. Prevention measures need to focus on identifying patients at higher risk for delirium development. |
요양병원과 종합병원 간호사들의 섬망에 대한 인식과 간호지식정도 | Purpose: This study was done to compare the comprehension and knowledge about delirium in nurses working at long-term care hospitals (NLH) with nurses working at a general hospital (NGH). Method: The participants were 191 nurses from a general hospital and 7 long-term care hospitals in Chungnam. The tool for comprehension consisted of the needs and importance of delirium education and the confidence of management for early detection, caring and prevention of delirium. The tool for knowledge of delirium developed by the author consisted of causing factors, symptoms, caring and prevention of delirium. Result: The comprehension of need and importance of delirium education was higher than the confidence for delirium management in participants. NLH nurses had a higher level in comprehension of the need and importance of delirium education and a lower level in confidence of delirium management than NGH nurses. The mean for delirium knowledge was 75.32% for all participants. The knowledge of NLH nurses was significantly lower than those of NGH nurses. All nurses showed low scores in confidence and knowledge of delirium prevention. Conclusion: A systematic educational program for nurses to enhance the ability for assessment, early detection and prevention of delirium for institutionalized elderly patients needs to be developed. |
일 종합병원 간호사들의 섬망에 대한 인식 및 교육요구에 관한 기초조사 | Purpose: The purpose of this survey was to investigate clinical nurses' understanding of delirium and their educational need of delirious patient care. Method: A survey questionnaire regarding nurses' general perception and understanding of delirium, experience with delirious patients and educational need was developed and conducted with 179 clinical nurses in a university hospital in Seoul. Data was analyzed using descriptive statistics. Results: Nurses thought that delirium was one of the most important nursing problems and they considered it to be more treatable than to be preventable. However, the majority of nurses were ilot confident in caring for delirious patients. Nurses reported that delirium happened most often after surgery, and that possible contributing factors could be changes in physical environment and anxiety/stress, as well as medication and long-term isolation. Thirteen nursing interventions were identified but half of the nurses utilized only one or two of the thirteen. The most frequently used intervention was reorienting the patient followed by medication and emotional support, presenting family, and close observation. 99.5% of nurses addressed the importance of professional education on delirium care, especially in the area of intervention and management. Conclusion: The results support the strong need for development of a multi-component educational program on delirium care. |
증례 / Famotidine에 의한 섬망 1예 | The use of histamine (H2)-receptor blockers has been associated with central nervous system (CNS) toxicities manifesting as delirium, mental confusion, dizziness, and hallucination. Elderly patients with renal or hepatic dysfunction are more susceptible to these adverse reactions. Most of these reactions have been reported with both cimetidine and ranitidine. Famotidine, one of H2 blockers, has been shown to be effective in improving symptoms and healing gastrointestinal lesions. Since 1986, an estimated 18.8 million worldwide patients have been treated with famotidine, but CNS adverse reactions associated with famotidine have been reported very rarely. The authors report a case of famotidine-associated delirium in an elderly patient with mild renal insufficiency, which was cleared completely after stopping the administration of famotidine. (Korean J Gastroenterol 2001;37:128-131) |
Lithium 투약도중 과나트륨혈증과 섬망을 동반한 신장성 뇨붕증 환자 1례 | Lithium is a widely used important drug in the treatment of manic-depressive illness and its prevention of relapse. However, this drug has a Low therapeutic index, therefore, it has many attendant side effects. The most prevalent renal effect of lithium is impairment of concentrating ability and this defect appeared into overt polyuria. A renal lesion is confined to the collecting tubule and 12-20% of patients taking lithium suffer from nephrogenic diabetes insipidus. This nephrogenic diabetes insipidus causes the states of extracellular fluid depletion, hypernatremia and precipitates lithium intoxication. In such situation, symptoms of nephrogenic diabetes insipidus and lithium intoxication are very similar, so we should be very cautious to discriminate them. We herein report a patient characterized by a prolonged stuporous state, hypernatremia and severe nephrogenic diabetes insipidus during lithium therapy. |
뇌졸중 후 섬망의 두부 침전기자극술을 포함한 한의복합치료에 대한 증례 보고 1례 | Objectives: This case study aimed to provide evidence of the combined use of Korean Medicine treatments, including electroacupuncture (EA) on scalp acupoints, as a useful intervention for post-stroke delirium. Methods: The patient in this study was diagnosed with Cerebral Infarction in Right Corpus Callosum and post-stroke delirium. The patient received eight sessions of EA on scalp acupoints, rehabilitation medicine treatment, and other Korean Medicine treatments such as acupuncture and herbal medicine. Evaluation of treatment effectiveness was done mainly through the Memorial Delirium Assessment Scale Korean (MDAS-K) and Mini-Mental State Examination Korean (MMSE-K). Results: MDAS-K score dropped from 20 to 9 and MMSE-K score increased from 15 to 21 during hospitalization, showing improvement in symptoms. Conclusions: Combined use of Korean medicine treatments including EA on scalp acupoints may be an effective treatment for post-stroke delirium. |
진정수면제를 음독한 노인 입원 환자에서 발생한 섬망에 대한 한의복합중재 증례보고 | Objectives: The purpose of this study was to report the effectiveness of the combination of Korean medicine therapy on elderly patients with delirium due to overdose of sedative-hypnotics. Methods: The patient was diagnosed with delirium, which occurred after an overdose of sedative- hypnotics. The patient received Korean Medicine treatment, including herbal medicine, acupuncture, moxibustion and psychotherapy, and other treatments. The evaluation variables to check the effectiveness of the interventions were the Korean Version of the Delirium Rating Scale- Revised-98 (K-DRS-R-98) Mini-Mental State Examination-Korean (MMSE-K) Clinical Dementia Rating (CDR) and Manual Muscle Test (MMT). Results: During the hospitalization period, the K-DRS-R-98 score decreased from 31 to 4, MMSE-K score increased from 18 to 26. CDR score decreased from 2 to 0. MMT in the Right lower extremity was improved. Normal daily activities were possible. Conclusions: Combining Korean Medicine treatments, including herbal medicine, acupuncture, moxibustion, psychotherapy, and other treatments, may help alleviate delirium. |
섬망을 호소하는 비경련성 간질 중첩증 환자에 대한 복합 한의치험 1례 | Nonconvulsive Status Epilepticus(NCSE) refers to continuous epileptic condition with altered mental status and behavioral symptoms, but without convulsive movement at least 10 minutes. In Salzburg criteria, well known as the diagnostic criteria of NCSE, it is diagnosed with clinical symptoms, electroencephalogram (EEG), and effects before and after the use of antiepileptic drugs (AEDs). Commonly being used to treat NCSE, AEDs are likely to have adverse effects. In the present case, a 85-year-old female NCSE patient complaining delirium underwent combined Korean medical treatment by acupuncture and herbal medicine for 13 days. The effect of treatment was assessed with delirium scales including Delirium Rating Scale-Revised-98(DRS-R-98) and Assessment Test for Delirium & Cognitive Impairment(4AT) per 2 days. After the treatment, both DRS-R-98 and 4AT scores decreased, and orientation and mental status of patient improved. This case report suggests that Korean medical treatment might be an effective option without side for those NCSE patients complaining delirium. |
수술 후 섬망 치험 1례를 통해 본 지언고론요법의 활용 | Objectives: The purpose of this study was to report the effectiveness of the combination of Giungoroen-therapy, as well as other Korean medicine therapy on postoperative delirium. Methods: The patient was diagnosed with postoperative delirium, that occurred after arthroscopic debridement two months before hospitalization. The patient received Giungoroen-therapy in addition to conventional Korean Medicine treatment, including acupuncture, herbal medicine, and moxibustion. The evaluation variables to check the effectiveness of the interventions, were the Korean Nursing Delirium Screening Scale (Korean Nu-DESC) and the Korean Version of the Delirium Rating Scale-Revised-98 (K-DRS-R-98). Results: During the hospitalization period, the Korean Nu-DESC score decreased from 5 to 1, and the K-DRS-R-98 score decreased from 36 to 23. The subjective expression of anxiety had been reduced. Conclusions: The combination of Giungoroen-therapy, as well as other Korean medicine therapy including acupuncture, moxibustion, and herbal medicine may be useful in alleviating postoperative delirium. |
柴胡加龍骨牡蠣湯으로 호전된 노인 섬망 환자 증례보고 | Objective: The purpose of this study is to report the effects of Shihogayonggolmoryo-tang on elderly delirium. Methods: A patient suffering from delirium was treated with Shihogayonggolmoryo-tang herbal therapy for 35 days. To evaluate the therapeutic effects, the Korean version of the Mini Mental State Examination (MMSE-K) and the Korean Nursing Delirium Screening Scale (nu-DESC) were used twice a week. Results: After treatment, the patient’s MMSE-K score increased from 0 to 12, and the nu-DESC results decreased 4 to 0. Conclusion: These scores suggest that therapy with Shihogayonggolmoryo-tang has a positive effect on elderly delirium. |
암 병원 간호사의 섬망에 대한 지식, 간호수행 및 스트레스 | Purpose: We aimed to elucidate the relationship between the knowledge, nursing performance, and stress of delirium in cancer hospital nurses. The results might help provide better and appropriate nursing care to patients with delirium. Methods: As a descriptive study, 143 nurses who had worked for over one year at one cancer hospital in S city were included in this study. The data collection period was from February 1 to 15, 2021. Results: It was found that cancer hospital nurses with delirium-related nursing education had a high knowledge of delirium. Cancer hospital nurses who were married and had an educational background above graduate school showed relatively high nursing performance against delirium. Also, cancer hospital nurses had relatively high stress levels. Conclusion: Therefore, an opportunity to develop and participate in a systematic education program is necessary to raise cancer hospital nurses’ knowledge levels of delirium and improve nursing performance for delirium. Furthermore, it is necessary to have a stress management program for delirium for cancer hospital nurses. |
COVID-19 환자에서 나타나는 섬망에 대한 고찰 | We reviewed the clinical features, prevalence, pathophysiology, and prevention and treatment of delirium in patients with coronavirus disease of 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, has neurotropic properties, and can penetrate the central nervous system and affect brain neurons. These characteristics may explain the fact that COVID-19 patients may be particularly susceptible to delirium. COVID-19 delirium occurred more frequently in intensive care unit and emergency room settings. Patients with neurologic disorders and the elderly were more vulnerable to delirium. Clinical symptoms of COVID-19 delirium may manifest as a hyper/hypoactive type. Prevention and treatment appear to be similar to conventional treatment strategies. And the patient’s feeling of isolation due to social distancing and a highly intensive labor force of medical personnel must be overcome. Melatonin, alpha-2 agonist, antipsychotics, and valproic acid have been recommended for the treatment of delirium symptoms. However, this article did not go through a systematic literature review. |
외상중환자실 환자의 섬망 발생 위험요인 | Purpose: This descriptive study aimed to present the incidence of delirium and identify risk factors for delirium in TraumaIntensive Care Unit (TICU) patients. Methods: The participants were 184 patients who were hospitalized in the TICUat a Regional Trauma Center in Gyeonggi-do. Data were collected between April and November 2019. For deliriummeasurement, the author used the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Diversedependent variables were collected through electronic medical records. Data were analyzed using descriptivestatistics, independent t-test, x2-test, and binomial logistic regression. Results: Incidence of delirium in TICU patientswas 34.8%. Logistic regression analysis showed that the risk factors for delirium in TICU patients were hemoglobin(Odds Ratio [OR]=0.62, 95% Confidence Interval [CI]=0.43~0.88), injury severity score (OR=1.10, 95% CI=1.01~1.20),length of TICU stay (OR=1.15, 95% CI=1.03~1.29), administered sedatives (OR=6.04, 95% CI=2.47~14.76), and useof restraints (OR=5.75, 95% CI=2.29~14.42). Conclusion: Based on the results of this study, healthcare providers,especially TICU nurses, should try to detect the signs and symptoms of delirium as early as possible, taking into accountthe specified risk factors of the patient. Preventive and practical intervention programs considering the risk factors mustalso be developed to prevent and alleviate delirium in TICU patients in the future. |
호스피스 말기암환자의 섬망 증상에 영향을 미치는 요인 | Objectives：Hyperactive delirium is a state of acute mental confusion including aggressive and impulsive behavior and it is burdensome for the family and caregivers of terminal cancer patients. Therefore, predicting the symptoms of hyperactive delirium can provide benefits to care terminal cancer patients. In this study, several risk factors were evaluated during hospitalization for predicting delirious symptom in terminal cancer patients. Methods：Patients who died of cancer in a palliative care unit from January 2011 to September 2012 were investigated by retrospective chart review. Clinical and laboratory data were collected to identify the factors associated with hyperactive delirium. Univariate and multivariate analysis by logistic regression were applied. Additional survival analysis was conducted to measure the onset of delirium symptoms after pneumonia. Results：During hospitalization, 49 of 201 patients showed the symptoms of hyperactive delirium (24.4%). Developing a delirious symptom was associated with male (OR=3.36, p=0.002), bone metastasis (OR=3.70, p=0.002), pneumonia during hospitalization (OR=3.17, p=0.02) and depressive mood (OR=2.53, p80.011). In additional survival analysis, half of patients developed symptoms of delirium within 3 days after pneumonia. Conclusion：Our results suggest that male, bone metastasis, depressive mood, and pneumonia are risk factors that can affect hyperactive delirium in terminally ill cancer patients. In addition, many patients with pneumonia abruptly developed the symptoms of hyperactive delirium within 3 days. Our finding may provide clues for predicting hyperactive delirium, and it can be helpful to manage delirium symptoms. |
노인 입원환자에서 Delirium Drug Scale과 섬망 발생의 연관성 분석 | Background : Drugs are one of the major causes of delirium in elderly patients. As drug-associated delirium is usually reversible, evaluating the drug burden is clinically important in terms of delirium prevention. The Delirium Drug Scale (DDS) is a quantification tool developed to assess the impact of drugs on delirium in elderly patients. This study aimed to investigate the association between the scores and the occurrence of delirium in Korean elderly hospitalized patients. Methods : We retrospectively reviewed the electronic medical records of patients who were admitted to a tertiary university hospital from January to December 2017, and underwent Comprehensive Geriatric Assessment. Lists of medications taken by the patients at the time of admission were collected and the occurrence of delirium within two days after admission was identified. The DDS score of each patient was calculated based on the collected medication data. The relationship between DDS scores and delirium occurrence was analyzed using logistic regression. Results : A total of 452 patients were included in the study. The mean age of the patients was 82.0 ± 7.2 years. Delirium was detected in 54 patients (11.9%) and 258 patients (57.1%) were exposed to one or more drugs known to be associated with delirium. The unadjusted odds ratio (OR) for the DDS score was 2.02 (95% confidence interval [CI]:1.66; 2.46). In the multivariable analysis, a history of delirium, polypharmacy, infection, dementia, and age were significantly associated with delirium. When the confounding variables were adjusted, DDS scores were associated with the occurrence of delirium with an OR of 2.15 (95% CI: 1.69; 2.73). Conclusion : DDS scores were associated with delirium occurrence among hospitalized older patients in Korea. The DDS can be considered an objective index when providing medication review services as part of a delirium prevention practice. |
완화의료병동 암환자들의 섬망 치료를 위해 사용된 항정신병 약물의 효과 및 안전성 비교 | Background: Delirium is a neuropsychiatric disorder characterized by sudden impairments in consciousness, attention, and perception. The evidence of successful pharmacological interventions for delirium is limited, and medication recommendations for managing delirium are not standardized. This study aimed to provide evidence of antipsychotics for symptomatic treatment of delirium in cancer patients receiving palliative care. Methods: We retrospectively reviewed adult cancer patients in palliative care who received antipsychotic delirium treatment at Severance Hospital between January 2016 and June 2019. The efficacy was evaluated primarily by resolution rates. The resolution of delirium was defined as neurological changes from drowsiness, confusion, stupor, sedation, or agitation to alertness or significant symptomatic improvements described in the medical records. The safety was studied primarily by adverse drug reaction incidence ratios. Results: Of the 63 enrolled patients, 60 patients were included in the statistical analysis and were divided into three groups based on which antipsychotic medication they were prescribed [quetiapine (n=27), haloperidol (n=25) and co-administration of quetiapine and haloperidol (n=8)]. The resolution ratio showed quetiapine to be more effective than haloperidol (p=0.001). No significant differences were seen in adverse drug reaction rates among the three groups (p=0.332). Conclusions: Quetiapine was considered the most effective medication for delirium, with no significant differences in adverse drug reaction rates. Therefore, quetiapine may be considered a first-line medication for treating delirium in cancer patients receiving palliative care. However, further studies comparing more diverse antipsychotics among larger populations are still needed. |
청력 저하 환자에서 발생하는 섬망의 특성에 대한 연구 | Objectives Several studies have delineated the relationship between hearing disturbances and the prevalence or characteristics of psychotic symptoms; however, most of those studies focused on psychiatric patients and not general inpatients. Delirium has a high incidence among general inpatients, and patients with delirium are easily affected by psychotic symptoms that lead to irritable behaviors. This study examined the relationship between hearing disturbance and psychotic symptoms among patients with delirium. Methods At the Asan Medical Center in Seoul, South Korea, this study examined 27 inpatients who had both delirium and hearing disturbances between January 1, 2009 and December 31, 2018, and 146 inpatients at the Asan Medical Center who had delirium but no hearing disturbances between July 1, 2018 and December 31, 2018. This study investigated whether the two groups showed differences in the prevalence and characteristics of delirium symptoms, particularly psychotic symptoms. In addition, the correlation between clinical characteristics of delirium and the recommended dosage of antipsychotics was analyzed in patients who had been diagnosed with delirium and had hearing disturbances. Results Compared to inpatients who only had delirium, those who had both delirium and hearing disturbances had a significantly higher prevalence of hallucination and delusion. Conclusion The prevalence of psychotic symptoms, such as hallucination and delusion, was higher in patients who had both delirium and hearing disturbances, which is in line with the results from previous studies on psychiatric patients. Physicians should focus on improving communication with such patients by employing non-verbal communication methods. |
응급실에서 섬망 위험이 높은 환자를 조기 인지하기 위한 평점표의 활용 | Objective: This study was conducted to evaluate scorecards for early recognition of high-risk patients of delirium in the emergency department (ED). Methods: Data from 399 consecutive patients aged 65 years or older between January 1, 2015 and December 31, 2015 were retrospectively analyzed. Delirium was identified by reviewing medical records and was confirmed by a psychiatrist. The study population was divided into a training and validation group. Predisposing factors were evaluated and validated by multivariate logistic regression analysis and a calibration plot, after which a scorecard was constructed using these factors and applying points to double odds to each regression coefficient. Results: Dementia, transfer from a long-term care facility, acute acid-base imbalance, moderate pain, and stroke were independent predisposing factors for delirium in ED, with assigned scores in the scorecard of 3, 2, 2, 2, and 2, respectively. The total score of the scorecard for delirious patients was significantly higher than that for non-delirious patients in both the training and validation groups. The coefficient of determination (R2) of the calibration plot was 0.74 and 0.68 in the training and validation group, respectively. In the receiver operation characteristic curve, the cut-off point of the scorecard for delirium was 2.5 and the sensitivity, specificity, and accuracy were 75.0%, 87.8%, and 86.7% in training group, while they were 76.9%, 85.1%, and 84.2% in the validation group, respectively. Conclusion: The scorecard was a useful screening tool for early recognition of patients with a high-risk of developing delirium in the ED. |
소아중환자실 입원 아동의 섬망 발생 관련 요인 | Purpose: This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors. Methods: The participants were 95 patients, newborn to 18 years, who were admitted to the PICU. The instruments used were the Richmond Agitation Sedation Scale (RASS), and the Cornell Assessment of Pediatric Delirium. Data analysis was performed using the descriptive, x2 test, t-test, and logistic regression analyses. Results: The incidence of delirium in children admitted to the PICU was 42.1%. There were significant differences according to age (x2=14.10, p=.007), admission type (x2=7.40, p=.007), use of physical restraints (x2=26.11, p<.001), RASS score (x2=14.80, p=.001), need for oxygen (x2=5.31, p=.021), use of a mechanical device (x2=9.97, p=.041), feeding (x2=7.85, p=.005), and the presence of familiar objects (x2=29.21, p<.001). Factors associated with the diagnosis of delirium were the use of physical restraint (odds ratio [OR]=13.82, 95% confidence interval [CI]=4.16~45.95, p<.001) and the presence of familiar objects (OR=0.09, 95% CI=0.03~0.30, p=.002). Conclusion: Periodic delirium assessments and intervention should be actively performed. The use of restraints should be minimized if possible. The caregiver should surround the child with familiar objects and ensure a friendly hospital environment that is appropriate for the child. |
소음인 알츠하이머 환자의 외상성 지주막하 출혈로 인한 섬망과 인지저하 치험 1례 | Objectives This study is to investigate the effect of sasang constitutional medicine on the delirium and cognitive decline caused by traumatic subarachnoid hemorrhage in a soeumin alzheimer patient Methods We have treated a 79-year-old Soeumin patient mainly with Doksampalmul-tang. She was already suffering from Alzheimer's disease. After traumatic subarachnoid hemorrhage, there were symptoms of delirium and cognitive decline. The degree of improvement was checked by K-MMSE and K-MOCA scores. Results The K-MMSE score improved from 0 to 11 and the K-MOCA score from 0 to 3. Conclusions Sasang constitutional medicine has been effective in the treatment of delirium and cognitive decline caused by traumatic subarachnoid hemorrhage. |
중환자실 급성중독환자에서 섬망의 위험인자 | Purpose: This study estimated the incidence of delirium and associated risk factors and outcomes in ICU patients with acute poisoning. Methods: Data were collected from ICU patients over 18 years of age that were admitted via the emergency center after presenting with poisoning from 2010 to 2015. Delirium was assessed retrospectively using the Intensive Care Delirium Screening Checklist (ICDSC). Risk factors were evaluated by univariate and multivariate analysis. Results: A total of 199 patients participated in this study and 68 (34.2%) were diagnosed with delirium based on the ICDSC score. The delirium group showed a significantly higher association with prolonged length of stay in the hospital and ICU in comparison with the non-delirium group. The delirium group was associated with greater use of physical restraint. A statistically greater number of patients with pharmaceutical substance poisoning developed delirium over a short period of time than those with non-pharmaceutical substance poisoning. There was no significant difference between the two groups with respect to age, sex, past history, GCS score, vital signs, application of ventilator care and renal replacement therapy. Conclusion: The finding that the delirium group had a greater length of stay in both the hospital and the ICU is consistent with the results of previous worldwide studies of the effects of delirium on the prognosis of patients who were admitted to the ICU, suggesting the possibility for domestic application. Additionally, use of physical restraint was positively related to the incidence of delirium. Thus, interventions for minimizing the use of physical restraints and considering alternatives are needed. |
일개 상급종합병원 신경과 병동 노인 입원 환자의 섬망 발생률과섬망 발생 위험요인 | Purpose: Although there is a high incidence of delirium with increased age, the risk factors have been too various. We investigated the incidence and risk factors in the older inpatient with neurological disorders. Methods: We reviewedthe Electronic Medical Records (EMR) of older patients admitted to a neurology unit from August 2016 toJanuary 2017. We analyzed the incidence and risk factors of delirium in 382 patients in a tertiary hospital. Deliriumwas determined daily using the Nursing Delirium Screening Scale (Nu-DESC). Demographic, disease, and environmentalcharacteristics were obtained by using structured EMR data. Results: The incidence rate of delirium was6.0% (n=23). Delirium was prevalent in patients who were older, had a lower serum hemoglobin, had hypertensionor had diabetes mellitus. Delirium was also observed in patients on antibiotics, having a higher number of drugsor catheters, or receiving mechanical monitoring. A longer hospital stay, being admitted to a sub-intensive careunit, and sleep deprivation were significantly associated with delirium. Multiple logistic regression analysis foundolder age, having sleep deprivation, a higher number of catheters placed, and having diabetes mellitus to be significantpredictors of delirium. Conclusion: This study shows that age, sleep deprivation, number of catheters, andcomorbidity of diabetes mellitus were identified as a risk factor for delirium. And it will guide the development ofalgorithms through its possible applications for the future in hospitalized older adults. |
하지 골절 노인환자의 수술 후 섬망 위험성 평가 | Objective：Delirium is very common in orthopedic elderly patients and increase comorbidity and mortality rates. By controling the risk factors of delirium, prevention strategy can be effective and reduce negative outcomes. The purpose of this study was to explore the usefulness of delirium risk assessment with some simple collateral questionaires. Methods：The subjects were 50 elderly patients (≥65 years old) who admitted to a department of orthopedic surgery for operations of lower extremity fractures. They were evaluated with Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Confusion Assessment Method and Korean Dementia Screening Questionnaire (KDSQ) by psychiatrists. The demographic data, medical histories, and orthopedic chart were checked through medical records of patients. Results：27 subjects (54.0%) were diagnosed as delirium. There was a significant difference between delirium group and control group with all KDSQ scores. Depressive category of KDSQ score had the highest correlation (coefficient=0.399) and can be independent risk factor of delirium (p=0.045). Conclusion：Cognitive impairment and depressive symptoms have high correlation with delirium. We found that just a few questions of cognitive impairment and depressive symptoms by caregivers can evaluate the risk factors of delirium. The simple collateral questionaires can be useful tool for exploring delirium risk factors. |
암 환자의 심리적 디스트레스, 섬망에 대한 간호사의 인식 및 직무 스트레스 | Purpose: The purpose of this study was to investigate nurses’ awareness of psychological distress and delirium in cancer patients and job stress. Methods: The participants were 256 nurses in a cancer general hospital. The nurses’ awareness of psychological distress and delirium was investigated using a self-report questionnaire (1-4 scale) developed by the researcher. Psychological distress was measured by depression, anxiety, and insomnia. Job stress was measured using the Korean version of the Expanded Nursing Stress Scale (1-4 scale). Results: The analysis of 9 questionnaires about nurses’ awareness was divided into two factors: nurses’ competence and importance. Nurses’ competence results were 2.06 (depression), 2.17 (anxiety), 2.29 (insomnia), and 2.41 (delirium). Importance results were 3.23 (depression), 3.20 (anxiety), 3.15 (insomnia), and 3.37 (delirium). Most nurses have experienced nursing psychological distress and delirium in cancer patients, but only about a quarter have received the relevant education. Job stress was 2.52 and in subcategories, work load received the highest score 2.92. Conclusion: Nurses recognize that psychological distress and delirium in cancer patients are very important, but they are less aware of their competence. Therefore, it is suggested to develop an educational program to improve nurses’ competence when dealing with psychological distress and delirium. |
한방치료로 호전된 섬망을 동반한 좌측 중대뇌동맥경색 환자의 치험 1례 | Objectives: The purpose of this case study is to describe the effect of Korean medicine on a patient with delirium caused by a left middle cerebral artery infarct. Methods: The patient was treated with Sopungbosimdodam-tang, acupuncture, and moxibustion. The Korean version of the Delirium Rating Scale (K-DRS), Neelon and Champagne (NEECHAM) Confusion Scale, and Korean Version of the Mini-Mental State Examination (MMSE-K) were used to evaluate the effect of the treatment. Results: After 50 days of treatment with Sopungbosimdodam-tang, the patient’s K-DRS score decreased from 16 to 8. The NEECHAM Confusion Scale also improved from 17 to 23, and the MMSE-K score improved from 1 to 7. Conclusion: This clinical study suggested that Korean medicine could contribute greatly to the treatment of delirium caused by a left middle cerebral artery infarct. |
섬망 돌봄 교육 프로그램 적용이 수술 후 노인을 돌보는 한국계 중국 간병인의 섬망 돌봄 지식 및 수행에 미치는 효과 | Purpose: Knowledge and performance of delirium care is important for caregivers of older people and in particular older postsurgical patients. The purpose of this study was to examine the effects of a delirium care education program for Korean-Chinese caregivers. Methods: A nonequivalent control group pretest-posttest design was used. Participants were 55 Korean-Chinese caregivers caring for elderly patients with delirium (27 in the experimental group and 28 in the control group) from one hospital in Seoul. The delirium care education program, which consisted of discussion on the experience of caring for patients with delirium, lecture, and quiz, was given individually. Effects were evaluated through pre-and post-tests that included measurement of knowledge and performance of delirium care. Results: After the delirium care education knowledge of delirium care significantly increased in the experimental group compared to the control group. There was no significant improvement in either group in the performance of delirium care after delirium care education. Conclusion: The findings of this study provide evidence for the potential utility of the delirium care education program for Korean-Chinese caregivers. This program could allow caregivers to provide quality care, and ultimately contribute to achieving excellence in delirium patient care. |
중환자실 섬망의 약물요법 | Delirium is defined as an acute disturbance of consciousness with inattention difficulties, changes in cognition or perceptual disturbance, which can develop over hours to days. Delirium is common in the medical and surgical intensive care units (ICU) and associated with many negative outcomes such as increased mortality, ICU and hospital length of stay, and cognitive impairment. A large number of studies have been conducted on various nonpharmacologic and pharmacologic strategies for prevention or treatment of delirium. The purpose of this article was to review the nonpharmacologic and pharmacologic agents used for delirium and review current studies on each strategy. Nonpharmacologic delirium managements using early mobilization and spontaneous awakening trials/spontaneous breathing trials have been demonstrated to reduce the incidence or duration of delirium in ICU patients. Pharmacologic medications such as haloperidol, atypical antipsychotics (e.g., risperidone, olanzapine, quetiapine, ziprasidone), and dexmedetomidine can be used to treat delirium in the ICU, although there are limited data on when to treat and which agents to use. Haloperidol and atypical antipsychotics have the potential to cause QT prolongation and should be used cautiously in ICU patients. |
노인요양병원 간호사의 섬망에 대한 지식, 섬망간호스트레스 및 섬망간호수행간의 관계 | Purpose. The purpose of this study was to investigate knowledge, stress and nursing performance about care for delirium in geriatric hospital nurses. Methods. For this study, data were collected from 242 nurses employed at geriatric hospitals with the capacity of more than 100 beds which were located in A, P and Y cites. Frequency analysis, t-test and one-way ANOVA were utilized to analyze the data and Scheffe test was used to conduct post-hoc tests. Results. Nurses showed significant differences in the level of Knowledge, as well as terminal care performance by marital status, nursing experience. A significant relationship was found between knowledge, stress and Delirium care performance. Conclusion. This study found nurses perform delirium care with a high level of stress but with insuffiecient understanding, and thus, showed great needs for related training. Such findings can be useful to develop educational programs to improve knowledge on delirium and plans to reduce stress from delirium for geriatric hospital nurses. |
종합병원 간호사의 섬망 간호수행 영향요인 | This study was conducted to identify factors affecting nursing performance of delirium among general hospital clinical nurses. Methods: This was a cross-sectional study and conducted from July 20 to July 30 2015, with a sample consisting of 167 registered nurses in three general hospitals. Data were analyzed with SPSS 21.0. Results: Nursing performance of deliriumhad significant positive correlations with knowledge about delirium(r=.25, p=.001), self-confidence in caring for patients with delirium(r=.45, p<.001) and nursingwork environment (r=.29, p<.001). In this study, factors affecting nursing performance of deliriumwere self-confidence in caring for patientswith delirium (β=.33, p<.001), nursing work environment (β=.26, p<.001), experience in nursing education about delirium(β=.18, p=.007) and clinical experience (β=.18, p=.007). The factors explained 32%of nursing performance of delirium. Conclusion: This study``s results can be used as basic data to develope educational programs related to deliriumcare through continuing education and to improve work environments in developing strategies to enhance nursing performance for patients with delirium. |
간호사의 섬망관련 지식, 간호 자신감과 섬망 간호 수행과의 관계 | Objectives: This study was conducted to investigate the correlation among nurses` knowledge, their self-confidence about care for delirium and nursing performance for patients with delirium. Methods: The study subjects are the 203 nurses working at general hospitals. The data were collected using the instruments for knowledge of delirium (47 items), performance (23 items), and self-confidence (15 items). The used statistical analysis were t-test, ANOVA, Pearson`s coefficient and multiple regression analysis. Results: Nursing performance level for patients with delirium was 2.85±0.47, knowledge of delirium nursing 32.15±4.36, and self-confidence in delirium nursing 52.00±17.05. The difference in performance were associated with number of caring experience with delirious patients (during for 1 year) (F=3.22, p=0.024), perceived importance (Caring delirious patient is an important nursing intervention) (F=5.85, p=0.003), necessity of education for delirium (F=5.58, p=0.004), and necessity of manuals for delirium care (t=2.11, p=0.036). The nursing performance for patients with delirium had positive relationship with knowledge of delirium (r=0.30, p=0.000) and self-confidence (r=0.35, p=0.000). Factors related to the nursing performance for patients with delirium were `self-confidence in nursing performance for patients with delirium` (β=0.24, p=0.001), `knowledge of delirium` (β=0.16, p=0.002), and `necessity of manuals for delirium care` (β=0.16, p=0.014). These variables explained 18.5% of the variance in nursing performance for patients with delirium. Conclusions: It is necessary to develop systematic educational program and manual for improving the knowledge, self-confidence and performance for patients with delirium among nurses working at general hospitals. |
외과계 중환자실 수술 후 환자의 섬망 예방 중재가 섬망 발생에 미치는 효과 | Purpose: This study was aimed to develop the multicomponent intervention for preventing delirium among postoperative patients in a surgical intensive care unit (SICU). Methods: Using a quasi-experimental pre & post-test design with a non-equivalent control group, a total of 88 hospitalized patients in a SICU participated in this study. The 44 patients were allocated in each experimental and control group. The experimental group received the multicomponent intervention for delirium prevention including a delirium assessment and nursing intervention using a checklist, whereas the control group was provided with a standard care. The primary outcome of this study was the delirium incidence during the course of hospitalization. Results: There were no significant differences in the demographic and clinical characteristics between the two groups. The delirium occurred in 19.2% in the experimental group, whereas 38.6% in the control group (x2=4.526, p<.05). Conclusion: The findings of the study demonstrated an effect of the multicomponent delirium prevention intervention in decreasing the delirium incidence rate over the standard care among the patients in SICU. |
섬망 환자에서 아형과 심각도의 임상적 관련 요인 | Objectives Delirium is commonly seen in clinical settings, and it can substantially influence the prognosis of patients. In this study, we investigated delirium with respect to its severity, classifi￢cation and characteristics on each subtype. Methods Severity of delirium was examined in delirium patients, who were referred to the de￢partment of psychiatry in a general hospital for multidisciplinary treatment. After classification based on subtypes, factors influencing these aspects of delirium were examined. Results Among the 193 consultation-liaison patients referred to the department of psychiatry in a general hospital, 61 patients (31.6%) were diagnosed with delirium. Compared to patients in the non-delirium group, patients in the delirium group were older, had a shorter education period, and medical history of surgery. Among the delirium patients, the hyperactive subtype was found to be the most common (57.4%) and patients with the mixed subtype showed the highest sever￢ity score for delirium symptoms. In addition, the patient with the hypoactive subtype had a higher frequency of medical history of depression compared to those with the other subtypes. Conclusion People with symptoms of hypoactive delirium can be misdiagnosed due to recur￢rence of depression, therefore, careful examination is required, particularly in patients with a histo￢ry of depression. |
신경외과 수술 후 노인 환자를 위한 섬망 사정도구의 임상활용 가능성 평가 | Purpose: The aim of this study was to evaluate the possibility for clinical use of delirium assessment tools, the Nursing Delirium Screening Scale (Nu-DESC) and the Delirium Observation Screening Scale (DOS), for postoperative neurosurgery patients. Methods: A sample of 100 elderly patients post neurosurgery was recruited from a neurosurgery ward in a university hospital located in Seoul, South Korea. Nurses (n=28) on the neurosurgery ward were asked to assess the participants using the Nu-DESC and the DOS. Based on the diagnosis of delirium made by a neuropsychiatrist, validity of the tools was evaluated. A questionnaire about ease of use of the tool was completed by the nurses. Results: As for the reliability of the tools, Cronbach's ? was .79, and .95 for the Nu-DESC and the DOS, respectively. Both of the tools showed high levels of sensitivity and specificity. As for ease of use in the clinical setting, the Nu-DESC (mean=39.2±4.82) had a higher (t=2.77, p=.01) score than the DOS (mean=37.39±5.97). Conclusion: Findings of this study confirmed that both the Nu-DESC and the DOS were highly reliable and valid tools to detect delirium in postoperative older neurosurgery patients, but the Nu-DESC was easier to use. |
노인 환자의 골관절염 수술 후 발생한 섬망과 섬망 위험요인 | Purpose: The purpose of this study was to evaluate the incidence of postoperative delirium in elderly patients with osteoarthritissurgery and identify risk factors for its development. Methods: This study enrolled 288 patients who underwent osteoarthritis surgery in a hospital between May and November 2014. Data were collected prospectively. The Nursing Delirium Screening Scale was used to detect delirium. Multivariable logistic regression analysis was used to identify independent risk factors for postoperative delirium. Patients were also followed for outcome. Results: Postoperative delirium developed in 42 patients (14.6%). Logistic regression analysis identified old age, low physical activity, antipsychotic agents, number of catheters, and intensive care unit admission as risk factors. Worse outcomes, including increased hospital mortality, reoperation, and discharge at care facilities, occurred in subjects who developed delirium. Conclusion: Osteoarthritis surgery in elderly patients was associated with a high incidence of postoperative delirium. The results of the this study regardingpatient populations vulnerable to delirium should be taken into account so that such patients could be identified preoperatively or in the immediate postoperative period. |
노인의 섬망, 치매 및 우울 선별에 대한 근거중심 실무지침 수용개작 | Purpose: The aim of this methodological study was translation and adaption of the evidence based guideline of the RNAO in Canada, for screening of delirium, dementia and depression in older adults. Methods: The guideline adaptation process was conducted according to the standardized methodology for nursing practice guideline adaptation developed by Korean Hospital Nurses Association. Quality of the RNAO guideline was evaluated using AGREE II tool. Then the guideline was translated into Korean and a preliminary guideline was established after appropriateness and applicability were checked by an expert group. Results: The adapted screening practice guideline consisted of 3 domains and 11 recommendations, including practice, education, organization and policy. Of the recommendations 9.1% were graded A, 27.3%, B, and 63.6%, C. Conclusion: This guideline is expected to contribute to improving nursing quality by offering it as a guide to evidence based practices for screening delirium, dementia and depression in Korean older adults. |
뇌졸중 후 섬망의 진단과 치료 | Delirium is an acute disturbance of consciousness and cognition with fluctuating course over a short period of time. Recognition of delirium in post-stroke patients is important because of its association with a longer stay in the hospital, a poor functional outcome, an increased risk of deteriorated cognition, and a higher mortality rate. It is occasionally under-recognized due to the fluctuating course and the neurological deficits that are caused by the stroke. Disturbance of several neurotransmitter systems including not only acetylcholine and dopamine but also serotonin, noradrenaline and gamma amino butyric acid have been implicated for the possible pathophysiology of delirium. Numerous potential precipitating and predisposing factors have been proposed such as comorbid condition, age, acute medical insults and environmental issues. In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological approaches for risk factors are the most effective strategy for prevention of delirium. Preventive interventions such as frequent reorientation, early and recurrent mobilization, pain management, adequate nutrition and hydration, reducing sensory impairments, and ensuring proper sleep patterns have all been shown to reduce the incidence of delirium, regardless of the care environment. Pharmacologic interventions and physical restraints should be reserved for patients who are a threat to their own safety or the safety of others. This review describes epidemiology, pathophysiology, risk factors, diagnostic methods, and management of delirium in post-stroke patients. |
지황백호탕으로 호전된 급성기 뇌경색 이후 섬망환자 보고 1례 | Object：The purpose of this study is to report the effect of Gihwangbaekho-tang on the patient who had suffered from delirium caused by acute cerebral infarction. Methods：We used Sasang Constitutional Medicine to the patient, a 80-year-old man, who had suffered from delirium. And we observed how clinical symptoms had changed. Result：After treatment, there was significant improvement on condition of the patient. And we found that Gihwangbaekho-tang was effective for delirium caused by acute cerebral infarction. |
병동 간호사를 대상으로 한 섬망간호 훈련 프로그램의 효과 | Purpose: The purpose of this study was to examine the effects of delirium care training program on the nurses’ knowledge of delirium, self-confidence and performance levels in caring patients with delirium. Methods: The study was used a quasi-experimental design. The participants were 131 nurses in general nursing units in B and J hospitals. Sixty four nurses in B hospital were allocated into the experimental group and 67 nurses from J hospital into the control group. The delirium care training program was composed of lecture and clinical practice. Clinicalpractice of delirium care was applied everyday for 4 consecutive weeks starting from the admission day of the older adults(≥70 years old), using ‘short CAM' and ‘nursing checklist for delirium prevention’. Results: The knowledge of delirium, self-confidence in caring patients, and performance levels of nursing care were significantly increased in the experimental group compared to the control group. Conclusion: The findings of this study provided the evidence for the potential utility of the delirium care training program and underscored the needs of broaderapplication of the training program of delirium care for nurses in general nursing units. |
정형외과에 입원한 노인 환자의 섬망 위험 요인 연구 | Objective：The aim of this study was to explore risk factors behind delirium in elderly inpatients with orthopedic problem. Methods：The subjects were 94 elderly patients (≥65 years old) who admitted to a department of orthopedic surgery. They were evaluated with Confusion Assessment Method (CAM) and were diagnosed by Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision through direct interview with psychiatrists. The demographic data, medical histories, and orthopedic chart were checked through medical records of patients. Results：20 subjects (21.3%) were diagnosed as delirium, and among them, 10 subjects had hyperactive type (50.0%), 6 had hypoactive type (30.0%) and 4 had mixed type (20.0%). Delirium group had high systolic blood pressure (p=0.007) and plasma glucose level (p=0.001) at the admission day. They had low hemoglobin (p=0.002) and potassium level (p=0.017) after surgery. Conclusion：In our study, there were many delirium patients, and even though there were many hypoactive type patients. It is assumed that delirium occurs more at the surgery or damage with larger loss of blood. It is important that we take care of management of past diseases rather than presence of past diseases. It is necessary to develop guidelines which would help to find out high risk patients for delirium. |
알코올 의존 환자에서 진전섬망과 금단증상의 연관성 | Objective：This study was performed to analyze the clinical variables associated with occurrence of delirium tremens (DT) in inpatients with alcohol dependence initially admitted with diseases unrelated to alcohol. Methods：This study included 132 inpatients seeking treatment for medical problem with acute alcohol withdrawal. The cases were divided into two groups : with DT group (n=44), without DT group (n=88). We compared the epidemiologic data, alcohol withdrawal symptoms and serum analysis data between two groups. We used the logistic regression to predict risk factors for DT. Results：The DT group had more severe alcohol withdrawal symptoms, more amount of drinking alcohol, more number of drinking per month, higher blood urea nitrogen (BUN), creatinine, amylase, C-reactive protein and lower serum total protein than the without-DT group. According to the result of a logistic regression, occurrence of DT showed correlation with the following factors : sweating, hallucination, agitation, amount of alcohol consumption, number of drinking per month. Conclusion：Our study suggests development of DT was correlated with severe alcohol withdrawal symptoms, high BUN, creatinine and low total serum protein. Therefore, during assessment of alcohol dependent patients, clinicians should keep these parameters in mind in order to prevent DT. |
회복실 간호사의 각성 섬망에 대한 지식과 각성 섬망 관련 업무 스트레스에 관한 연구 | Purpose: This study was done to identify the level of knowledge on and stress from delirium among recovery room nurses, and correlations between these factors. Methods: In this study, 125 nurses agreed to participate in the study were surveyed from October 8 to October 28, 2013. Data were analyzed using t-test, ANOVA, Scheffe test and Pearson correlation. Results: Average percentage of correct answers to questions about delirium was 81.9% and the mean score was 26.22 (±5.01). The mean score for recovery room nurses`` work stress from emergency delirium was 3.86 (±0.99). Extent of knowledge on delirium significantly differed by age (F=15.017, p .001), length of clinical experience (F=22.132, p .001), length of recovery room experience (F=10.538, p .001), education (F=3.312, p =.040), and marital status (t=4.107, p .001). Stress from ED was significantly related to age (F=9.185, p .001), clinical experience (F=7.077, p=.001), and marital status (t=-2.027, p =.045). Knowledge on delirium had a negative relationship with stress from delirium (r=-.514, p .001). Conclusion: Results show that nurses gained knowledge of delirium from their own clinical experience indicating a need to develop educational programs to improve knowledge on delirium and plans to reduce stress from delirium for recovery room nurses. |
섬망 증세와 신체 활동도에 호전을 보인 뇌전이가 있는 소세포폐암 환자 1례 | ObjectivesThe aim of this study was to report the improvement of delirium and performance status in the small-cell lung cancer patient who had multiple brain metastases and pericardial effusion after Sasang constitutional treatment. MethodsWe retrospectively reviewed the medical records, medical laboratory and image scans of 71-year-old male patient diagnosed as small-cell lung cancer. ResultsThe small-cell lung cancer with multiple brain metastases patient sometimes talked deliriously even after the whole brain radiation therapy. During the hospitalization period, he showed delirium. We treated him with Gihwangbaekho-tang and Dojeokgangki-tang as a main therapy. After treatment, he didn't show delirium and performance status was improved. ConclusionsA small-cell lung cancer with multiple brain metastases patient showed the improvement of symptoms (delirium, poor performance status, constipation and poor oral intake) with the treatment of Gihwangbaekho-tang, Yanggyuksanhwa-tang and Dojeokgangki-tang. |
졸피뎀 유발 섬망의 발생률 및 위험요인 | Background/Aims: Zolpidem is a safe and effective drug for the treatment of insomnia. However, there are some reports of adverse effects, such as delirium, after administration of zolpidem. The aim of this study was to evaluate the incidence of and risk factors for zolpidem-induced delirium. Methods: This retrospective study enrolled 481 patients who were admitted to hospital and received zolpidem between January and May 2011. We analyzed the incidence and risk factors associated with zolpidem-induced delirium. Results: Zolpidem-induced delirium occurred in 19 of 481 (4.0%) patients. Zolpidem-induced delirium was significantly associated with old age (≥ 65 years; odds ratio [OR] = 4.35, 95% confidence interval [CI] = 1.52-12.44, p = 0.006) and co-administration of benzodiazepine (OR = 4.30, 95% CI = 1.52-12.12, p = 0.006). When males > 65 years-old took both benzodiazepine and zolpidem simultaneously, the incidence of delirium was notably elevated (OR = 6.04, 95% CI = 1.80-20.20, p = 0.003). Other factors, including dosage, did not influence the occurrence of delirium. Conclusions: Old age and co-administration of benzodiazepine were independent risk factors for zolpidem-induced delirium. Therefore, a detailed medical history should be taken before prescribing zolpidem to an older person, and zolpidem should be used cautiously, with careful monitoring, in these patients. (Korean J Med 2013;84:804-809) |
노인의 섬망 사정을 위한 도구의 임상적 사용 용이성에 관한 연구 | Purpose: This study was undertaken to identify which delirium screening instrument would be more useful in clinical practice. Methods: Data were collected from 118 nurses from six hospitals in five provinces in Korea. For the delirium screening three instruments were compared: NEECHAM Confusion Scale (NEECHAM), Nursing Delirium Screening Scale (Nu-DESC), Delirium Observation Scale (DOS). The MMSE-K was used for concurrent validity. The nurse subjects were surveyed as to the practical clinical value of each instrument. Cronbach's α coefficient and Kuder-Richardson 20 were used to confirm the reliability. Results: The range of three scales reliability was .70~.82 and the range of correlation coefficient was .63~.82 with MMSE-K. For sensitivity of NEECHAM, Nu-DESC and DOS was 1.00, 1.00 and 0.81 respectively and specificity NEECHAM, Nu-DESC and DOS was 0.88, 0.89 and 0.89 respectively. Nurses rated the practical use of the DOS scale as significantly easier to use than the NEECHAM and Nu-DESC. Conclusion: NEECHAM, Nu-DESC and DOS scales were acceptable in terms of reliability, validity, sensitivity and specificity. However, nurses rated the DOS scale as easier scale to use and had more relevance to their practice. |
정형외과병원 간호사의 섬망간호에 대한 지식, 수행 및 스트레스 | Purpose: This study was conducted to investigate the correlation among nurses' knowledge, performance, and stress about care for delirium. Methods: The data were collected using the instruments for knowledge about nursing care (50 items), performance (23 items), and stress (20 items). Descriptive statistics and Pearson’s correlation coefficient were used to analyze the data of 222 participants. Results: Nursing knowledge were different by clinical experience (F=3.12, p=.016), position at work (t=-2.54, p=.012), experience in caring patients with delirium (t=3.90, p<.001), and conflicts with other disciplines on matters related to delirium (t=4.00, p=.001). The difference in performance were associated with age (F=4.19, p=.001), clinical experience (F=2.67, p=.003), and whether there was a guideline for managing the patients with delirium (t=2.30, p=.022). Stress of nurses was different by whether they had a religion or not (t=-2.41, p=.017). The knowledge of care for delirium had the positive relationship with performance (r=.21, p=.001) and negative relationship with stress (r=-.29, p=.001). Conclusion: It is necessary to develop educational program and guideline for improving the knowledge and performance in care for delirium among nurses working at orthopedic hospitals. |
섬망 교육 프로그램이 중환자실 간호사의 섬망 지식, 간호중재 중요도 및 수행에 미치는 영향 | Purpose: The purpose of this study was to develop a delirium education program for nurses and assess its effects on knowledge of delirium, the importance of nursing intervention, and nursing practice. Method: Participants comprised 60 nurses in a university hospital. The experimental group participated in a 3-hour delirium education program. Data were collected using structured questionnaires. Chi square and independent t-tests were conducted to examine similarities in demographic and dependent variables, and an independent t-test was used to test the hypothesis. Results: The experimental group obtained significantly higher scores than the control group in knowledge of delirium(t=14.52, p<.001), importance of nursing intervention(t=13.76, p<.001), and nursing practice (t=13.71, p<.001). Conclusion: Results suggest that delirium education is an effective tool to improve knowledge of delirium, importance of nursing intervention, and nursing practice. Therefore, delirium education would be beneficial for general ward and recently graduated nurses as well as ICU and experienced nurses. |
노인 입원 환자에서 섬망 발생과 결과에 대한 후향적 연구 | Objectives：This study was aimed to examine the development and outcome of delirium in elderly inpatients retrospectively. Methods：We reviewed medical records of 2,570 patients, who were referred to consultation of psychiatry between January 2007 and December 2011. We found 916 patients(35.6%) who were confirmed as delirium by psychiatrists with DSM-IV-TR diagnostic criteria. The epidemiologic and clinical information were obtained and the factors affecting on recovery and recurrence of delirium were explored. All statistical analyses were conducted by using Pearson Chi-Square test, Student`s t-test, Binary logistic regression analysis with SPSS 17.0. Results：916 patients presented delirium. 577 patients(63.0%) were men and 339 patients(37.0%) were women. The mean of age was 74.6 years. The most frequently prescribed medicine was risperidone(52.7%), and followed by quetiapine(26.8%), olanzapine (9.9%). We found significant differences in Sex, Age, Ambulation state and Treatment in recovered and unchanged patients group. Additionally we also found that male sex can be a risk factor of recurrent delirium(OR 1.914, CI 1.102-3.323). Conclusion：These results suggest that female, advanced age, ambulation and antipsychotic medication can be associated with positive outcome of delirium, whereas male can increase the risk of recurrence of delirium.
Objectives：This study was aimed to examine the development and outcome of delirium in elderly inpatients retrospectively. Methods：We reviewed medical records of 2,570 patients, who were referred to consultation of psychiatry between January 2007 and December 2011. We found 916 patients(35.6%) who were confirmed as delirium by psychiatrists with DSM-IV-TR diagnostic criteria. The epidemiologic and clinical information were obtained and the factors affecting on recovery and recurrence of delirium were explored. All statistical analyses were conducted by using Pearson Chi-Square test, Student`s t-test, Binary logistic regression analysis with SPSS 17.0. Results：916 patients presented delirium. 577 patients(63.0%) were men and 339 patients(37.0%) were women. The mean of age was 74.6 years. The most frequently prescribed medicine was risperidone(52.7%), and followed by quetiapine(26.8%), olanzapine (9.9%). We found significant differences in Sex, Age, Ambulation state and Treatment in recovered and unchanged patients group. Additionally we also found that male sex can be a risk factor of recurrent delirium(OR 1.914, CI 1.102-3.323). Conclusion：These results suggest that female, advanced age, ambulation and antipsychotic medication can be associated with positive outcome of delirium, whereas male can increase the risk of recurrence of delirium. |
응급실에서의 노인환자의 섬망 | Objectives：It is known that delirium is common among elder patients and is associated poor clinical outcomes. As elderly patients are increasing in emergency department(ED), the prevalence of delirium should be on the rise. However delirium has been under-recognized by medical team. Our study was designated to evaluate the frequency, the clinical effect and risk factors of delirium of hospitalized elder patients in ED. Methods：We retrospectively reviewed elderly patients admitted to general ward after over 24 hours hospitalization in ED between January 2008 and December 2008. examined the frequency and assessed the clinical effect and risk factors. Results：Among 414 patients, 42 patients(10.1%) developed delirium in ED over 12 month period studied. The development of delirium in ED was associated with significant poor outcomes ; increased hospital mortality and prolonged hospital stays. Independent risk factors of delirium were stroke, metabolic derangements, dementia, hemodynamic instability, depression. Conclusion：ED environment can be important risk factors of delirium, thus ED physician should try to recognize and correct the possible risk factors of delirium earlier and in particular, should try to reduce exposure time to the ED environment in elderly patients. |
인공관절치환수술 노인의 섬망 발생 영향요인 | Purpose: This retrospective chart review study was carried out in order to examine the frequency of delirium, and to identify the risk factors associated with the development of delirium in elderly patients with arthroplasty. Methods: Data were collected from medical records of patients who received arthroplasty during one and half year in a hospital. Three hundred sixty five patients were selected for the study. The onset of delirium was reviewed based on the result of psychological doctor's consultation or nurse's assessment with Confusion Assessment Method and delirium onset risk factors were examined. Data were analyzed with descriptive statistics, t-test, x2-test, Fisher's exact test and logistic regression analysis. Results: Delirium occurred with 31 patients (8.5%) out of 365 patients who underwent arthroplasty. There were statistically significant differences between incidence of delirium and gender (x2=6.11, p=.025), age (x2=32.81, p<.001), hearing difficulty (x2=8.08, p=.012), albumin level of preoperational day (t=-3.43, p<.001), albumin (t=-2.20, p=.028) and hemoglobin level (t=-2.83, p=.005)of operational day. Age and gender were the most significant predictive factors with regard to the incidence of delirium. Conclusion: Through understanding of these results, nurses will be able to identify those patients who may be at risk for developing delirium in early stages.
Purpose: This retrospective chart review study was carried out in order to examine the frequency of delirium, and to identify the risk factors associated with the development of delirium in elderly patients with arthroplasty. Methods: Data were collected from medical records of patients who received arthroplasty during one and half year in a hospital. Three hundred sixty five patients were selected for the study. The onset of delirium was reviewed based on the result of psychological doctor's consultation or nurse's assessment with Confusion Assessment Method and delirium onset risk factors were examined. Data were analyzed with descriptive statistics, t-test, x2-test, Fisher's exact test and logistic regression analysis. Results: Delirium occurred with 31 patients (8.5%) out of 365 patients who underwent arthroplasty. There were statistically significant differences between incidence of delirium and gender (x2=6.11, p=.025), age (x2=32.81, p<.001), hearing difficulty (x2=8.08, p=.012), albumin level of preoperational day (t=-3.43, p<.001), albumin (t=-2.20, p=.028) and hemoglobin level (t=-2.83, p=.005)of operational day. Age and gender were the most significant predictive factors with regard to the incidence of delirium. Conclusion: Through understanding of these results, nurses will be able to identify those patients who may be at risk for developing delirium in early stages. |
한국의 노인환자에 대한 섬망 및 졸음 유발 약물의 사용평가 | In Korea, elderly population aged 65 and older are about 5.0% and 10.7% in 1990 and 2009, respectively. Since elderly people may experience physiologic changes with aging and their pharmacodynamic and pharmcokinetic parameters also have been undergone changes, several adverse drug reactions can occur more frequently than young people. Especially,neuropsychiatric adverse drug reactions such as delirium and drowsiness endanger elderly patients more. The purpose of this study is to evaluate the outpatient prescriptions using drug causing delirium and drowsiness in elderly patients aged 65 and older. We retrospectively reviewed prescriptions for elderly patients collected from four community pharmacies from January 2nd to February 1st, 2010. One pharmacy was located closed to a general hospital, and others were located closed to a internal medicine or an ENT clinic. The each number of the collected prescriptions was followings; Group A (n=496) from internal medicine department of a general hospital; Group B (n=44) from ENT department of general hospital; Group C (n=144) from internal medicine clinic; Group D (n=110) from ENT clinic. In result, in Group A, the average number of prescribed drugs causing delirium or drowsiness per Rx was 2.38 In Group B, the average number of prescribed drugs causing delirium or drowsiness per Rx was 2.09 In Group C, the average number of prescribed drugs causing delirium or drowsiness per Rx was 2.51. In Group D, the average number of prescribed drugs causing delirium or drowsiness per Rx was 2.72. Especially, in Group D, the percentage of prescription that drugs causing delirium or drowsiness per Rx prescribed more than 3 is 52.73% In all the 4 groups, over the 60%of drugs causing delirium and/or drowsiness per prescription of elderly patients were prescribed. It means elderly patients take 2 drugs causing delirium and/or drowsiness among 3 drugs, which is very serious. Frequently prescribed drugs causing delirium and/or drowsiness were followings; GI agents, antitussives & expectorants, histamine H1 antagonist,analgesics, antibiotics. Among these drugs, GI agents was high raking in all the 4 groups, and pharmacists should caution elderly patients when counseling. In the internal medicine groups (Group A,C), drugs concerning chronic diseases were prescribed frequently. In conclusion, pharmacist's role is important. Pharmacists are well informed of the drugs causing delirium or drowsiness and it is important to explain about ADRs slowly and easily to the elderly patients that receive drugs causing delirium or drowsiness. And institutional device is needed. For example, when doctors prescribe drugs for the elderly patients, message is needed that supply some informations about drugs causing delirium or drowsiness. |
고관절 골절 수술후 발생한 섬망환자의 치과보철물에 의한 폐렴 | We report a case of delayed diagnosed pneumonia due to an aspirated metallic crown, which had been detached from a molar tooth. Dental prosthesis should be checked and a careful review of the chest radiograph is mandatory when an elderly patient with delirium after hip fracture surgery develops pneumonia postoperatively. (J Korean Soc Traumatol 2012;25:97-100) |
간호사의 섬망사정능력 | Purpose: The purpose of this study was to identify related factors of perceived delirium assessment ability (PDAA)of clinical nurses. Methods: A descriptive survey design with a convenience sampling was used with 266 nurses who were recruited from P university hospital. Data were analyzed using descriptive statistics, ANOVA, Pearson correlation, and stepwise multiple regression with the SPSS/WIN 18.0 program. Results: Nurses scored low for knowledge of symptoms and management of delirium. Factors related to PDAA were ‘sufficiency in opportunities for education about delirium’ (β=.325, p<.001), ‘experience of caring for patients with delirium’ (β=.228, p<.001),‘duration of work’ (β=.139, p = .004), and ‘level of knowledge on delirium’ (β=.128, p = .021). These variables explained 24.2% of the variance in PDAA. Conclusion: Findings of the study indicate that nurses need up-to-date educational programs that include actual practices of delirium assessment as well as global knowledge of delirium. Because most nursing floors do not have care manuals for patients with delirium, having care manuals and corresponding educations is essential. Further studies including participants from broader geographical areas and methodology to examine the effects of educational program on PDAA are warranted to enhance the generalizability of the findings and examine the effectiveness of the program. |
섬망 치료에 있어서 Quetiapine과 Risperidone의 효과 비교 | Objectives：It has been shown that risperidone, an atypical antipsychotics, has effectiveness for treatment of delirium as good as haloperidol and has less side effects than haloperidol. Quetiapine also has less extrapyramidal side effects and has effectiveness for treatment of delirium. The aim of this study was to investigate whether quetiapine is effective for the treatment of delirium compared with risperidone. Methods：All subjects(71 patients) were randomized to receive either risperidone(35 patients) or quetiapine(36 patients) with fixed dose at the first day of treatment. Then, all subjects received either medications with flexible doses according to judgement on clinical status of patients. The effectiveness was evaluated using Clinical Global Impression-Severity(CGI-S), Korean version of Delirium Rating Scale(K-DRS), Korean Mini Mental Status Examination(K-MMSE), and Korean version of Delirium Rating Scale-Revised-98. Results：There was no significant difference between both groups in the baseline K-DRS, K-DRS-R-98, K-MMSE and CGI scores. At the seventh day of the treatment, K-DRS, K-DRS-R-98 and CGI scores were significantly improved from the baseline both in the quetiapine and risperidone treatment group. Conclusion：Quetiapine is effective for treatment of delirium.
Objectives：It has been shown that risperidone, an atypical antipsychotics, has effectiveness for treatment of delirium as good as haloperidol and has less side effects than haloperidol. Quetiapine also has less extrapyramidal side effects and has effectiveness for treatment of delirium. The aim of this study was to investigate whether quetiapine is effective for the treatment of delirium compared with risperidone. Methods：All subjects(71 patients) were randomized to receive either risperidone(35 patients) or quetiapine(36 patients) with fixed dose at the first day of treatment. Then, all subjects received either medications with flexible doses according to judgement on clinical status of patients. The effectiveness was evaluated using Clinical Global Impression-Severity(CGI-S), Korean version of Delirium Rating Scale(K-DRS), Korean Mini Mental Status Examination(K-MMSE), and Korean version of Delirium Rating Scale-Revised-98. Results：There was no significant difference between both groups in the baseline K-DRS, K-DRS-R-98, K-MMSE and CGI scores. At the seventh day of the treatment, K-DRS, K-DRS-R-98 and CGI scores were significantly improved from the baseline both in the quetiapine and risperidone treatment group. Conclusion：Quetiapine is effective for treatment of delirium. |
섬망 치료에 있어 Aripiprazole과 Haloperidol의 효과 및 부작용 비교 | Objectives:To compare the efficacy and the safety of aripiprazole and haloperidol in the treatment of patients with delirium. Methods:26 patients with delirium were randomized to receive either aripiprazole or haloperidol and finally 20 patients were analyzed. We collected demographic and clinical data. The Korean Version of Delirium Rating Scale-revised-98 (K-DRS-98) and Korean Version of Drug Induced Extrapyramidal Symptom Scale (DIEPSS-K) were assessed. Blood samples were collected to an- alyze serum sodium ion concentration, plasma cortisol and prolactin level and pulse oximetry was used for measuring oxygen satu- ration. Results:K-DRS-98 severity scores decreased in both groups significantly over the study period, but no statistically significant difference was observed between the two groups. No significant extrapyramidal syndromes were noted in both groups, but the use of haloperidol was associated with increased plasma prolactin level (From 24.0±28.1 ng/mL to 32.0±20.0 ng/mL, p=0.005). Conclusion:Aripiprazole is as effective as haloperidol in the treatment of delirium and aripiprazole may be safer than haloperi- dol in that haloperidol is associated with increased plasma prolactin level.
Objectives:To compare the efficacy and the safety of aripiprazole and haloperidol in the treatment of patients with delirium. Methods:26 patients with delirium were randomized to receive either aripiprazole or haloperidol and finally 20 patients were analyzed. We collected demographic and clinical data. The Korean Version of Delirium Rating Scale-revised-98 (K-DRS-98) and Korean Version of Drug Induced Extrapyramidal Symptom Scale (DIEPSS-K) were assessed. Blood samples were collected to an- alyze serum sodium ion concentration, plasma cortisol and prolactin level and pulse oximetry was used for measuring oxygen satu- ration. Results:K-DRS-98 severity scores decreased in both groups significantly over the study period, but no statistically significant difference was observed between the two groups. No significant extrapyramidal syndromes were noted in both groups, but the use of haloperidol was associated with increased plasma prolactin level (From 24.0±28.1 ng/mL to 32.0±20.0 ng/mL, p=0.005). Conclusion:Aripiprazole is as effective as haloperidol in the treatment of delirium and aripiprazole may be safer than haloperi- dol in that haloperidol is associated with increased plasma prolactin level. |
섬망 환자에서 Amisulpride의 유효성 및 내약성에 관한 예비 연구 | Objectives：Delirium is a disorder that needs active treatments since it is associated with poor outcomes such as comorbidity, longer hospital stay, higher mortality rate, higher rates of institutional care and dementia. This study was done to investigate the efficacy and safety of amisulpride, a atypical antipsychotic drug that is in possession of distinguishable pharmacodynamic profile characteristics from other widely used atypical antipsychotic drugs, but it has characteristics that are most similar to haloperidol which was the most commonly used antipsychotic drug treating patients with delirium in a safe manner. Methods：We recruited 19 delirium patients. Korean version of Delirium Rating Scale-Revised-98(K-DRS-R-98) and Korean version of Delirium Rating Scale(K-DRS) had been used to measure severity and improvement of delirium symptoms. Clinical Global Impression Severity Score(CGI-S) had been used to examine general medical conditions in the patients. The assessment on side effects began from day 2 for every visit to patients using Simpson-Angus Scale(SAS), Barnes Akathisia Rating Scale(BARS), Abnormal Involuntary Movement Scale(AIMS). Results：A total of 14 patients completed the study. They were administered with mean amisulpride dose 86.16 (SD=39.01) mg per day. The K-DRS scores were decreased from 21.57±4.72 before the treatment to 7.14±0.84 after the treatment(p＜0.01). The K-DRS-R-98 scores also were significantly decreased from 25.07±6.40 before the treatment to 9.93±1.09 after the treatment(p＜0.01). Among detailed K-DRS-R-98 scale items, the sleep item also showed a significant decrease(p＜0.01). There was no patient who suffered serious side effects. In 35.7% of the patients, the mild rigidity and mild tremor of extrapyramidal symptoms occurred. Conclusion：Amisulpride is expected to be used effectively and safely in treating delirium patients |
암환자 섬망의 중증도와 사망위험도의 관계 | Objectives：To assess the association between severity of delirium and mortality in cancer patients and to investigate the phenomenology of delirium among those facing imminent death. Methods：We retrospectively reviewed the charts of 112 cancer patients with delirium at a cancer center. The subjects were categorized into three groups(deceased before discharge, discharged without hope for improvement, and improved). Severity of delirium was assessed using Korean version of the Delirium Rating Scale-Revised-98(K-DRS-R-98), and the scores of the three groups were compared after adjusting for the demographic and clinical factors that differed in the univariate analyses(p＜0.1). Results：Of the 112 patients, 20(17.9%) died prior to discharge, 28(25.0%) were discharged without hope for improvement, and 64(57.1%) improved during the index admission period. We found a significant difference in the total K-DRS-R-98 scores of the three groups(24.2, 26.1, and 21.2, respectively, p=0.002), which was maintained after adjusting for potential confounding factors(age, abnormality of white blood cell counts, and use of antibiotics and opioids). The total K-DRS-R-98 scores in the post-hoc analyses were significantly higher in the deceased-before-discharge and discharged-without-hope-for-improvement groups than in the improved group(p=0.017 and ＜0.001, respectively). According to scores on the K-DRS-R-98, sleep-wake cycle disturbances, language and cognitive abnormalities, and difficulties with attention, short-term memory, and visuospatial abilities were more frequent in cancer patients in the deceased-before-discharge and discharged-without-hope groups than in the improved group. Conclusion：The severity of delirium at the time of psychiatric consultation was significantly associated with mortality in cancer patients with delirium.
Objectives：To assess the association between severity of delirium and mortality in cancer patients and to investigate the phenomenology of delirium among those facing imminent death. Methods：We retrospectively reviewed the charts of 112 cancer patients with delirium at a cancer center. The subjects were categorized into three groups(deceased before discharge, discharged without hope for improvement, and improved). Severity of delirium was assessed using Korean version of the Delirium Rating Scale-Revised-98(K-DRS-R-98), and the scores of the three groups were compared after adjusting for the demographic and clinical factors that differed in the univariate analyses(p＜0.1). Results：Of the 112 patients, 20(17.9%) died prior to discharge, 28(25.0%) were discharged without hope for improvement, and 64(57.1%) improved during the index admission period. We found a significant difference in the total K-DRS-R-98 scores of the three groups(24.2, 26.1, and 21.2, respectively, p=0.002), which was maintained after adjusting for potential confounding factors(age, abnormality of white blood cell counts, and use of antibiotics and opioids). The total K-DRS-R-98 scores in the post-hoc analyses were significantly higher in the deceased-before-discharge and discharged-without-hope-for-improvement groups than in the improved group(p=0.017 and ＜0.001, respectively). According to scores on the K-DRS-R-98, sleep-wake cycle disturbances, language and cognitive abnormalities, and difficulties with attention, short-term memory, and visuospatial abilities were more frequent in cancer patients in the deceased-before-discharge and discharged-without-hope groups than in the improved group. Conclusion：The severity of delirium at the time of psychiatric consultation was significantly associated with mortality in cancer patients with delirium. |
폐렴 치료 중 위증(위證)을 동반한 섬망 발생 환자 치험1례 | Delirium is an acute syndrome of disorientaion caused by dysfunction of brain and has many various symptoms. The characteristic symptoms of delirium are conscious disturbance with disorientation, dysarthria and emotional disturbance. We experienced 84-year-old man who had Wi syndrome(위證) as well as delirium during the treatment of pneumonia, and whose condition was improved through Oriental medical treatment. The patient was diagnosed as Yangmyeong Disease(陽明病) that was caused by heat in the stomach and stool in the colon, and was treated with Daeseungki-tang (Dachengqi-tang, 大承氣湯). We were able to improve the delirium caused by high fever infection through Oriental medical treatment. |
섬망 심각도와 관련된 위험 요인 | ObjectivesZZThe purpose of this study was to investigate the relationship between the sum of the risk factors for delirium and the severity of delirium and to identify those risk factors which increase the severity of delirium. MethodsZZThe participants were 151 patients who were consulted with a consultation-liaison psychiatrist and diagnosed using DSM-IV criteria as suffering from delirium. Sociodemographic and clinical characteristics were obtained through structured interviews and medical chart reviews. The severity of delirium symptoms was measured by the Korean version of the Delirium Rating Scale-Revised 98 (K-DRS-R98). Patients were divided into two groups : a ‘mild delirium group (MDG)’, whose total scores on the K-DRS-R98 were below 16, and a ‘severe delirium group (SDG)’ with the scores above 16. ResultsZZThere was a positive correlation between the sum of known risk factors for delirium and total scores on the K-DRS-R98 (p=0.009). The SDG showed a significantly higher incidence of abnormal potassium levels, abnormal sodium levels, old age, and polypharmacy than the MDG (p=0.010, p=0.046, p=0.042, and p=0.033 respectively). In a logistic regression model, old age, abnormal sodium and potassium levels, and polypharmacy were found to predict increased severity of the delirium (p=0.001, p=0.007, p=0.019, and p=0.005 respectively). ConclusionZZThe present findings suggested that there are certain factors which not only affect the occurrence of delirium, but also severity of delirium symptoms.
ObjectivesZZThe purpose of this study was to investigate the relationship between the sum of the risk factors for delirium and the severity of delirium and to identify those risk factors which increase the severity of delirium. MethodsZZThe participants were 151 patients who were consulted with a consultation-liaison psychiatrist and diagnosed using DSM-IV criteria as suffering from delirium. Sociodemographic and clinical characteristics were obtained through structured interviews and medical chart reviews. The severity of delirium symptoms was measured by the Korean version of the Delirium Rating Scale-Revised 98 (K-DRS-R98). Patients were divided into two groups : a ‘mild delirium group (MDG)’, whose total scores on the K-DRS-R98 were below 16, and a ‘severe delirium group (SDG)’ with the scores above 16. ResultsZZThere was a positive correlation between the sum of known risk factors for delirium and total scores on the K-DRS-R98 (p=0.009). The SDG showed a significantly higher incidence of abnormal potassium levels, abnormal sodium levels, old age, and polypharmacy than the MDG (p=0.010, p=0.046, p=0.042, and p=0.033 respectively). In a logistic regression model, old age, abnormal sodium and potassium levels, and polypharmacy were found to predict increased severity of the delirium (p=0.001, p=0.007, p=0.019, and p=0.005 respectively). ConclusionZZThe present findings suggested that there are certain factors which not only affect the occurrence of delirium, but also severity of delirium symptoms. |
다음증, 약물 남용, 섬망 등을 보이며 불안을 동반한 39세 남자 환자 | ObjectivesZZThe first objective of this study was to examine the extent to which the results of the visual interpretation of brain single photon emission computed tomography (SPECT) images correspond with those of SPM analysis in patients with traumatic brain injury (TBI). The second objective was to explore the possibility of the clinical application of SPM analysis for finding the brain lesions related to the neuropsychiatric symptoms, of which the patients complained. MethodsZZSPECT images from 10 TBI patients (all male, mean age: 46.8±12.32) and 10 age- and sex-matched control subjects were interpreted by an experienced radiologist. Their SPECT images were also analyzed by SPM2 software for comparing the individual images with the controls. ResultsZZThe results of visual interpretation of SPECT images generally corresponded with those of SPM analysis in five of the 10 TBI cases. In the remaining cases, brain lesions not identified from visual interpretation were found through SPM analysis. The location of these lesions included the anterior cingulate gyrus, caudate nucleus, thalamus, and subcallosal gyrus. SPM analysis also made it easy to find brain hypoperfusion areas associated with the TBI patients’ neuropsychiatric symptoms. ConclusionZZThis study suggested possible clinical applications of SPM analysis of SPECT data from patients with TBI. Its advantages and limitations were discussed. |
암환자 섬망의 약물치료 | Objectives: Despite the fact that delirium is a frequent neuropsychiatric disorder in cancer patients, there are, in Korea, no guidelines for the pharmacological treatment of such delirium. This systematic review evaluated the efficacy and safety of some pharmacological interventions and summarized the results. Methods: We searched PubMed, Embase, CINAHL, the Cochrane Library, and the KMbase, targeting from January 1990 to October 2008, using key words. Moreover, we included systematic reviews, meta-analyses, and randomized controlled trial literature in the search. Then, we stratified the trials based on their evidence levels. Results and Conclusion: We identified 13 randomized, controlled studies and 2 case-control studies that met our inclusion criteria. These showed that haloperidol was the medication of choice to treat delirium. In addition, they revealed that atypical antipsychotics have not shown clear superiority with regard to effectiveness as compared to haloperidol. Neither donepezil nor rivastigmine were shown to be effective in preventing or treating delirium. |
일 대학병원 정신과에 협진 의뢰된 환자 중 의뢰의가 섬망 진단을 놓치게 하는 요인: 예비연구 | Objectives: The misdiagnosis of delirium may result in a delay of correct diagnosis and appropriate treatment of the delirium. Additionally, aggravation of physical illnesses can occur. The objective of this study was to investigate patient characteristics in cases of misdiagnosed delirium upon psychiatric consultation in a university hospital. Methods: Subjects included patients with delirium among all who we had consulted over a 12week span. Psychiatric diagnosis was made by two well-trained psychiatrists by means of the DSM-IV-TR. Cognitive function, level of delirium, and physical function were evaluated by the Korean version of Mini Mental Status Examination (MMSE-K), the Delirium Rating Scale-Revised-98(DRS-R-98), the Clinical Global Impression-Severity (CGI-S), the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and the Global Assessment of Functioning Scale (GAF). In addition, we collected socio-demographic information, date of admission and consultation, present causes of consultation, and speculated psychiatric diagnoses made by referring physicians. Results: Among 45 subjects with delirium, only 28 patients (62%) were diagnosed with delirium by referring physicians at the time of consultation. The remaining 17 patients (38%) had been diagnosed with other illnesses. The group of misdiagnosed patients tended to have a longer duration of formal education than those that had been correctly diagnosed. Conclusion: Early diagnosis and intervention of delirium can minimize subsequent problems related to delayed diagnosis. Therefore, it is vital to identify the factors related to misdiagnoses by referring physicians. This study showed that a longer duration of formal education is a contributing factor for the misdiagnosis of delirium. Longer education may cover up the typical symptoms of delirium. This can keep referring physicians from making a correct diagnosis. This study was a pilot study investigating diagnostic accuracy of delirium by referring physicians. Additional, well-controlled studies are warranted. |
급성기 뇌졸중에서 섬망이 기능 회복에 미치는 영향 | Objective: To investigate the risk factors for poststroke delirium and evaluate its influence on functional recovery after ischemic stroke. Method: Risk factors for delirium were investigated retrospectively in three hundred twenty nine acute ischemic stroke patients over 60 years of age. Among the 329 patients, sixty seven developed delirium. Data were analyzed between delirium group (n=22) and control group (n=22) according to age, sex, lesion location and clinical features. Korean modified Barthel index (K-MBI), Korean National Institutes of Health stroke scale (K-NIHSS) and Korean mini-mental state examination (KMMSE) were measured at second and sixth weeks after onset and compared for both groups. Results: Parameters showing statistically significant difference between two groups were age over 80, hyponatremia, sleep deprivation, cognitive impairment and cardiogenic embolism. There was no significant difference in K-MBI, K-NIHSS and K-MMSE scores at second week between the two groups. The delirium group showed significantly less improvement in K-MBI and K-NIHSS scores compared to control group (9.5±10.2 vs 18.5±11.6, p=0.011; ?0.7±1.2 vs ?1.8±1.3, p=0.014). There was no significant improvement in K-MMSE score. Conclusion: The possible risk factors for delirium in acute ischemic stroke are age over 80, hyponatremia, sleep deprivation, cognitive impairment and cardiogenic embolism. Stroke patients with comorbid delirium showed poorer functional outcome. Delirium seems to have detrimental effect in functional recovery after stroke. (J Korean Acad Rehab Med 2010; 34: 403-408) |
간이식 수술 후 발생한 술 후 섬망의 위험 인자에 대한 고찰 | Background: Postoperative delirium (POD) after liver transplantation is a serious complication. This study investigated the incidence and the risk factors of POD in liver transplantation recipients. Methods: Three hundred and sixty eight adult recipients who had undergone liver transplantation were included. We reviewed medical records and the POD was determined by either psychiatric consultation or established diagnostic criteria. Recipients were divided into two groups according to the occurrence of POD: POD group (n=150) and non-POD group (n=218), and risk factors were assessed. Results: One hundred fifty (40.8%) of the 368 recipients developed POD after liver transplantation. History of alcohol consumption and alcoholic liver disease, history of hepatic encephalopathy, preoperative mental status changes, ventilator care, dialysis, hypotension, and ICU care were significantly higher in the POD group. In the preoperative laboratory test, sodium was lower while bilirubin, PT (INR) and MELD score were higher in the POD group. Postoperative variables including dialysis, ventilator care duration, ICU stay, hospital stay, glucose and ammonia were significantly higher in the POD group. Three variables were identified as independent predictors of POD in a multiple regression analysis: history of alcohol consumption (odds ratio, 2.04; 95% confidence interval [CI], 1.12-3.72; P=0.02), history of hepatic encephalopathy (odds ratio, 2.54; 95% CI, 1.46-4.41, P<0.01), and MELD score (odds ratio, 1.03; 95% CI, 1.00-1.06; P=0.02). Conclusions: The development of POD and related morbidity and mortality would be reduced if we identified the recipients with risk factors preoperatively and applied early intervention. (Korean J Anesthesiol 2009;57:584∼9) |
섬망 치료에 있어서 지프라시돈(Ziprasidone)과 리스페리돈(Risperidone)의 효과 비교 | Objectives：It has been shown that risperidone, an atypical antipsychotics, has effectiveness for treatment of delirium as good as haloperidol and has less side effects than haloperidol. Ziprasidone also has less extrapyramidal and anticholinergic side effects, but there has been little information published on ziprasidone for the treatment of patients with delirium. Therefore, this study investigated whether ziprasidone had effectiveness for treatment of delirium and whether there was a differential effect between risperidone and ziprasidone. Methods：Sixteen patients with delirium were enrolled in this study. All subjects(16 patients) were randomized to receive either risperidone(7 patients) or ziprasidone(9 patients) with fixed dose at the first day of treatment. Risperidone group was given 1mg and ziprasidone group was given 20mg at the first day of treatment in the night. Then, all subjects received either medications with flexible doses according to judgement on clinical status of patients. The effectiveness was evaluated using Clinical Global Impression-Severity(CGI-S), Korean version of Delirium Rating Scale(K-DRS), Korean Mini Mental Status Examination(K-MMSE), and Korean version of Delirium Rating Scale- Revised-98. The side effects was evaluated using Extrapyramidal Symptom Rating Scale(ESRS) which was administered by a trained psychiatrist. Results：There was no significant difference between both groups in the baseline K-DRS, K-DRS-R-98, KMMSE and CGI scores. At the seventh day of the treatment, K-DRS, K-DRS-R-98 and CGI scores were significantly decreased from the baseline in the ziprasidone treatment group, but not in risperidone treatment group. Conclusion：These results suggest that ziprasidone appears to be more effective than risperidone for treatment of delirium.
Objectives：It has been shown that risperidone, an atypical antipsychotics, has effectiveness for treatment of delirium as good as haloperidol and has less side effects than haloperidol. Ziprasidone also has less extrapyramidal and anticholinergic side effects, but there has been little information published on ziprasidone for the treatment of patients with delirium. Therefore, this study investigated whether ziprasidone had effectiveness for treatment of delirium and whether there was a differential effect between risperidone and ziprasidone. Methods：Sixteen patients with delirium were enrolled in this study. All subjects(16 patients) were randomized to receive either risperidone(7 patients) or ziprasidone(9 patients) with fixed dose at the first day of treatment. Risperidone group was given 1mg and ziprasidone group was given 20mg at the first day of treatment in the night. Then, all subjects received either medications with flexible doses according to judgement on clinical status of patients. The effectiveness was evaluated using Clinical Global Impression-Severity(CGI-S), Korean version of Delirium Rating Scale(K-DRS), Korean Mini Mental Status Examination(K-MMSE), and Korean version of Delirium Rating Scale- Revised-98. The side effects was evaluated using Extrapyramidal Symptom Rating Scale(ESRS) which was administered by a trained psychiatrist. Results：There was no significant difference between both groups in the baseline K-DRS, K-DRS-R-98, KMMSE and CGI scores. At the seventh day of the treatment, K-DRS, K-DRS-R-98 and CGI scores were significantly decreased from the baseline in the ziprasidone treatment group, but not in risperidone treatment group. Conclusion：These results suggest that ziprasidone appears to be more effective than risperidone for treatment of delirium. |
섬망환자의 한방치료 증례보고 4례 | Objectives: The purpose of this study is to report the effect of oriental medical treatments on the patients with delirium. Methods: Four patients diagnosed with delirium by DSM-ⅣTM was treated Onbaek-won(Wenbai-yuan), Jugeo-hwan(Zhouju-wan) and herb medicine. The severity of delirium was assessed by using MMSE-K. And then, we investigated and analyzed the clinical symptoms of the patients. Results: After oriental medical treatments, the symptoms of delirium were disappeared and MMSE-K score was improved. Conclusions: It could be suggested that oriental medical treatments were effective on delirium. Further study of the effect of oriental medical treatments on delirium is needed in the near future. |
소아 사시 교정술에서 마취제가 각성 섬망에 미치는 영향 | Background: This study was designed to compare the effects of anesthetic methods used recently on emergence delirium in pediatric strabismus surgery. Methods: Two hundred and thirty two children, aged 2-10 years, undergoing strabismus surgery, were randomly assigned to one of eight groups; ketamine-desflurane (n = 30), ketamine-sevoflurane (n = 30), ketamine-propofol (n = 30), ketamine-remifentanil (n = 27), midazolam-desflurane (n = 28), midazolam-sevoflurane (n = 30), midazolam-propofol (n = 27), and midazolam-remifentanil (n = 30). Anesthesia was induced with ketamine 1.0 mg/kg or midazolam 0.15 mg/kg. Laryngeal mask airway (LMA) was placed with rocuronium 0.5 mg/kg. Anesthesia was maintained with desflurane 5-6 vol%, sevoflurane 2-3 vol%, propofol 7-8 mg/kg/hr, and remifentanil 0.5μg/kg/min under N2O 66% in O2. Ventilation was controlled to maintain normocapnia. The status of emergence delirium (ED) was evaluated by a blinded observer until discharge from postanesthetic care unit. Results: There was no differences in age, sex, weight, height, anesthetic time, and recovery time among the eight groups. ED occurred in 54 children (23.3%), but severe ED needed treatment was not occurred. Compared with ketamine group, midazolam group showed less incidence of ED. Propofol and remifentanil groups showed less incidence of ED compared with desflurane and sevoflurane groups. ED group was more younger and more temperamental compared with nonED group. Conclusions: Propofol or remifentanil anesthesia provided less incidence of ED compared with desflurane and sevoflurane in pediatric strabismus surgery. (Korean J Anesthesiol 2007; 52: 138~42) |
알콜성 진전섬망으로 진단된 신지부청(神志不淸) 환자 치험 1례 | Delirium Tremens is the most terrible and dramatic syndrome in Alcohol Withdrawal Syndrome. Delirium Tremens is one of acute psychiatric symptoms and happens that a chronic drinker is suddenly off drinking for any reasons. In Oriental medicine, Alcohol Withdrawal Syndrome is comprised in a category of Jusang(酒傷).In this case, we described a 53-year old man who diagnosed as Delirium tremens. He suffered mental derangement and headache, and his condition was improved through oriental medical treatment. |
환각 및 지남력 저하에 대한 약물치료 중 발생한 섬망 환자 1例 증례보고 | Delirium is a acute syndrome of disorientation caused by dysfunction of brain tissue and has a many varied symptom. The characteristic symptoms of delirium are conscious disturbance with disorientation and dys-mnesia and emotional disturbance.We experienced a 77 year-old male who had a hallucination and disorientation as well as delirium caused by antipsychotic medication, and whose condition was improved through discontinuing medication and traditional Korean medical treatment. We had given herb medication, acupuncture treatment and decreased medication to this patient, and observed. The patient`s delirium symptom had improved through oriental medical treatment and decreasing medication. It was able to improve a delirium caused by not specified origin and side effect of drug abuse through oriental medical treatment and decreasing medication. |
섬망을 동반한 번조(煩躁) 환자의 치험 1례 | Delirium is a set of symptoms that includes Disturbance of consciousness, attention, cognition, sleep-wake cycle. It usually appears as a disease progresses. Also it can be considered as one of byun-jo(煩躁)'s symptoms because it shows similar symptom and progress to byun-jo(煩躁). One patient was admitted who was suffering delirium, restlessness, chest discomfort, disorientation. The patient was diagnosed as delirium and byun-jo that was caused by heat in the heart and stomach, and was treated with Chungul-san(淸鬱散). In the course of treatment, symptoms improved gradually. Resu suggest that Chungul-san(淸鬱散) is effective on delirium, byun-jo caused by heat in stomach. |
섬망을 동반한 번조(煩躁) 환자의 치험 1례 | Delirium is a set of symptoms that includes Disturbance of consciousness, attention, cognition, sleep-wake cycle. It usually appears as a disease progresses. Also it can be considered as one of byun-jo(煩躁)'s symptoms because it shows similar symptom and progress to byun-jo(煩躁). One patient was admitted who was suffering delirium, restlessness, chest discomfort, disorientation. The patient was diagnosed as delirium and byun-jo that was caused by heat in the heart and stomach, and was treated with Chungul-san(淸鬱散). In the course of treatment, symptoms improved gradually. Resu suggest that Chungul-san(淸鬱散) is effective on delirium, byun-jo caused by heat in stomach. |
알코올 금단 섬망 발생의 예측 | Objectives：It has been known that children reved symptoms of Posttraumatic Stress Disorder (PTSD) after experiencing traumas similar to adults. But there are a few studies regarding the psychopathologies of PTSD in preschool children. Considering more active brain and psychological development in preschool children, it is expected that trauma of preschool children causes more serious psychopathologies than those of children with older ages or adults. This study aims to investigate psychopathologies of 9 preschool children experiencing a single, severe trauma, specifically in the respect of PTSD diagnosis. Methods：Nine preschool children, 3-5 years old, experiencing physical injuries caused by attack from a psychotic patient during lunch time at kindergarten, were evaluated for clinical diagnoses through semi-structured interviews using Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and Research Diagnostic Criteria (RDC for Kiddies) of PTSD for preschool children. Results：Five (56% by DSM-IV) and Six (67%, by RDC) out of 9 children were diagnosed as to have PTSD. Among those children with PTSD, four (44%) showed Separation Anxiety Disorder (SAD) and one (17%) showed Major Depressive disorder (MDD) as comorbid diagnoses. On subclinical level, two of 9 children (22%) suffered from separation anxiety, seven (78%) from aggressive behaviors, and two (22%) from depressive mood. Sleep disturbances (89%) and reexperiencing of trauma (89%) were the most prominent symptoms of PTSD in preschool children. Conclusion：While preschool children showed profiles of PTSD symptoms similar to those of adults, it was critical to use more developmentally sensitive diagnostic tools for a better detection of psychopathologies. Young children experiencing severe trauma showed other comorbid psychopathologies along with PTSD. For proper diagnosis and intervention, it is important to make an accurate clinical diagnosis based on developmentally appropriate diagnostic process and tools.
Objectives：Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. Methods：The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. Results：The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. Conclusion：Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible. (J Korean Neuropsychiatr Assoc 2004;43(5):559-563) |
한국판 섬망 평가 척도의 표준화 | Objective ：The purpose of this study was to examine the regional cerebral blood-flow(rCBF) difference between boys with pure ADHD and normal controls before and after methylphenidate treatment, and also we examined the association between rCBF changes and cognitive characteristics of boys with pure ADHD before and after methylphenidate treatment. Methods ：The rCBF of 5 boys with pure ADHD and 5 control boys were examined by Tc-99m ECD brain SPECT and cognitive characteristics by ADS and every 5 ADHD boys took MPH for 12 to 16 weeks. After that all ADHD boys took Tc-99m ECD brain SPECT and checked ADS again. rCBF difference and changes before and after MPH treatment were quantified and analyzed by using SPM. And, associations between types of cognitive changes measured by ADS and rCBF changes were examined, and quantitative associations between them were also analyzed by using Pearson’s coefficient correlation. Results ：1) Before MPH treatment, rCBF of ADHD boys were significantly decreased in left orbitofrontal area and left caudate nucleus compared to normal controls. 2) After MPH treatment, rCBF of the same regions were significantly increased. 3) There was positive correlation between the degree of commission error(impulsivity, disinhibition) among the ADS variables and the degree of blood-flow decrease in above two areas before MPH treatment but after MPH treatment, only with the degree of rCBF increase in Lt orbitofrontal area. Conclusion ：These results suggest that the pathophysiology of impulsivity or disinhibition of the characteristic symptoms of ADHD boys is associated with hypoactivities of left orbitofrontal area and left caudate nucleus, and MPH pharmacodynamics in ADHD boys is associated to their actions on these two areas. |
노인 환자에서 고관절 치환술 중 발생한 심정지와 술후 섬망 - 증례 보고 - | An Eighty-year-old female patient was transferred to the operating room for hip arthroplasty under the general anesthesia. Immediately after injection of two units of methylmethacrylate bone cement into the intramedullary canal, systolic blood pressure rapidly decreased and cardiac arrest occurred. The patient was turned to the supine position and was successfully resuscitated with intravenous administration of fluids, injection of epinephrine and external cardiac massage. In the intensive-care unit, she was treated for acute pulmonary edema. Three days later, postoperative delirium was developed. She spoke incoherently, was disoriented, and showed impairment of memory and attention. She was treated with haloperidol, lorazepam and sedative drug, five days later recovered. The patient was discharged to home without any sequelaes, but she died due to pneumonia two months later postoperatively at home. (Korean J Anesthesiol 1999; 36: 365∼369) |
노인에서 경막외-전신마취 병용후 섬망 - 증례 보고 - | Postoperative delirium is defined as an acute change with cognitive status characterized by fluctuating consciousness and unattention occurring within 30 days after operation. Postoperative delirium is a common complication of surgery in elderly people, but have been often unrecognized, under-diagnosed, under-treated, and under-investigated. We present a case of postoperative delirium in elderly patient who should have been treated with psychotherapy and antipsychotic drugs in psychiatric department after combined epidural-general anesthesia with continuous epidural bupivacaine and fentanyl infusion for postoperative pain control. (Korean J Anesthesiol 1999; 36: 165∼168) |
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This is an abstract of a paper derived from a search for “delirium” in KISS (Koreanstudies Information Service System). "ko_data.csv" is abstract in Korean, and "en_data.csv" is abstract in English.
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