譫妄的治療需要識別和管理根本原因,控制譫妄症狀,並降低[[併發症]]的風險。<ref name="SIGN">{{Cite web|title=SIGN 157 Delirium|url=https://www.sign.ac.uk/sign-157-delirium|access-date=2020-05-15|website=www.sign.ac.uk|archive-date=2022-12-06|archive-url=https://web.archive.org/web/20221206065513/https://www.sign.ac.uk/sign-157-delirium|dead-url=no}}</ref> 在某些情況下,臨時或對症(英語:symptomatic)治療用於安慰患者或促進其他護理(例如防止患者拔出[[呼吸管]])。[[抗精神病藥]]不被支持使用於治療或預防住院患者的譫妄;但是,如果正在經歷[[幻覺]]等造成痛苦的狀態,或對自己或他人造成[[危險]],則可使用之。<ref>Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825-e873. doi:10.1097/CCM.0000000000003299</ref><ref>Santos C.D., Rose M.Q. Extrapyramidal symptoms induced by treatment for delirium: A case report. ''Crit. Care Nurs..'' 2021;41(3):50-54. doi:10.4037/ccn2021765</ref><ref name="Siddiqi2016">{{Cite journal |last1=Siddiqi |first1=Najma |last2=Harrison |first2=Jennifer K. |last3=Clegg |first3=Andrew |last4=Teale |first4=Elizabeth A. |last5=Young |first5=John |last6=Taylor |first6=James |last7=Simpkins |first7=Samantha A. |date=2016-03-11 |title=Interventions for preventing delirium in hospitalised non-ICU patients |url= |journal=The Cochrane Database of Systematic Reviews |volume=3 |pages=CD005563 |doi=10.1002/14651858.CD005563.pub3 |issn=1469-493X |pmid=26967259}}</ref><ref name="JAGS2016">{{cite journal |vauthors=Neufeld KJ, Yue J, Robinson TN, Inouye SK, Needham DM |date=April 2016 |title=Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis |journal=Journal of the American Geriatrics Society |volume=64 |issue=4 |pages=705–14 |doi=10.1111/jgs.14076 |pmc=4840067 |pmid=27004732}}</ref><ref name="Burry Cochrane">{{cite journal |display-authors=6 |vauthors=Burry L, Mehta S, Perreault MM, Luxenberg JS, Siddiqi N, Hutton B, Fergusson DA, Bell C, Rose L |date=June 2018 |title=Antipsychotics for treatment of delirium in hospitalised non-ICU patients |url=https://kclpure.kcl.ac.uk/portal/en/publications/antipsychotics-for-treatment-of-delirium-in-hospitalised-nonicu-patients(27bfcdeb-c56c-431e-930e-e29977f5f500).html |journal=The Cochrane Database of Systematic Reviews |volume=2018 |issue=6 |pages=CD005594 |doi=10.1002/14651858.CD005594.pub3 |pmc=6513380 |pmid=29920656 |access-date=2023-05-07 |archive-date=2019-11-07 |archive-url=https://web.archive.org/web/20191107075053/https://kclpure.kcl.ac.uk/portal/en/publications/antipsychotics-for-treatment-of-delirium-in-hospitalised-nonicu-patients(27bfcdeb-c56c-431e-930e-e29977f5f500).html |dead-url=no }}</ref> 當譫妄是由[[酒精戒斷症候群|酒精戒斷]]或[[鎮靜劑|鎮靜催眠]]戒斷等[[藥物戒斷]]引起時,通常使用[[苯二氮卓類]]藥物進行治療。<ref name="Attard-2008">{{cite journal |vauthors=Attard A, Ranjith G, Taylor D |date=August 2008 |title=Delirium and its treatment |journal=CNS Drugs |volume=22 |issue=8 |pages=631–44 |doi=10.2165/00023210-200822080-00002 |pmid=18601302 |s2cid=94743}}</ref> 有證據表明,非藥物治療組合可以降低住院患者發生譫妄的風險(參見[[譫妄#預防]])。<ref name="Siddiqi2016" /> 根據 [[精神疾病診斷與統計手冊|DSM]]-5-TR 的文本,雖然譫妄只影響總人口的 1至2%,但到醫院就診的成年人中有 18至35% 會出現譫妄,而 29至65% 的人住院時會出現譫妄。 術後 11至51% 的老年人、[[加護病房|重症監護病房]]中的 81% 的老年人以及療養院或急症後護理環境中的 20至22% 的人發生譫妄。<ref name="DSM-5-TR" /> 在需要重症監護的人中,譫妄是隔年死亡的[[風險因子|風險因素]]。<ref name="DSM-5-TR" /><ref name="pmid15082703">{{cite journal |author-link=Eugene Wesley Ely |display-authors=6 |vauthors=Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE, Inouye SK, Bernard GR, Dittus RS |date=April 2004 |title=Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit |journal=JAMA |volume=291 |issue=14 |pages=1753–62 |doi=10.1001/jama.291.14.1753 |pmid=15082703 |doi-access=free}}</ref>
譫妄存在於一系列[[喚醒]]水平中,可以是介於正常清醒/警覺和昏迷(低度活動型)之間的狀態,也可以是一種心理生理喚醒增強(高度活動型)的狀態。 它也可以在兩者之間交替(混合型)。 雖然包含注意力、意識和認知的急性障礙,但譫妄症候群包括範圍廣泛的其他神經精神障礙。<ref name=":2">{{Cite book|title=The American Psychiatric Publishing textbook of psychiatry|url=https://archive.org/details/americanpsychiat0000unse_q9l4|date=2008|editor=Hales, Robert E.|editor2=Yudofsky, Stuart C.|editor3=Gabbard, Glen O.|publisher=American Psychiatric Publishing|isbn=9781585622573|edition=5th|location=Washington, DC|oclc=145554590}}</ref>
* '''思覺失調和其他錯誤信念'''({{lang|en|Psychotic and other erroneous beliefs}}):[[思覺失調]]的症狀包括多疑、高估的想法和坦率的[[妄想]]。譫妄所致之妄想通常形成不良且機械性重複較少,相對[[精神分裂症]]或[[阿茲海默症|阿爾茨海默症]]中的情況而言。它們通常與直接環境中迫在眉睫的危險或威脅的迫害主題有關(例如「被[[護理人員|護士]]毒死」)。
* '''情緒不穩定'''({{lang|en|Mood lability}}):對感知或傳達的情緒狀態的扭曲以及情緒狀態的波動可能表現為譫妄(例如,在恐怖、悲傷和開玩笑之間快速變化)。<ref>{{cite journal |display-authors=6 |vauthors=Leentjens AF, Rundell J, Rummans T, Shim JJ, Oldham R, Peterson L, Philbrick K, Soellner W, Wolcott D, Freudenreich O |date=August 2012 |title=Delirium: An evidence-based medicine (EBM) monograph for psychosomatic medicine practice, commissioned by the Academy of Psychosomatic Medicine (APM) and the European Association of Consultation Liaison Psychiatry and Psychosomatics (EACLPP) |journal=Journal of Psychosomatic Research |volume=73 |issue=2 |pages=149–52 |doi=10.1016/j.jpsychores.2012.05.009 |pmid=22789420}}</ref>
* '''活動量改變'''({{lang|en|Motor activity changes}}):譫妄通常被分為精神高度活動型、低度活動精神活動過度型和混合型<ref>{{cite journal |vauthors=Lipowski ZJ |date=March 1989 |title=Delirium in the elderly patient |journal=The New England Journal of Medicine |volume=320 |issue=9 |pages=578–82 |doi=10.1056/NEJM198903023200907 |pmid=2644535}}</ref>,儘管關於它們的流行程度的研究並不一致。<ref>{{cite journal |vauthors=de Rooij SE, Schuurmans MJ, van der Mast RC, Levi M |date=July 2005 |title=Clinical subtypes of delirium and their relevance for daily clinical practice: a systematic review |url=https://archive.org/details/sim_international-journal-of-geriatric-psychiatry_2005-07_20_7/page/609 |journal=International Journal of Geriatric Psychiatry |volume=20 |issue=7 |pages=609–15 |doi=10.1002/gps.1343 |pmid=16021665 |s2cid=37993802}}</ref> 低度活動的病例容易被漏診或誤診為[[情緒障礙症|抑鬱症]]。 一系列研究表明,混合型在潛在的病理生理學、治療需求、功能預後和死亡風險方面存在差異,儘管不一致的混合型定義和較差的低活性混合型檢測可能會影響對這些發現的解釋。<ref>{{cite journal |vauthors=Meagher D |date=February 2009 |title=Motor subtypes of delirium: past, present and future |journal=International Review of Psychiatry |volume=21 |issue=1 |pages=59–73 |doi=10.1080/09540260802675460 |pmid=19219713 |s2cid=11705848}}</ref> 在譫妄的構造下統一精神活動減退和活動過度狀態的概念通常來自 Zbigniew J. Lipowski。<ref name="Lipowski">{{Cite book|title=Delirium: Acute Brian Failure in Man|publisher=Charles C Thomas|isbn=0-398-03909-7|location=Springfield, IL|year=1980}}</ref>
** '''高度活動'''({{lang|en|Hyperactive}})的症狀包括過度警惕、煩躁、快速或大聲說話、易怒、好鬥、急躁、咒罵、唱歌、大笑、不合作、欣快、憤怒、徘徊、容易受驚、快速運動反應、注意力分散、離題、噩夢和持續的想法 (過度活躍的子類型定義為以上至少三個)。<ref name=":3">{{cite journal |vauthors=Liptzin B, Levkoff SE |date=December 1992 |title=An empirical study of delirium subtypes |journal=The British Journal of Psychiatry |volume=161 |issue=6 |pages=843–5 |doi=10.1192/bjp.161.6.843 |pmid=1483173 |s2cid=8754215}}</ref>
“容忍,預期,不鼓動”(T-A-DA;'''t'''olerate, '''a'''nticipate, and '''d'''on't '''a'''gitate) 是治療譫妄病人的方法。護理人員規劃護理時要考慮患者預期的行為,讓患者在一個特定的區域隔離靜養,最好有人不停陪伴看顧:
治療已出現的譫妄具挑戰性,因此,最好在譫妄開始之前進行預防。 預防方法包括篩查以確定處於危險中的人,以及基於藥物和非藥物的治療。<ref name=":6">{{Cite journal |last1=Burton |first1=Jennifer K. |last2=Craig |first2=Louise |last3=Yong |first3=Shun Qi |last4=Siddiqi |first4=Najma |last5=Teale |first5=Elizabeth A. |last6=Woodhouse |first6=Rebecca |last7=Barugh |first7=Amanda J. |last8=Shepherd |first8=Alison M. |last9=Brunton |first9=Alan |last10=Freeman |first10=Suzanne C. |last11=Sutton |first11=Alex J. |date=2021-11-26 |title=Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients |url= |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=11 |pages=CD013307 |doi=10.1002/14651858.CD013307.pub3 |issn=1469-493X |pmc=8623130 |pmid=34826144 |last12=Quinn |first12=Terry J.}}</ref>
在認知風險人群中,估計有 30至40% 的譫妄病例可以預防,而譫妄的高發生率對護理質量產生負面影響。<ref name="Inouye20062">{{cite journal |vauthors=Inouye SK |date=March 2006 |title=Delirium in older persons |url=http://nrs.harvard.edu/urn-3:HUL.InstRepos:13956255 |journal=The New England Journal of Medicine |volume=354 |issue=11 |pages=1157–65 |doi=10.1056/NEJMra052321 |pmid=16540616 |s2cid=245337 |access-date=2023-05-07 |archive-date=2021-08-28 |archive-url=https://web.archive.org/web/20210828054457/https://dash.harvard.edu/handle/1/13956255 |dead-url=no }}</ref> 識別住院患者是否有譫妄之風險,可被用以協助預防發病;這包括 65 歲以上、有認知障礙、正在接受對人體影響重大的手術或患有嚴重疾病的個人<ref name="NICE" />;此類人群被建議進行常規譫妄篩查。 包括不同方法在內的個別化預防方法據稱可將老年人的譫妄發生率降低 27%。<ref>{{cite journal |vauthors=Martinez F, Tobar C, Hill N |date=March 2015 |title=Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature |journal=Age and Ageing |volume=44 |issue=2 |pages=196–204 |doi=10.1093/ageing/afu173 |pmid=25424450 |doi-access=free}}</ref><ref name="Siddiqi2016" />
=== 預防 ===
==== 非藥物性預防 ====
可以藉由使用針對[[風險因子|風險因素]](例如[[便秘]]、[[脱水|脫水]]、低[[血氧飽和度]]水平、無法移動的狀態、視力或聽力障礙、睡眠障礙、功能衰退等)的非藥物方法來預防和治療譫妄,同時去除或盡量減少有問題的藥物。<ref name="NICE">{{Cite web|title=Delirium: Prevention, diagnosis and management in hospital and long-term care|url=https://www.nice.org.uk/guidance/cg103|access-date=2023-01-31|website=National Institute for Health and Care Excellence|archive-date=2023-06-09|archive-url=https://web.archive.org/web/20230609150014/https://www.nice.org.uk/guidance/CG103|dead-url=no}}</ref><ref name=":0">{{Cite journal |last1=Oh |first1=Esther S. |last2=Fong |first2=Tamara G. |last3=Hshieh |first3=Tammy T. |last4=Inouye |first4=Sharon K. |date=September 26, 2017 |title=Delirium in Older Persons: Advances in Diagnosis and Treatment |journal=JAMA |volume=318 |issue=12 |pages=1161–1174 |doi=10.1001/jama.2017.12067 |issn=1538-3598 |pmc=5717753 |pmid=28973626}}</ref> 確保治療環境(例如個別化護理、清晰的溝通、在白天進行充足的照明和定向活動(如藉由時鐘和日曆等確認時刻、日期和季節等、確認彼此指稱之認知、討論時事、在人與物件上放置標示等、討論有關照片或其他紀念物的內容等<ref>{{Cite web|title=The Benefits of Reality Orientation in Alzheimer's and Dementia|url=https://www.verywellhealth.com/treating-alzheimers-disease-with-reality-orientation-98682|access-date=2023-05-07|website=Verywell Health|language=en|archive-date=2023-05-15|archive-url=https://web.archive.org/web/20230515193810/https://www.verywellhealth.com/treating-alzheimers-disease-with-reality-orientation-98682|dead-url=no}}</ref>)、促進[[睡眠衛生]](如最小化夜間聲響和光線之影響)、盡量減少房間搬遷、擁有家庭照片等熟悉的物品、提供[[耳塞]]以及充足的營養 、[[疼痛管理]]和協助早期活動(英語:early mobilization))也可能有助於預防譫妄。<ref name="Siddiqi2016" /><ref name="Inouye2006">{{cite journal |vauthors=Inouye SK |date=March 2006 |title=Delirium in older persons |url=http://nrs.harvard.edu/urn-3:HUL.InstRepos:13956255 |journal=The New England Journal of Medicine |volume=354 |issue=11 |pages=1157–65 |doi=10.1056/NEJMra052321 |pmid=16540616 |s2cid=245337 |access-date=2023-05-07 |archive-date=2021-08-28 |archive-url=https://web.archive.org/web/20210828054457/https://dash.harvard.edu/handle/1/13956255 |dead-url=no }}</ref><ref>{{cite journal |vauthors=Poongkunran C, John SG, Kannan AS, Shetty S, Bime C, Parthasarathy S |date=October 2015 |title=A meta-analysis of sleep-promoting interventions during critical illness |journal=The American Journal of Medicine |volume=128 |issue=10 |pages=1126–1137.e1 |doi=10.1016/j.amjmed.2015.05.026 |pmc=4577445 |pmid=26071825}}</ref><ref>{{cite journal |vauthors=Flannery AH, Oyler DR, Weinhouse GL |date=December 2016 |title=The Impact of Interventions to Improve Sleep on Delirium in the ICU: A Systematic Review and Research Framework |journal=Critical Care Medicine |volume=44 |issue=12 |pages=2231–2240 |doi=10.1097/CCM.0000000000001952 |pmid=27509391 |s2cid=24494855}}</ref> 藥物預防和治療的研究薄弱,不足以提出適當的建議。<ref name=":0" />
這些干預措施是管理急性譫妄的第一步,並且與譫妄預防策略有許多重疊。<ref name=":02">{{Cite book|title=Risk reduction and management of delirium : a national clinical guideline.|others=Scottish Intercollegiate Guidelines Network., Scotland. Healthcare Improvement Scotland.|isbn=9781909103689|location=Edinburgh|oclc=1099827664|year=2019}}</ref> 除了治療直接危及生命的譫妄原因(例如[[缺氧|低氧]]、[[低血壓]]、[[低血糖]]、[[脱水|脫水]]等)外,干預措施還包括減少環境噪音、優化醫院環境、提供適當的照明、緩解疼痛、促進健康的睡眠喚醒週期,並儘量減少房間的變化。<ref name=":02" /> 儘管多元護理和綜合老年護理更專門針對譫妄患者,但多項研究未能找到證據表明它們可以譫妄之持續時間。<ref name=":02" />
家人、朋友和其他看護者可以頻繁的協助消除患者的疑慮,並幫助其進行觸覺和語言定向、認知刺激(例如定期探訪以及提供其熟悉的物件、時鐘、日曆等),以及協助其可以從事活動(例如隨時提供助聽器和眼鏡)。<ref name="Inouye20062" /><ref name="NICE" /><ref>{{cite journal |vauthors=Rudolph JL, Marcantonio ER |date=May 2011 |title=Review articles: postoperative delirium: acute change with long-term implications |journal=Anesthesia and Analgesia |volume=112 |issue=5 |pages=1202–11 |doi=10.1213/ANE.0b013e3182147f6d |pmc=3090222 |pmid=21474660}}</ref> 有時可能需要口頭和非口頭的緩和技巧以消除患者疑慮並使之平靜下來。<ref name="NICE" /> 束縛被盡可能避免用以干預譫妄;該類方法已被認為是受傷和加重症狀的[[風險因子|危險因素]],尤其是對於老年住院患者。<ref name=":12">{{Citation|last1=DeWitt|first1=Marie A.|title=Delirium|date=2018-07-06|work=The American Psychiatric Association Publishing Textbook of Neuropsychiatry and Clinical Neurosciences|publisher=American Psychiatric Association Publishing|doi=10.1176/appi.books.9781615372423.sy08|isbn=978-1-61537-187-7|last2=Tune|first2=Larry E.|s2cid=240363328}}</ref> 在譫妄期間應謹慎使用約束的唯一情況是保護生命維持干預措施,例如氣管插管。<ref name=":12" />
「容忍、預期、不激化」(英語:'''t'''olerate, '''a'''nticipate, '''d'''on't '''a'''gitate,縮寫作「T-A-DA」)方法對於老年譫妄患者來說可能是一種有效的管理技術,只要在照顧者和患者的安全不會受威脅的情況下,照顧者容忍並不去挑戰其異常行為(包括[[幻覺]]和[[妄想]])。<ref name="oh">{{cite journal |vauthors=Oh ES, Fong TG, Hshieh TT, Inouye SK |date=September 2017 |title=Delirium in Older Persons: Advances in Diagnosis and Treatment |journal=JAMA |volume=318 |issue=12 |pages=1161–1174 |doi=10.1001/jama.2017.12067 |pmc=5717753 |pmid=28973626}}</ref> 該模式的實施可能需要在醫院的特定區域進行。 所有不必要的附件都被移除以預期更大的移動可能,並避免過度的重定向/質疑來防止激化。<ref name="oh" />
==結論==
==結論==
譫妄在[[失智症]]患者身上是很常見的,它的發生意謂著身體疾病正在進行或惡化中,一定要仔細查證並治療。家屬以及第一線的醫療人員應了解譫妄症狀並保持警覺性以作緊急的處理。若病患突然意識混亂,請仔細查證身體疾病等可能問題,並請照會[[精神科]]。<ref>{{Cite web|title=Delirium - Symptoms and causes - Mayo Clinic|url=https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386|access-date=2022-02-23|archive-date=2022-07-18|archive-url=https://web.archive.org/web/20220718133106/https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386}}</ref>
譫妄的發生意謂著身體疾病正在進行或惡化中,一定要仔細查證並治療。家屬以及第一線的醫療人員應了解譫妄症狀並保持警覺性以作緊急的處理。若病患突然意識混亂,請仔細查證身體疾病等可能問題,並請考慮照會[[精神科]]進行治療。<ref>{{Cite web|title=Delirium - Symptoms and causes - Mayo Clinic|url=https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386|access-date=2022-02-23|archive-date=2022-07-18|archive-url=https://web.archive.org/web/20220718133106/https://www.mayoclinic.org/diseases-conditions/delirium/symptoms-causes/syc-20371386}}</ref>
== 注释 ==
{{Notefoot}}
== 参考文献 ==
== 参考文献 ==
{{Reflist}}
{{Reflist|30em}}
* National Institute for Health and Clinical Excellence. Clinical guideline 103: Delirium. London, 2010.
* Inouye SK (March 2006). "Delirium in older persons". N. Engl. J. Med. 354 (11): 1157–65. doi:10.1056/NEJMra052321. PMID 16540616. Archived from the original on 2011-07-22.
* Flaherty, J.; Little, M. (2011). "Matching the Environment to Patients with Delirium: Lessons Learned from the Delirium Room, a Restraint-Free Environment for Older Hospitalized Adults with Delirium". Journal of the American Geriatrics Society. 59: 295–300. doi:10.1111/j.1532-5415.2011.03678.x.
*《台灣失智症協會會》大腦的急性混亂–譫妄;李淑花;2007年3月
*《台灣失智症協會會》大腦的急性混亂–譫妄;李淑花;2007年3月
*《[[哈佛醫學院|美國哈佛醫學院]]》老年人譫妄({{lang|en|Delirium in older persons}});Inouye SK;PMID 16540616;2006年5月
*《{{link-en|National Institute for Health and Care Excellence||英國國家健康與照顧卓越研究院}}》臨床指南103:譫妄({{lang|en|Clinical guideline 103: Delirium}});2010年
*《{{link-en|Journal of Applied Gerontology||美國應用老年學期刊}}》讓環境與譫妄患者能相互匹配:從譫妄病房中吸取的教訓,這應該是一個專為患有譫妄症的老年住院成人提供的無約束環境({{lang|en|Matching the Environment to Patients with Delirium: Lessons Learned from the Delirium Room, a Restraint-Free Environment for Older Hospitalized Adults with Delirium}});Flaherty, J.; Little, M.;2011年
*《[[英國醫學期刊]]》老年人譫妄({{lang|en|Delirium in older people}});Young, J.、Inouye, S.;PMID 17446616;2007年
*《[[英國醫學期刊]]》老年人譫妄({{lang|en|Delirium in older people}});Young, J.、Inouye, S.;PMID 17446616;2007年
*《{{link-en|Journal of Applied Gerontology||美國應用老年學期刊}}》預防和治療住院成人譫妄的抗精神病藥物:系統性回顧與整合分析({{lang|en|Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis}});Karin J Neufeld、Jirong Yue、Thomas N Robinson、Sharon K Inouye、Dale M Needham;PMID 27004732;2016年5月
*《{{link-en|Journal of Applied Gerontology||美國應用老年學期刊}}》預防和治療住院成人譫妄的抗精神病藥物:系統性回顧與整合分析({{lang|en|Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis}});Karin J Neufeld、Jirong Yue、Thomas N Robinson、Sharon K Inouye、Dale M Needham;PMID 27004732;2016年5月
思覺失調和其他錯誤信念(Psychotic and other erroneous beliefs):思覺失調的症狀包括多疑、高估的想法和坦率的妄想。譫妄所致之妄想通常形成不良且機械性重複較少,相對精神分裂症或阿爾茨海默症中的情況而言。它們通常與直接環境中迫在眉睫的危險或威脅的迫害主題有關(例如「被護士毒死」)。
活動量改變(Motor activity changes):譫妄通常被分為精神高度活動型、低度活動精神活動過度型和混合型[18],儘管關於它們的流行程度的研究並不一致。[19]低度活動的病例容易被漏診或誤診為抑鬱症。 一系列研究表明,混合型在潛在的病理生理學、治療需求、功能預後和死亡風險方面存在差異,儘管不一致的混合型定義和較差的低活性混合型檢測可能會影響對這些發現的解釋。[20]在譫妄的構造下統一精神活動減退和活動過度狀態的概念通常來自 Zbigniew J. Lipowski。[21]
^Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825-e873. doi:10.1097/CCM.0000000000003299
^Santos C.D., Rose M.Q. Extrapyramidal symptoms induced by treatment for delirium: A case report. Crit. Care Nurs.. 2021;41(3):50-54. doi:10.4037/ccn2021765
^ 11.011.111.211.3Siddiqi, Najma; Harrison, Jennifer K.; Clegg, Andrew; Teale, Elizabeth A.; Young, John; Taylor, James; Simpkins, Samantha A. Interventions for preventing delirium in hospitalised non-ICU patients. The Cochrane Database of Systematic Reviews. 2016-03-11, 3: CD005563. ISSN 1469-493X. PMID 26967259. doi:10.1002/14651858.CD005563.pub3.
^Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. April 2004, 291 (14): 1753–62. PMID 15082703. doi:10.1001/jama.291.14.1753.
^Leentjens AF, Rundell J, Rummans T, Shim JJ, Oldham R, Peterson L, et al. Delirium: An evidence-based medicine (EBM) monograph for psychosomatic medicine practice, commissioned by the Academy of Psychosomatic Medicine (APM) and the European Association of Consultation Liaison Psychiatry and Psychosomatics (EACLPP). Journal of Psychosomatic Research. August 2012, 73 (2): 149–52. PMID 22789420. doi:10.1016/j.jpsychores.2012.05.009.
^Martinez F, Tobar C, Hill N. Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature. Age and Ageing. March 2015, 44 (2): 196–204. PMID 25424450. doi:10.1093/ageing/afu173.
^Flannery AH, Oyler DR, Weinhouse GL. The Impact of Interventions to Improve Sleep on Delirium in the ICU: A Systematic Review and Research Framework. Critical Care Medicine. December 2016, 44 (12): 2231–2240. PMID 27509391. S2CID 24494855. doi:10.1097/CCM.0000000000001952.
《美國應用老年學期刊(英语:Journal of Applied Gerontology)》讓環境與譫妄患者能相互匹配:從譫妄病房中吸取的教訓,這應該是一個專為患有譫妄症的老年住院成人提供的無約束環境(Matching the Environment to Patients with Delirium: Lessons Learned from the Delirium Room, a Restraint-Free Environment for Older Hospitalized Adults with Delirium);Flaherty, J.; Little, M.;2011年
《英國醫學期刊》老年人譫妄(Delirium in older people);Young, J.、Inouye, S.;PMID 17446616;2007年
《美國應用老年學期刊(英语:Journal of Applied Gerontology)》預防和治療住院成人譫妄的抗精神病藥物:系統性回顧與整合分析(Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis);Karin J Neufeld、Jirong Yue、Thomas N Robinson、Sharon K Inouye、Dale M Needham;PMID 27004732;2016年5月