综合医院精神科会诊患者谵妄的临床特点

Clinical characteristics of delirium patients referred to consultation-liaison psychiatry in general hospitals

目的:探讨综合性医院精神科会诊中的谵妄与精神病专科医院中的谵妄的临床特点。方法:对综合性医院中精神科会诊中的58例谵妄患者(会诊组)与同期在精神病院的54例患者(非会诊组)的临床资料进行对照分析,并使用谵妄评分量表中文修订版(CAM-CR)测评。结果:会诊组中的谵妄患者年龄偏大,病因复杂,内科疾病以呼吸系统感染、脑卒中、心血管疾患多见,外科疾病以脑外伤、手术后、骨折多见,其中多系统疾病引起谵妄的几率最高,CAM-CR精神运动性抑制因子分显著高于非会诊组;非会诊组相对年龄偏小,病因简单,以精神活性物质依赖戒断、老年痴呆、抗精神病药应用不当多见,CAM-CR总分及意识水平的改变、知觉障碍、精神运动性兴奋因子分均显著高于会诊组。结论:综合性医院中的谵妄患者年龄大,病因症状复杂,误诊率高,预后差。会诊联络亟待加强。

Objective： To explore the clinical characteristics of delirium patients referred to consultationliaison psychiatry in general hospitals, as well as those in psychiatric hospitals. Method：The clinical data of 58 delirium patients referred to consultation-liaison psychiatry in general hospitals （consulation-liaison group） and 54 delirium patients in psychiatric hospitals （ non-consulation-liaison group） admitted were included for a contrast analysis. They were all evaluated by the Chinese revision of confusion assessment method（CAM-CR）. Results：Delirium patients in the consultation-liaison group were with elder age and complex etiology. Medicine diseases they suffering from were mainly in respiratory tract infections, brain stroke and cardiovascular diseases ,while the surgical diseases were mainly in cerebral trauma, post-operation and fractures. Among them, multi-system diseases had the highest probability of causing delirium. The psychomotor retardation score in CAM-CR was significantly higher than the non-consultation-liaison group. However, delirium patients in non- consulation-liaison group were with younger age and simple etiology. Their diseases were mainly caused by with- drawing from psychoactive substances, senile dementia and improper application of antipsychotics. The total score, change in the level of consciousness, perceptual disturbance and psychomotor excitation scores in CAM- CR were all significantly higher than the consuhationhaison group. Conclusion： Eider age,complex etiology and symptoms,high misdiagnosis rate and poor prognosis are among the main features in delirium patients in general hospitals, the consultation liaison needs to be strengthened.