2552 Delirium Thai
Transcript of 2552 Delirium Thai
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(Delirium)
2552
2550 5,512 15 8 2
3
.
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. .
. Delirium Tremens ( Organic cause) Alcohol Dependence 1
Delirium , , Delirium , , Delirium
(Delirium)
(Delirium)
1. (Explicit knowledge)2. (COPs) (Tacit knowledge)
3. (Delirium)
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3.1 (Explicit knowledge) (COPs) (Tacit knowleage)(Delirium)
. .
4. 5.
1 (Explicit knowledge)1.1 (Delirium)
- - -/ - -
1.2 (Delirium)- (Delirium)
1.3 1.1 (Delirium)
. Delirium
. . %
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/
. reticuture function
. acetylcholineant cholinergic activity (Delirium)
- - - - - -- --(INFECTIOUS)-(WITHDRAWAL)
- --- Metabolism - - - - 1)
2) ( )
. :
. : . (disorientation) .
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.
.
.
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( sleep-wake cycle) ( stupor)
sun downing ( ( ICU syndrome)
( , -)
A. (attention)
B. Cognition ( ) (perceptual disturbance)
C. () (fluctuation)
D.
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. : :
- - -
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.
.
.
(delirium)
-Haloperidol Halop ./ .-./ (delirium)
3
-Lorazepam 2 /
- Vitamin B complex
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(Delirium) (Cognitive function)
(Delirium)
1.2 (Delirium) ( Delirium)
(Delirium)
1.2.1 Tool delirium index
1.2.2 MMSE-Thai 2002
1.2.3 CAM (Confusion Assessment Method).. (Alcohol Withdrawal Scale : AWS)1.2.5 TDRS (Thai delirium rating scale)
1. 2.1 Tool Delirium Index
Delirium DI MMSE MMSE
1. Inattention () W O R L D ( 1
)2
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3 (Focusing)
.
.
/ ( ) (Coma)
. , (Disorientation) ( ) ( )
. (
1 1
2 2 3
- 3
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. (Perceptual disturbance)
2 (
) ()
7. (Motor disturbance)
, ()
= , , 9 (Replace)
( )1.2.2 MMSE-Thai 2002
MMSEThai 2002
........... ............ ............ ............ ...................................HN.... ,
()
1. Orientation for time ( )
( )
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. ............................... . ............................... . ............................... . ............................... . ............................... 2. Orientation for place ( ) ()( ).
2.1.1 ........ ............................... .. ............................... .. .......... ............ ......... 2.1.4 ............................... 2.1.5 .......... ............ .........
. .. ............................... 2.2.2 /// ............................... 2.2.3 / .......... ............ ......... 2.2.4 ............................... 2.2.5 .......... ............ .........
3. Registration ( ) () (,,...) () (,,...) 3
( ) ........... ........... .........
...............................
4. Attention / Calculation (5 ) () (,,...) ? . .4.1
............ ............ ............ ............ ............ () , .
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4.2 () (,,...) (,,...) --- - (,,...)
............ ............ ............ ............ ............
5. Rccall (3 ) ( ) ........... ........... .........
...............................
6. Naming (2 )
. ...............................
. ...............................
7. Repletion ( )( () () (,,...) ()
...............................
8. Verbal Command ( ) () (,,...) .......... .(, , ) - (, , )
9. Written Command ( ) (,,...) (,,...) ..............................
10. Writing( ) (,,...)
..................................................................................................................................
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11. Visuocostruction ( ) ()
........................................................................................ ............... ............. ............ .......
(Cut-off point) (Cognitive impairment)
(-)
1423
( ,,) 17 30
22 30
.......... .......... ..................................
1.2.3 CAM ( Confusion Assessment Method) 2
Part 1
A:
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A1 ; 1-2 / A2; 1 (Fluctuate) / B
B1 - ( 1)
/
B2 . .
. .
1 /
B3 ( )
.... ..
1 /
B4 5 9 2 2 9 5 /
Part 2 1.
( A1 A2 ) /
2.
( B1 B4 ) /
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ITEM 2 : TREMOR ()0
1
2 3
ITEM 3 : ANXIETY ()0 1 2 3 panic attacks
ITEM 4: AGITATION ()0 1 2
3
ITEM 5: AXILLA REMPERATURE ()0 37.0 c 1 37.1c . c2 37.6c . c3 38.1 c . c4 38.5 c
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ITEM 6: HALLUCINATION ()
ITEM 7 : ORIENTATION ( )0 1 2
3
4
....................................... ...................
ALCOHOL WITHDRWAL SCALE HN: ............:
: /../. ......................... AM/PM
0 1
AWS TOTAL
1-4 = Mild withdrawal
5-9 = Moderate withdrawal
10-14 = Severe withdrawal
15 = Severe withdrawal
Reference: John B. saunders, Clinical Protocols for Detoxification in Hospitais and Detoxification Facilities (2002)
Translated by: Phunnapa Kittirattanpaiboon, Suan Prung Psychiatric Hospital (2004).
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2 3
0 1 2 3
/panic
0 1 2 3
0 37.0 C 1 37.1 C . c2 37.6 C . c3 38.1 C . c4 38.5 C
0
V = 2 T = 3 A = 4
0
2
3 .
AWS 1
2
3
4
5
1
6
3 4 Semi-comatose 7
5 ComatosePupils + reacls - no reaction Size in mm 8
B brisk S Sluggish
Nurse Initials
Reaction
1.2.5 TDRS (Thai delirium rating scale) 6
1.2.5 TDRS (Thai delirium rating scale) 6
TDRS 6 ITEM
1.
Reference : John B. Saunders. Clinical Protocols for Detoxification in Hospitals and Detoxification Facilities Z2002 July 2004
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1 2 ( ) 1 2
2.
hyperactive hypoactive variant
3. cognitive status
cognitive portion ( TMSE 5 orientation 10 ,registration 3 , attention and calculation 5 , racall 3 , language 9 ) 4 cognitive deficit 2 cognitive deficit recall organic amnestic syndromes 1
4. (
) 1 5.
stupor coma coma
6.
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2
Thai Delirium Rating Scales 6 ITEM
1. 0
1 6 2 1 3 1 3
2.
0 1 2 superficial pain 3 deep pain catatonia
3. cognitive status
0 cognitive deficits (
TMSE 21 )
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1 cognitive deficits ( TMSE 15-21 )
2 cognitive deficits ( TMSE orientation ) recall( recall 1 )3 cognitive deficits 24 registration recall 4 cognitive deficits motor vocal perseveration, confabulation
recent remote
4.
0 1 2
5.
0 1
2
3 4 stupor coma
6.
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0 2 4 24
1.3 - : 2531 B12
Delirium AffectiveDisorder,Schizophrenia paranoid states, Delirium Progressive dementia Evans1983 Goggans-1984 15 Zucker organic brain syndrome B12
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4070 matsushita,T.,2004 Thai delirium rating scale ( TDRS) Thai mentalstatus examination (TMSE) Poli F, Beck CT.- 2004, Somprakit P,-2002, Littaker D,-2000
- :2543 Thai delirium ratingscale (TDRS) 85 delirium 10 97 91
- :2543 Thai delirium ratingscale ( TDRS) 6 85 delirium 10 TDRS
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. (Delirium) 5
.
..52.. 52
4
( delirium) 2552 200 (. %) Delirium 23 25(12.5%) Delirium
Delirium 1 ( delirium)
1
1
delirium delirium
1
0 1 9.1 127 67.2
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1
6
- - 9 4.8
2 1
3 27.3 27 14.3
3
1 3
7 63.6 26 13.7
delirium delirium
2
0
1 9.1 118 62.4
1
5 45.5 47 24.9
2 superficial pain
3 27.3 19 10.1
3
2 18.2 5 2.6
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deep pain
catatonia3 cognitive status
3.1
- 4 36.4 153 81.0- 5 45.5 29 15.4
- 2 18.2 7 3.70
delirium delirium
3.2
- 4 36.4 163 86.2- 5 45.5 19 10.1- 2 18.2 7 3.7 3.3
4 36.4 168 88.9
5 45.5 14 7.4- 2 18.2 7 3.73.4
- 7 63.6 181 95.8- 2 18.2 2 1.1- 2 18.2 6 3.23.5 0 () 3 27.3 146 77.2
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3
2 18.2 1 0.5
4 stupor coma - - - -
6
0
1 9.1 165 87.3
2
4 36.4 13 6.9
4 24
6 54.5 11 5.8
, 10.73, 3.69 2.67, 3.46
( Delirium)
(Delirium) (cut of point)
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