Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Symptomatic and Clinical Profiles Across Motoric Subtypes in Delirium

섬망의 운동성 아형에 따른 증상과 임상적 특징

  • Paik, Soo-Hyun (Department of Psychiatry, Yonsei University Wonju College of Medicine) ;
  • Min, Seongho (Department of Psychiatry, Yonsei University Wonju College of Medicine) ;
  • Ahn, Joung-Sook (Department of Psychiatry, Yonsei University Wonju College of Medicine) ;
  • Park, Ki-Chang (Department of Psychiatry, Yonsei University Wonju College of Medicine) ;
  • Kim, Min-Hyuk (Department of Psychiatry, Yonsei University Wonju College of Medicine)
  • 백수현 (연세대학교 원주의과대학 정신건강의학교실) ;
  • 민성호 (연세대학교 원주의과대학 정신건강의학교실) ;
  • 안정숙 (연세대학교 원주의과대학 정신건강의학교실) ;
  • 박기창 (연세대학교 원주의과대학 정신건강의학교실) ;
  • 김민혁 (연세대학교 원주의과대학 정신건강의학교실)
  • Received : 2015.08.07
  • Accepted : 2015.09.29
  • Published : 2015.12.31
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Abstract

Objectives : To investigate clinical and symptomatic differences among motoric subtypes of delirium. Methods : A total of 256 patients referred to psychiatric consultation services for delirium due to general medical condition were assessed retrospectively. Motoric subtypes were determined according to Lipowski's criteria for hyperactive, hypoactive and mixed subtypes. All patients were evaluated according to Delirium Rating Scale-Revised-98(DRS-98-R) by trained psychiatrists to obtain symptomatic profiles of delirium. Results : Hyperactive subtype were 50.8%(n=130), mixed 46.1%(n=118) and hypoactive 3.1%(n=8). Hyperactive patients were younger than mixed subtype($69.62{\pm}13.976$ vs. $73.97{\pm}11.569$, p=0.022) and received antipsychotics to manage symptoms of delirium more frequently(83.8% vs. 57.6%, p<0.001). Hyperactive patients had higher DRS-R-98 scores on both noncognitive($7.14{\pm}3.543$ for hyperactive, $5.62{\pm}3.279$ for mixed subtype) and cognitive subscales($10.00{\pm}3.574$ for hyperactive, $6.38{\pm}2.875$ for hypoactive, $7.43{\pm}3.771$ for mixed subtype, p<0.001). Conclusions : We demonstrated that clinical and symptomatic profiles were different across motoric subtypes in delirium. Diagnostic and therapeutic approach should be made differently according to motoric subtypes of delirium and special attention is needed not to underestimate or delay treatment in specific motoric subtype of delirium.

연구목적 본 연구에서는 섬망의 운동성 아형 간의 증상과 임상적 특징의 차이를 알아보고자 한다. 방 법 일 대학병원에 입원하여 정신건강의학과에 협진의뢰된 환자 중 일반신체질환에 의한 섬망으로 진단된 256명을 대상으로 후향적으로 의무기록을 검토하였다. 운동성 아형은 Lipowski의 분류 체계에 따라 과활동형, 저활동형 및 혼재형으로 분류하였으며, 섬망평가척도를 이용하여 증상을 평가하였다. 결 과 과활동형이 130명(50.8%), 혼재형은 118명(46.1%), 저활동형은 118명(3.1%)이었다. 과활동형은 평균연령이 혼재형 환자보다 적었으며(p=0.022), 섬망을 치료하기 위해 항정신병 약물을 더 자주 사용하였다(p<0.001). 과활동형은 인지적 및 비인지적 증상 점수가 타 아형에 비해 높았다(각각 p=0.002, p<0.001). 결 론 섬망의 운동성 아형에 따라 증상 및 임상적 특징에서 차이가 있었다. 운동성 아형에 따라 진단 및 치료적 접근 방법을 달리하여, 특정 아형의 섬망 진단이 간과되거나 치료가 지연되지 않도록 관심을 가질 필요가 있다.

Keywords

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