'''{{ruby-py|譫|-{zh-hans:Zhān;zh-tw:ㄓㄢ;zh-hk:zim<sup>1</sup>}-|}}妄'''<ref>{{Citeweb|title=“谵妄”字的解释{{!}} 汉典|url=https://www.zdic.net/hans/%E8%B0%B5%E5%A6%84|access-date=2022-02-06|work=www.zdic.net|language=zh-cn|archive-date=2022-06-07|archive-url=https://web.archive.org/web/20220607041317/https://www.zdic.net/hans/%E8%B0%B5%E5%A6%84}}</ref><ref>{{Cite web|title=《重編國語辭典修訂本》-譫妄|url=https://dict.revised.moe.edu.tw/dictView.jsp?ID=116002&word=%E8%AD%AB%E5%A6%84#searchL|access-date=2022-02-23|archive-date=2022-07-18|archive-url=https://web.archive.org/web/20220718134633/https://dict.revised.moe.edu.tw/dictView.jsp?ID=116002&word=%E8%AD%AB%E5%A6%84#searchL}}</ref>(英語:Delirium;或稱'''急性意识错乱状态'''(英語:acute confusional state),一種不被鼓勵使用的模糊術語<ref name="slooter2020">{{cite journal |vauthors=Slooter A, Otte WM, Devlin JW, Arora RC, Bleck TP, Claassen J, Duprey MS, Ely EW, Kaplan PW, Latronico N, Morandi A, Neufeld KJ, Sharshar T, MacLullich A, Stevens RD |date=February 2020 |title=Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies |journal=Intensive Care Medicine |volume=46 |issue=5 |pages=1020–1022 |doi=10.1007/s00134-019-05907-4 |pmc=7210231 |pmid=32055887}}</ref>)是一種特定的急性意識模糊狀態,可歸因於醫療狀況、精神活性物質的影響或多種原因的直接生理後果,發展過程通常數小時到數天。<ref name="Delirium">{{Cite journal |last1=Wilson |first1=Jo Ellen |last2=Mart |first2=Matthew F. |last3=Cunningham |first3=Colm |last4=Shehabi |first4=Yahya |last5=Girard |first5=Timothy D. |last6=MacLullich |first6=Alasdair M. J. |last7=Slooter |first7=Arjen J. C. |last8=Ely |first8=E. Wesley |date=2020-11-12 |title=Delirium |journal=Nature Reviews. Disease Primers |volume=6 |issue=1 |pages=90 |doi=10.1038/s41572-020-00223-4 |issn=2056-676X |pmc=9012267 |pmid=33184265 |s2cid=226302415 |doi-access=free}}</ref><ref name="DSM-5-TR">{{Cite web|title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR™)|url=https://www.appi.org/products/dsm|access-date=April 18, 2022|website=American Psychiatric Association|archive-date=2022-04-22|archive-url=https://web.archive.org/web/20220422004848/https://www.appi.org/products/dsm|dead-url=no}}</ref> 作為一種[[症候群]],譫妄表現為[[注意|注意力]]、[[意識]]和高級[[認知]]等產生障礙。譫妄患者可能會出現其他神經精神障礙,包括精神運動活動的變化(例如精神活動過度活躍(參看{{Link-en|Psychomotor agitation|Psychomotor agitation}})、精神活動減退(參看{{Link-en|Psychomotor retardation|Psychomotor retardation}})或混合水平的活動)、[[晝夜節律]]紊亂、[[情緒]]障礙和[[感知|知覺]]障礙(例如[[幻觉|幻覺]]和[[妄想]])。
'''譫妄'''{{Notetag| {{標音|字=譫 |繁= |简= |拼音=zhān |注音=ㄓㄢ |粵音= |粵切= |粵IPA= |粵拼=zim<sup>1</sup>|臺羅= |中古= |南京= |上古= |反切= |同音字= }} }}<ref>{{Cite encyclopedia|title=譫妄|encyclopedia=[[重編國語辭典修訂本]] |url=https://dict.revised.moe.edu.tw/dictView.jsp?ID=116002&word=%E8%AD%AB%E5%A6%84#searchL|access-date=2022-02-23|archive-date=2022-07-18|archive-url=https://web.archive.org/web/20220718134633/https://dict.revised.moe.edu.tw/dictView.jsp?ID=116002&word=%E8%AD%AB%E5%A6%84#searchL}}</ref>(英語:{{lang|en|delirium}};或稱'''急性意识错乱状态'''(英語:{{lang|en|acute confusional state}}),一種不被鼓勵使用的模糊術語<ref name="slooter2020">{{cite journal |vauthors=Slooter A, Otte WM, Devlin JW, Arora RC, Bleck TP, Claassen J, Duprey MS, Ely EW, Kaplan PW, Latronico N, Morandi A, Neufeld KJ, Sharshar T, MacLullich A, Stevens RD |date=February 2020 |title=Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies |journal=Intensive Care Medicine |volume=46 |issue=5 |pages=1020–1022 |doi=10.1007/s00134-019-05907-4 |pmc=7210231 |pmid=32055887}}</ref>)是一種特定的急性意識模糊狀態,可歸因於醫療狀況、精神活性物質的影響或多種原因的直接生理後果,發展過程通常數小時到數天。<ref name="Delirium">{{Cite journal |last1=Wilson |first1=Jo Ellen |last2=Mart |first2=Matthew F. |last3=Cunningham |first3=Colm |last4=Shehabi |first4=Yahya |last5=Girard |first5=Timothy D. |last6=MacLullich |first6=Alasdair M. J. |last7=Slooter |first7=Arjen J. C. |last8=Ely |first8=E. Wesley |date=2020-11-12 |title=Delirium |journal=Nature Reviews. Disease Primers |volume=6 |issue=1 |pages=90 |doi=10.1038/s41572-020-00223-4 |issn=2056-676X |pmc=9012267 |pmid=33184265 |s2cid=226302415 |doi-access=free}}</ref><ref name="DSM-5-TR">{{Cite web|title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR™)|url=https://www.appi.org/products/dsm|access-date=April 18, 2022|website=American Psychiatric Association|archive-date=2022-04-22|archive-url=https://web.archive.org/web/20220422004848/https://www.appi.org/products/dsm|dead-url=no}}</ref> 作為一種[[症候群]],譫妄表現為[[注意|注意力]]、[[意識]]和高級[[認知]]等產生障礙。譫妄患者可能會出現其他神經精神障礙,包括精神運動活動的變化(例如精神活動過度活躍(參看{{Link-en|Psychomotor agitation|Psychomotor agitation}})、精神活動減退(參看{{Link-en|Psychomotor retardation|Psychomotor retardation}})或混合水平的活動)、[[晝夜節律]]紊亂、[[情緒]]障礙和[[感知|知覺]]障礙(例如[[幻觉|幻覺]]和[[妄想]])。
在診斷上,譫妄包括急性精神錯亂綜合徵及其潛在的器質性過程<ref name="DSM-5-TR2">{{Cite web|title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR™)|url=https://www.appi.org/products/dsm|access-date=April 18, 2022|website=American Psychiatric Association|archive-date=2022-04-22|archive-url=https://web.archive.org/web/20220422004848/https://www.appi.org/products/dsm|dead-url=no}}</ref>,稱為急性[[腦病變|腦病]]<ref name="slooter2020" />。譫妄的原因可能是大腦內部的疾病過程,也可能是大腦外部之影響過程。譫妄可能是潛在疾病(如[[感染]]或[[缺氧]])、藥物[[副作用]]、物質[[中毒]](如[[鴉片類藥物|阿片類藥物]]或[[致幻劑]])、[[藥物戒斷|物質戒斷]](如[[酒精戒斷症候群|酒精戒斷]]或[[鎮靜劑]]戒斷),或多種影響個人整體健康之因素的結果(例如[[營養不良]]、[[疼痛]]等)。 相反,原發性精神障礙(例如[[精神分裂症]]、[[雙相情緒障礙症|雙相情感障礙]])導致的情緒和行為特徵不符合“譫妄”的診斷標準。<ref name="Delirium" />
在診斷上,譫妄包括急性精神錯亂綜合徵及其潛在的器質性過程<ref name="DSM-5-TR2">{{Cite web|title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR™)|url=https://www.appi.org/products/dsm|access-date=April 18, 2022|website=American Psychiatric Association|archive-date=2022-04-22|archive-url=https://web.archive.org/web/20220422004848/https://www.appi.org/products/dsm|dead-url=no}}</ref>,稱為急性[[腦病變|腦病]]<ref name="slooter2020" />。譫妄的原因可能是大腦內部的疾病過程,也可能是大腦外部之影響過程。譫妄可能是潛在疾病(如[[感染]]或[[缺氧]])、藥物[[副作用]]、物質[[中毒]](如[[鴉片類藥物|阿片類藥物]]或[[致幻劑]])、[[藥物戒斷|物質戒斷]](如[[酒精戒斷症候群|酒精戒斷]]或[[鎮靜劑]]戒斷),或多種影響個人整體健康之因素的結果(例如[[營養不良]]、[[疼痛]]等)。 相反,原發性精神障礙(例如[[精神分裂症]]、[[雙相情緒障礙症|雙相情感障礙]])導致的情緒和行為特徵不符合“譫妄”的診斷標準。<ref name="Delirium" />
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==結論==
==結論==
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>
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>
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