谵妄是一种急性混乱状态,最常见于重症监护病房的老年患者。在大多数情况下,早期识别,避免触发因素和保守措施对管理层来说是足够的,但有时症状仍然存在,尽管有足够的医疗服务,这有利于难治性谵妄。难治性谵妄没有明确的定义,但在一些病例报告和文献中,尽管经过适当的治疗而不损害意识,但仍存在症状。这种难治性症状的治疗需要仔细评估以确定原因和主要症状。这进一步有助于选择更好的治疗方案。通常难以处理此类病例,需要镇静剂和抗精神病药来逆转病情。非典型抗精神病药物在难治性谵妄的治疗中发挥着重要作用。并且选择适合患者特征且副作用可忽略不计的药物至关重要。我们提出了一个这样的案例,他的谵妄有多种原因,具有主要的过度活跃状态和非典型抗精神病药控制的难治性症状,抗抑郁药,和苯二氮卓类药物.
Delirium is an acute confusional state, most commonly observed in elderly patients admitted to the critical care unit. In most cases, early recognition, avoiding triggering factors and conservative measures are adequate for the management, but sometimes symptoms persist despite adequate medical care, which goes in the favor of refractory delirium. Refractory delirium has no clear-cut definition but it is discussed in some of the
case reports and literature as the presence of symptoms despite adequate treatment without impairing consciousness. Management of such refractory symptoms requires careful evaluation to identify the cause and predominant symptoms, which further helps in choosing a better therapeutic regime. It is often difficult to manage such cases and require sedatives and anti-psychotics to reverse the condition. Atypical antipsychotics are now playing a prominent role in the management of refractory delirium, and the selection of a drug that is suitable for the patient profile with negligible side effects is of utmost importance. We are presenting one such
case, with multiple causes for his delirium, with a predominant hyperactive state and the refractory symptoms managed by atypical antipsychotics, antidepressants, and benzodiazepines.