Januar 2013

Delirium tremens, delirium, delirium acutum, malignt neuroleptika syndrom eller katatoni, that´s the question

The velanskrevne The England Journal of Medicine bringer nu som igennem mange år indlæg med kasuistikker og tilmed i en form med grundig præsentation af en sygehistorie efterfulgt af kyndige klinikere eller eksperters vurdering af klinik, diagnose og behandling. For nyligt bragte tidsskriftet en case med et kompliceret behandlingsforløb af en delirøs tilstand hos en alkoholafhængig person, der blev indlagt med kramper og i en agiteret tilstand. Han havde betydelig somatisk komorbiditet. Behandlingsforløbet var kompliceret med langvarig konfusion, måske fordi den sederende behandling ikke var intensiv nok set med danske øjne Det drøftes om diazepam behandlingen var medvirkende til det protraherede forløb. ECT indgår ikke i overvejelserne.

Nejad SH, Schaefer PW, Bajwa EK, Smith FA. Case records of the Massachusetts General Hospital. Case 39-2012. A 55-year-old man with alcoholism, recurrent seizures, and agitation N Engl J Med. 2012 Dec 20;367(25):2428-34 

PMID: 23252529

Differentialdiagnostiske vanskeligheder ved delirøse tilstande drøftes i en anden artikel, der også inddrager sygehistorier og dermed gør læsningen særligt stimulerende. Her omtales og anvendes ECT. Det understreges at tilstande med ”excited delirium” er potentielt livstruende. Næppe sensationel ny viden i Dansk psykiatri, men det er altid godt at få skærpet det diagnostisk blik ved delirium. Denne artikel kan frit downloades via PubMed.

Samuel E, Williams RB, Ferrell RB. Excited delirium: Consideration of selected medical and psychiatric issues. Neuropsychiatr Dis Treat. 2009;5:61-6.

Excited delirium, sometimes referred to as agitated or excited delirium, is the label assigned to the state of acute behavioral disinhibition manifested in a cluster of behaviors that may include bizarreness, aggressiveness, agitation, ranting, hyperactivity, paranoia, panic, violence, public disturbance, surprising physical strength, profuse sweating due to hyperthermia, respiratory arrest, and  death. Excited delirium is reported to result from substance intoxication, psychiatric illness, alcohol withdrawal, head trauma, or a combination of these.  This communication reviews the history of the origins of excited delirium, selected research related to its causes, symptoms, management, and the links noted between it and selected medical and psychiatric conditions. Excited delirium involves behavioral and physical symptoms that are also observed in medical and psychiatric conditions such as rhabdomyolysis, neuroleptic malignant  syndrome, and catatonia. A useful contribution of this communication is that it links the state of excited delirium to conditions for which there are known and effective medical and psychiatric interventions.

PMID: 19557101  (frit tilgængelig via PubMed)

Raben Rosenberg