2552 delirium thai

7/26/2019 2552 Delirium Thai

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(Delirium)

2552

2550 5,512 15 8 2

3

.


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2

. .

. 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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4

/

. reticuture function

. acetylcholineant cholinergic activity (Delirium)

- - - - - -- --(INFECTIOUS)-(WITHDRAWAL)

- --- Metabolism - - - - 1)

2) ( )

. :

. : . (disorientation) .


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5

.

.

.

.

.

.


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6

.

( sleep-wake cycle) ( stupor)

sun downing ( ( ICU syndrome)

( , -)

A. (attention)

B. Cognition ( ) (perceptual disturbance)

C. () (fluctuation)

D.


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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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4

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

-

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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2552 delirium thai

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