acute brain syndrome acute brain failure acute confusional
譫妄之同義詞 • • • • 急性大腦徵候群(acute brain syndrome) 急性腦衰竭(acute brain failure) 急性惑亂狀態(acute confusional state) 急性器質性精神病(acute organic psychosis) 急性外生性反應症(acute exogenous reaction) 急性可逆性精神病(acute reversible psychosis) 急性癡呆症(acute dementia) 可逆性癡呆症(reversible dementia) 中毒性精神病(toxic psychosis) 傳染性-消耗性精神病(infective-exhaustive psychosis) 新陳代謝性腦病(metabolic encephalopathy) 器質性大腦徵候群(organic brain syndrome) ICU 精神病(ICU psychosis) 可逆性大腦功能失調(reversible cerebral dysfunction) 可逆性認知功能失調(reversible cognitive dysfunction)
DSM-IV-TR 譫妄之診斷條件 A. 意識障礙以致難以集中注意力 Disturbance of consciousness (i. e. , reduced clarity of awareness about the environment) with reduced ability to focus, sustain, or shift attention. B. 認知及感知能力受損(非原有失智症所致) A change in cognition (e. g. , memory deficit, disorientation, language disturbance) or development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia. C. 急性發作(數小時至數日)且其狀態常波動 The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of a day. D. 因傷病或生理失衡所致 Evidence from the history, physical examination, or laboratory findings indicate that the disturbance is caused by direct physiologic consequences of a general medical condition. Adopted from. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, D. C. , American Psychiatric Association, 2000: 143. Copyright 2000, American Psychiatric Association. 前驅症狀 請說出譫妄和精神病/失智異同之處
常見引發譫妄之藥物 抗乙醯膽鹼藥物 (artane, akineton, antihistamine, antispasmodics, tricyclic antidepressants, antipsychotics) 麻醉性止痛藥 (meperidine) 鎮定劑及安眠藥 類固醇 中樞降血壓藥物(methyldopa, reserpine) 抗巴金森氏症藥物 (levodopa) 交感神經促進劑(ritalin, pseudoephedrine, dextroamphetamine) 其他 (aminophylline, insulin, thyroxine)
進一步之檢查 • • Cultures of blood, urine, sputum, stool Brain CT scan / MR imaging f. T 4, TSH STS (梅毒篩檢) Cortisol level Lumbar puncture EEG 絕大部份引發譫妄的病因 在病程初期皆具可逆性。
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