以Olanzapine治療住院中的譫妄病人

Olanzapine for the Treatment of Delirium in Hospitalized Patients

林承儒(Chen-Ju Lin) ； 方俊凱(Chun-Kai Fang) ； 陳虹汶(Hong-Wen Chen) ； 賴允亮(Yuen-Liang Lai)

《內科學誌》 16卷1期 (2005/02) Pp. 48-52

https://doi.org/10.6314/JIMT.2005.16(1).07

摘要

譫妄(delirium)是住院病人常見的精神科併發症，是一種急性發作、呈現瞬間與波動性病程的器質性精神症候群。從過去的醫學研究可知，綜合醫院的住院病人中，約有15%-30%的病人發生過譫妄症。根本治療譫妄症針對的是致病的生理狀態，而緩解治療則試圖控制激動等症狀。處理譫妄症狀的方法包括藥物及非藥物治療。單獨使用非藥物治療或支持療法對控制譫妄症狀時常是無效的，所以使用抗精神病藥物治療是必須的。Haloperidol，是第一代的抗精神病藥物，具有較少之心血管與呼吸系統副作用及較輕微之抗膽鹼作用，是治療譫妄症之首選藥物。但第一代抗精神病藥物的主要缺點常引起包括錐體外徑症候群(extrapyramidal syndrome)等副作用。第二代抗精神病藥物如risperidone及olan-zapine有較低的錐體外徑副作用(extrapyramidal side effect)及相關副作用。故本文提出經由olanzapine治療的三例個案，比較其中文版譫妄量表(Delirium Rating scale, DRS)在治療前後的變化，可見這三例個案有極大進步，以此提供大家在治療譫妄症病人的另一方向思維。

關鍵字

譫妄症 ； 金菩薩 ； 中文版譫妄量表

並列摘要

Delirium is a common and often serious neuropsychiatric complication in hospitalized patients with medical illness. Delirium is a syndrome of disturbed consciousness, cognition, and perception that develops over a short period of time and tends to fluctuate during the course of the day. From the previous study, the prevalence of delirium has been estimated from 15% to 30% among hospitalized patients. The standard approach to managing delirium in the medically ill includes a search for underlying causes, correction of those factors, and management of the symptoms of delirium. The palliative therapy is trying to control the agitated behavior. The management of the symptoms of delirium involves the use of both nonpharmacological and pharmacological interventions. Nonpharmacological or supportive interventions alone are often not effective in controlling the symptoms of delirium, and symptomatic treatment with neuroleptics or antipsychotic medications is necessary. Haloperidol, a first-generation antipsychotics, is the first choice for delirium treatment, which has little cardiac or respiratory side effect and few anticholinergic effects. The major disadvantage of the use of first generation antipsychotics includes the development of extrapyramidal side effect and etc. Second-generation antipsychotics such as risperidone and olanzapine result in lower incidence of extrapyramidal and related side effects. Our case report presents three delirium case treated by olanzapine and by the great improvement in DRS within the first 3 days of treatment. Hope this experience can provide you another thinking process to treat delirium hospitalized patients.

並列關鍵字

Delirium ； Olanzapine ； Delirium Rating Scale, DRS