Delirium Part 2 Evaluation Management - …：谵妄2部分评价与管理—…精选.pptVIP

Recommended Reading Inouye SK. Delirium in older persons. NEJM 2006;354:1157-65 Schneider LS et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer’s disease. NEJM 2006;355:1525-38. Sink KM et al. Pharmacological treatment of neuropsychiatric symptoms of dementia. JAMA 2005;293:596-608. * * The first half of the delirium talk focused on trying to prevent delirium and then being able to recognize it when it does occur. This half will focus on how to evaluate and treat the patient after the delirium is diagnosed (via the CAM or other diagnostic tool). * We begin with a typical presentation of delirium. * Conclude this case by stating that this is a typical presentation of delirium in an older hospitalized patient, and that there are a multitude of teaching points throughout this case in both the evaluation and management of this patient. We will return to this case at the end. * Importance of a systematic approach needs to be emphasized, as well as the fact that this approach can, and should, be individualized (within the general framework discussed in the next few slides). In other words, because there is no one “gold standard” or “official” way of evaluating the delirious patient, the most important thing for clinicians to do is to develop their own approach so that they are better able to care for patients as well as better able to teach the care to others. * Repeat that there are few studies that actually try to identify causes of delirium Take home point from this study is that while the authors were confident of the cause of the delirium in a little over 1/3 of the patients, that left 2/3’s with one or more probable causes. Other important point is that of the 22 patients with more than one possible cause, the average was 2.8 possible etiologies per patient (driving home the point that, most of the time, one should not stop evaluating and treating the delirium just because of one potential factor being found). * This is an example o