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      KCI등재

      섬망 아형의 임상적 의의 = Clinical Implication of Delirium Subtype

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      https://www.riss.kr/link?id=A76521312

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      다국어 초록 (Multilingual Abstract)

      Delirium is a common and serious condition which is often under-detected and under-treated. This may be partly due to a lack of concensus regarding the definition of its subtypes. Subtypes of delirium may be explained according to different pathophysiologic mechanisms. Three subtypes (hyperactive, hypoactive, mixed) of delirium, based on arousal disturbance and psychomotor behavior have been identified. However, definitions may vary from author to author. Irrespective of the way delirium is diagnosed and the subtypes defined, the hypoactive subtype is more prevalent than the hyperactive. Despite this prevalence, a diagnosis of hypoactive delirium is often missed, and rather ismost frequently misdiagnosed as depression or dementla. The hypoactive delirium subtype may be less responsive to antipsychotic drug therapy than the hyperactive delirium subtype. Clinical subtypes of delirium may provide information concerning the etiology, the pathogenesis, and the prognosis of delirium, but also may have therapeutic consequences. There remains no consensus regarding the optimal classification system for delirium subtypes. More studies are needed to isolate two, three, or more delirium subtypes, in terms of predicting factors, outcome predictors, and therapeutic management.
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      Delirium is a common and serious condition which is often under-detected and under-treated. This may be partly due to a lack of concensus regarding the definition of its subtypes. Subtypes of delirium may be explained according to different pathophysi...

      Delirium is a common and serious condition which is often under-detected and under-treated. This may be partly due to a lack of concensus regarding the definition of its subtypes. Subtypes of delirium may be explained according to different pathophysiologic mechanisms. Three subtypes (hyperactive, hypoactive, mixed) of delirium, based on arousal disturbance and psychomotor behavior have been identified. However, definitions may vary from author to author. Irrespective of the way delirium is diagnosed and the subtypes defined, the hypoactive subtype is more prevalent than the hyperactive. Despite this prevalence, a diagnosis of hypoactive delirium is often missed, and rather ismost frequently misdiagnosed as depression or dementla. The hypoactive delirium subtype may be less responsive to antipsychotic drug therapy than the hyperactive delirium subtype. Clinical subtypes of delirium may provide information concerning the etiology, the pathogenesis, and the prognosis of delirium, but also may have therapeutic consequences. There remains no consensus regarding the optimal classification system for delirium subtypes. More studies are needed to isolate two, three, or more delirium subtypes, in terms of predicting factors, outcome predictors, and therapeutic management.

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      참고문헌 (Reference)

      1 Akechi T, "Usage of haloperidol for delirium in cancer patients" 4 : 390-392, 1996

      2 Trzepacz PT, "Update on the neuropathogenesis of delirium" 10 : 330-334, 1999

      3 Slatkin N, "Treatment of opioid-induced delirium with acetylcholinesterase inhibitors: a case report" 27 : 268-273, 2004

      4 Lipowski ZJ, "Transient cognitive disorders (delirium, acute confusional states) in the elderly" 140 : 1426-1436, 1983

      5 Pro JD, "The use of the electroencephalogram in the diagnosis of delirium" 38 : 804-808, 1977

      6 Moyle J, "The use of propofol in palliative medicine" 10 : 643-646, 1995

      7 POSNER JB, "The toxic effects of carbon dioxide and acetazolamide in hepatic encephalopathy" 39 : 1246-1258, 1960

      8 Cutting J, "The role of right hemisphere dysfunction in psychiatric disorders" 160 : 583-588, 1992

      9 O'Keeffe S, "The prognostic significance of delirium in older hospital patients" 45 : 174-178, 1997

      10 Trzepacz PT, "The neuropathogenesis of delirium. A need to focus our research" 35 : 374-391, 1994

      1 Akechi T, "Usage of haloperidol for delirium in cancer patients" 4 : 390-392, 1996

      2 Trzepacz PT, "Update on the neuropathogenesis of delirium" 10 : 330-334, 1999

      3 Slatkin N, "Treatment of opioid-induced delirium with acetylcholinesterase inhibitors: a case report" 27 : 268-273, 2004

      4 Lipowski ZJ, "Transient cognitive disorders (delirium, acute confusional states) in the elderly" 140 : 1426-1436, 1983

      5 Pro JD, "The use of the electroencephalogram in the diagnosis of delirium" 38 : 804-808, 1977

      6 Moyle J, "The use of propofol in palliative medicine" 10 : 643-646, 1995

      7 POSNER JB, "The toxic effects of carbon dioxide and acetazolamide in hepatic encephalopathy" 39 : 1246-1258, 1960

      8 Cutting J, "The role of right hemisphere dysfunction in psychiatric disorders" 160 : 583-588, 1992

      9 O'Keeffe S, "The prognostic significance of delirium in older hospital patients" 45 : 174-178, 1997

      10 Trzepacz PT, "The neuropathogenesis of delirium. A need to focus our research" 35 : 374-391, 1994

      11 Rudberg MA, "The natural history of delirium in older hospitalized patients: a syndrome of heterogeneity" 26 : 169-174, 1997

      12 Armstrong SC, "The misdiagnosis of delirium" 38 : 433-439, 1997

      13 Breitbart W, "The memorial delirium assessment scale" 13 : 128-137, 1997

      14 Inouye SK, "The dilemma of delirium: clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly medical patients" 97 : 278-288, 1994

      15 Morita T, "Successful palliation of hypoactive delirium due to multi-organ failure by oral methylphenidate" 8 : 134-137, 2000

      16 Bottomley DM, "Subcutaneous midazolam infusion in palliative care" 5 : 259-261, 1990

      17 Flacker JM, "Serum anticholinergic activity changes with acute illness in elderly medical patients" 54 : M12-M16, 1999

      18 van der Mast RC, "Serotonin and amino acids: partners in delirium pathophysiology?" 5 : 125-131, 2000

      19 Boettger S, "Risperidone in the treatment of hypoactive and hyperactive delirium" 2007

      20 Meagher DJ, "Relationship between symptoms and motoric subtype of delirium" 12 : 51-56, 2000

      21 Meagher DJ, "Relationship between etiology and phenomenologic profile in delirium" 11 : 146-149, 1998

      22 Van der Rijt C, "Quantitative EEG analysis and survival in liver disease" 61 : 502-504, 1985

      23 Mercadante S, "Propofol in terminal care" 10 : 639-642, 1995

      24 Camus V, "Phenomenology of acute confusional states" 181 : 256-257, 2002

      25 Breitbart W, "Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer" 10 : 131-141, 1995

      26 de Sousa E, "Midazolam in terminal care" 1 : 67-68, 1988

      27 Soininen H, "Longitudinal EEG spectral analysis in early stage of Alzheimer's disease" 72 : 290-297, 1989

      28 Trzepacz PT, "Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine" 5 : 132-148, 2000

      29 Trzepacz PT, "Further analyses of the delirium rating scale" 17 : 75-79, 1995

      30 Trzepacz PT, "Further analyses of the delirium rating scale" 17 : 75-79, 1995

      31 Camus V, "Factor analysis supports the evidence of existing hyperactive and hypoactive subtypes of delirium" 15 : 313-316, 2000

      32 Platt MM, "Efficacy of neuroleptics for hypoactive delirium" 6 : 66-67, 1994

      33 de Rooij SE, "Delirium subtype identification and the validation of the delirium rating scale--Revised-98 (Dutch version) in hospitalized elderly patients" 21 : 876-882, 2006

      34 Marcantonio E, "Delirium severity and psychomotor types: their relationship with outcomes after hip fracture repair" 50 : 850-857, 2002

      35 Dolan MM, "Delirium on hospital admission in aged hip fracture patients: prediction of mortality and 2-year functional outcomes" 55 : M527-M534, 2000

      36 Lipowski ZJ, "Delirium in the elderly patient" 320 : 578-582, 1989

      37 Francis J, "Delirium in older patients" 40 : 829-838, 1992

      38 Francis J, "Delirium in older patients" 40 : 829-838, 1992

      39 Lawlor PG, "Delirium at the end of life: critical issues in clinical practice and research" 284 : 2427-2429, 2000

      40 Lipowski ZJ, "Delirium (acute confusional states)" 258 : 1789-1792, 1987

      41 O'Keeffe ST, "Clinical significance of delirium subtypes in older people" 28 : 115-119, 1999

      42 Sandberg O, "Clinical profile of delirium in older patients" 47 : 1300-1306, 1999

      43 Hemmingsen R, "Cerebral blood flow during delirium tremens and related clinical states studied with xenon-133 inhalation tomography" 145 : 1384-1390, 1988

      44 Ross CA, "CNS arousal systems: possible role in delirium" 3 : 353-371, 1991

      45 Levin HS, "Behavioral sequelae of closed head injury" 35 : 720-727, 1978

      46 Breitbart W, "An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients" 43 : 175-182, 2002

      47 Boettger S, "An open label trial of aripiprazole in the treatment of delirirum" 2007

      48 Liptzin B, "An empirical study of delirium subtypes" 161 : 843-845, 1992

      49 Medina JL, "Agitated delirium caused by infarctions of the hippocampal formation and fusiform and lingual gyri: a case report" 24 : 1181-1183, 1974

      50 Stiefel F, "Acute confusional states in patients with advanced cancer" 7 : 94-98, 1992

      51 Kobayashi K, "A retrospective study on delirium type" 46 : 911-917, 1992

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