gykwak03/KISS_delirium_papaers huggingface dataset:
Title: 암환자 섬망의 약물치료

Objectives: Despite the fact that delirium is a frequent neuropsychiatric disorder in cancer patients, there are, in Korea, no guidelines for the pharmacological treatment of such delirium. This systematic review evaluated the efficacy and safety of some pharmacological interventions and summarized the results. Methods: We searched PubMed, Embase, CINAHL, the Cochrane Library, and the KMbase, targeting from January 1990 to October 2008, using key words. Moreover, we included systematic reviews, meta-analyses, and randomized controlled trial literature in the search. Then, we stratified the trials based on their evidence levels. Results and Conclusion: We identified 13 randomized, controlled studies and 2 case-control studies that met our inclusion criteria. These showed that haloperidol was the medication of choice to treat delirium. In addition, they revealed that atypical antipsychotics have not shown clear superiority with regard to effectiveness as compared to haloperidol. Neither donepezil nor rivastigmine were shown to be effective in preventing or treating delirium.
Title: 일 대학병원 정신과에 협진 의뢰된 환자 중 의뢰의가 섬망 진단을 놓치게 하는 요인: 예비연구

Objectives: The misdiagnosis of delirium may result in a delay of correct diagnosis and appropriate treatment of the delirium. Additionally, aggravation of physical illnesses can occur. The objective of this study was to investigate patient characteristics in cases of misdiagnosed delirium upon psychiatric consultation in a university hospital. Methods: Subjects included patients with delirium among all who we had consulted over a 12week span. Psychiatric diagnosis was made by two well-trained psychiatrists by means of the DSM-IV-TR. Cognitive function, level of delirium, and physical function were evaluated by the Korean version of Mini Mental Status Examination (MMSE-K), the Delirium Rating Scale-Revised-98(DRS-R-98), the Clinical Global Impression-Severity (CGI-S), the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and the Global Assessment of Functioning Scale (GAF). In addition, we collected socio-demographic information, date of admission and consultation, present causes of consultation, and speculated psychiatric diagnoses made by referring physicians. Results: Among 45 subjects with delirium, only 28 patients (62%) were diagnosed with delirium by referring physicians at the time of consultation. The remaining 17 patients (38%) had been diagnosed with other illnesses. The group of misdiagnosed patients tended to have a longer duration of formal education than those that had been correctly diagnosed. Conclusion: Early diagnosis and intervention of delirium can minimize subsequent problems related to delayed diagnosis. Therefore, it is vital to identify the factors related to misdiagnoses by referring physicians. This study showed that a longer duration of formal education is a contributing factor for the misdiagnosis of delirium. Longer education may cover up the typical symptoms of delirium. This can keep referring physicians from making a correct diagnosis. This study was a pilot study investigating diagnostic accuracy of delirium by referring physicians. Additional, well-controlled studies are warranted.
Title: 급성기 뇌졸중에서 섬망이 기능 회복에 미치는 영향

Objective: To investigate the risk factors for poststroke delirium and evaluate its influence on functional recovery after ischemic stroke. Method: Risk factors for delirium were investigated retrospectively in three hundred twenty nine acute ischemic stroke patients over 60 years of age. Among the 329 patients, sixty seven developed delirium. Data were analyzed between delirium group (n=22) and control group (n=22) according to age, sex, lesion location and clinical features. Korean modified Barthel index (K-MBI), Korean National Institutes of Health stroke scale (K-NIHSS) and Korean mini-mental state examination (KMMSE) were measured at second and sixth weeks after onset and compared for both groups. Results: Parameters showing statistically significant difference between two groups were age over 80, hyponatremia, sleep deprivation, cognitive impairment and cardiogenic embolism. There was no significant difference in K-MBI, K-NIHSS and K-MMSE scores at second week between the two groups. The delirium group showed significantly less improvement in K-MBI and K-NIHSS scores compared to control group (9.5±10.2 vs 18.5±11.6, p=0.011; ?0.7±1.2 vs ?1.8±1.3, p=0.014). There was no significant improvement in K-MMSE score. Conclusion: The possible risk factors for delirium in acute ischemic stroke are age over 80, hyponatremia, sleep deprivation, cognitive impairment and cardiogenic embolism. Stroke patients with comorbid delirium showed poorer functional outcome. Delirium seems to have detrimental effect in functional recovery after stroke. (J Korean Acad Rehab Med 2010; 34: 403-408)
Title: 간이식 수술 후 발생한 술 후 섬망의 위험 인자에 대한 고찰

Background: Postoperative delirium (POD) after liver transplantation is a serious complication. This study investigated the incidence and the risk factors of POD in liver transplantation recipients. Methods: Three hundred and sixty eight adult recipients who had undergone liver transplantation were included. We reviewed medical records and the POD was determined by either psychiatric consultation or established diagnostic criteria. Recipients were divided into two groups according to the occurrence of POD: POD group (n=150) and non-POD group (n=218), and risk factors were assessed. Results: One hundred fifty (40.8%) of the 368 recipients developed POD after liver transplantation. History of alcohol consumption and alcoholic liver disease, history of hepatic encephalopathy, preoperative mental status changes, ventilator care, dialysis, hypotension, and ICU care were significantly higher in the POD group. In the preoperative laboratory test, sodium was lower while bilirubin, PT (INR) and MELD score were higher in the POD group. Postoperative variables including dialysis, ventilator care duration, ICU stay, hospital stay, glucose and ammonia were significantly higher in the POD group. Three variables were identified as independent predictors of POD in a multiple regression analysis: history of alcohol consumption (odds ratio, 2.04; 95% confidence interval [CI], 1.12-3.72; P=0.02), history of hepatic encephalopathy (odds ratio, 2.54; 95% CI, 1.46-4.41, P<0.01), and MELD score (odds ratio, 1.03; 95% CI, 1.00-1.06; P=0.02). Conclusions: The development of POD and related morbidity and mortality would be reduced if we identified the recipients with risk factors preoperatively and applied early intervention. (Korean J Anesthesiol 2009;57:584∼9)
Title: 섬망환자의 한방치료 증례보고 4례

Objectives: The purpose of this study is to report the effect of oriental medical treatments on the patients with delirium. Methods: Four patients diagnosed with delirium by DSM-ⅣTM was treated Onbaek-won(Wenbai-yuan), Jugeo-hwan(Zhouju-wan) and herb medicine. The severity of delirium was assessed by using MMSE-K. And then, we investigated and analyzed the clinical symptoms of the patients. Results: After oriental medical treatments, the symptoms of delirium were disappeared and MMSE-K score was improved. Conclusions: It could be suggested that oriental medical treatments were effective on delirium. Further study of the effect of oriental medical treatments on delirium is needed in the near future.
Title: 소아 사시 교정술에서 마취제가 각성 섬망에 미치는 영향

Background: This study was designed to compare the effects of anesthetic methods used recently on emergence delirium in pediatric strabismus surgery. Methods: Two hundred and thirty two children, aged 2-10 years, undergoing strabismus surgery, were randomly assigned to one of eight groups; ketamine-desflurane (n = 30), ketamine-sevoflurane (n = 30), ketamine-propofol (n = 30), ketamine-remifentanil (n = 27), midazolam-desflurane (n = 28), midazolam-sevoflurane (n = 30), midazolam-propofol (n = 27), and midazolam-remifentanil (n = 30). Anesthesia was induced with ketamine 1.0 mg/kg or midazolam 0.15 mg/kg. Laryngeal mask airway (LMA) was placed with rocuronium 0.5 mg/kg. Anesthesia was maintained with desflurane 5-6 vol%, sevoflurane 2-3 vol%, propofol 7-8 mg/kg/hr, and remifentanil 0.5μg/kg/min under N2O 66% in O2. Ventilation was controlled to maintain normocapnia. The status of emergence delirium (ED) was evaluated by a blinded observer until discharge from postanesthetic care unit. Results: There was no differences in age, sex, weight, height, anesthetic time, and recovery time among the eight groups. ED occurred in 54 children (23.3%), but severe ED needed treatment was not occurred. Compared with ketamine group, midazolam group showed less incidence of ED. Propofol and remifentanil groups showed less incidence of ED compared with desflurane and sevoflurane groups. ED group was more younger and more temperamental compared with nonED group. Conclusions: Propofol or remifentanil anesthesia provided less incidence of ED compared with desflurane and sevoflurane in pediatric strabismus surgery. (Korean J Anesthesiol 2007; 52: 138~42)
Title: 알콜성 진전섬망으로 진단된 신지부청(神志不淸) 환자 치험 1례

Delirium Tremens is the most terrible and dramatic syndrome in Alcohol Withdrawal Syndrome. Delirium Tremens is one of acute psychiatric symptoms and happens that a chronic drinker is suddenly off drinking for any reasons. In Oriental medicine, Alcohol Withdrawal Syndrome is comprised in a category of Jusang(酒傷).In this case, we described a 53-year old man who diagnosed as Delirium tremens. He suffered mental derangement and headache, and his condition was improved through oriental medical treatment.
Title: 환각 및 지남력 저하에 대한 약물치료 중 발생한 섬망 환자 1例 증례보고

Delirium is a acute syndrome of disorientation caused by dysfunction of brain tissue and has a many varied symptom. The characteristic symptoms of delirium are conscious disturbance with disorientation and dys-mnesia and emotional disturbance.We experienced a 77 year-old male who had a hallucination and disorientation as well as delirium caused by antipsychotic medication, and whose condition was improved through discontinuing medication and traditional Korean medical treatment. We had given herb medication, acupuncture treatment and decreased medication to this patient, and observed. The patient`s delirium symptom had improved through oriental medical treatment and decreasing medication. It was able to improve a delirium caused by not specified origin and side effect of drug abuse through oriental medical treatment and decreasing medication.
Title: 섬망을 동반한 번조(煩躁) 환자의 치험 1례

Delirium is a set of symptoms that includes Disturbance of consciousness, attention, cognition, sleep-wake cycle. It usually appears as a disease progresses. Also it can be considered as one of byun-jo(煩躁)'s symptoms because it shows similar symptom and progress to byun-jo(煩躁). One patient was admitted who was suffering delirium, restlessness, chest discomfort, disorientation. The patient was diagnosed as delirium and byun-jo that was caused by heat in the heart and stomach, and was treated with Chungul-san(淸鬱散). In the course of treatment, symptoms improved gradually. Resu suggest that Chungul-san(淸鬱散) is effective on delirium, byun-jo caused by heat in stomach.
Title: 한국판 섬망 평가 척도의 표준화

Objective ：The purpose of this study was to examine the regional cerebral blood-flow(rCBF) difference between boys with pure ADHD and normal controls before and after methylphenidate treatment, and also we examined the association between rCBF changes and cognitive characteristics of boys with pure ADHD before and after methylphenidate treatment. Methods ：The rCBF of 5 boys with pure ADHD and 5 control boys were examined by Tc-99m ECD brain SPECT and cognitive characteristics by ADS and every 5 ADHD boys took MPH for 12 to 16 weeks. After that all ADHD boys took Tc-99m ECD brain SPECT and checked ADS again. rCBF difference and changes before and after MPH treatment were quantified and analyzed by using SPM. And, associations between types of cognitive changes measured by ADS and rCBF changes were examined, and quantitative associations between them were also analyzed by using Pearson’s coefficient correlation. Results ：1) Before MPH treatment, rCBF of ADHD boys were significantly decreased in left orbitofrontal area and left caudate nucleus compared to normal controls. 2) After MPH treatment, rCBF of the same regions were significantly increased. 3) There was positive correlation between the degree of commission error(impulsivity, disinhibition) among the ADS variables and the degree of blood-flow decrease in above two areas before MPH treatment but after MPH treatment, only with the degree of rCBF increase in Lt orbitofrontal area. Conclusion ：These results suggest that the pathophysiology of impulsivity or disinhibition of the characteristic symptoms of ADHD boys is associated with hypoactivities of left orbitofrontal area and left caudate nucleus, and MPH pharmacodynamics in ADHD boys is associated to their actions on these two areas.
Title: 노인 환자에서 고관절 치환술 중 발생한 심정지와 술후 섬망 - 증례 보고 -

An Eighty-year-old female patient was transferred to the operating room for hip arthroplasty under the general anesthesia. Immediately after injection of two units of methylmethacrylate bone cement into the intramedullary canal, systolic blood pressure rapidly decreased and cardiac arrest occurred. The patient was turned to the supine position and was successfully resuscitated with intravenous administration of fluids, injection of epinephrine and external cardiac massage. In the intensive-care unit, she was treated for acute pulmonary edema. Three days later, postoperative delirium was developed. She spoke incoherently, was disoriented, and showed impairment of memory and attention. She was treated with haloperidol, lorazepam and sedative drug, five days later recovered. The patient was discharged to home without any sequelaes, but she died due to pneumonia two months later postoperatively at home. (Korean J Anesthesiol 1999; 36: 365∼369)
Title: 노인에서 경막외-전신마취 병용후 섬망 - 증례 보고 -

Postoperative delirium is defined as an acute change with cognitive status characterized by fluctuating consciousness and unattention occurring within 30 days after operation. Postoperative delirium is a common complication of surgery in elderly people, but have been often unrecognized, under-diagnosed, under-treated, and under-investigated. We present a case of postoperative delirium in elderly patient who should have been treated with psychotherapy and antipsychotic drugs in psychiatric department after combined epidural-general anesthesia with continuous epidural bupivacaine and fentanyl infusion for postoperative pain control. (Korean J Anesthesiol 1999; 36: 165∼168)
Title: 노인 환자에서 전신마취와 부위마취시 수술후 섬망빈도의 비교

Background: Elderly patients often have postoperative psychiatric disorders compared with young patients. Methods : This study was undertaken to compare the effects of general or regional anesthesia on postoperative psychiatric disorders in 31 elderly patients with elective orthopedic and urological surgery. Mini Mental States Examinations(MMSE) was done to find out postoperative delirium at preoperative, postoperative 6hours, 1st, 3rd, and 7th days. Results : Mean changes in MMSE score after general anesthesia were significantly decreased compared with preoperative score and with in regional anesthesia at postoperative 6 hours and 1st day. Postoperative MMSE scores were decreased below 17 points in 17 patients among 22 patients in general anesthesia and 3 patients among 26 patients in regional anesthesia. Hospital admission duration were significantly prolonged in general anesthesia compare with regional anesthesia. Conclusions: The incidence of postoperative delirium is more common after general aneshtesia than after regional anesthesia. Therefore regional anesthesia is recommeded in elderly patients to decrease postoperative delirium. (Korean J Anesthesiol 1998; 34: 623∼629)
Title: 중환자실 퇴원환자의 인지장애 위험요인

Purpose : This study aimed to identify the prevalence and risk factors of cognitive impairment in survivors discharged from the intensive care unit (ICU). Methods : This secondary analysis study utilized data from a multicenter prospective cohort of post-ICU patients. We analyzed the data of 175 patients enrolled in the primary cohort who completed the cognitive function evaluation three months after ICU discharge. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale. The cut-off points for cognitive impairment were < 23 for face-to-face evaluation and < 18 for telephone evaluation. Results : The prevalence of cognitive impairment three months after ICU discharge was 32.6%. Significant risk factors for cognitive impairment were age ≥ 60 years (OR=10.52, 95% CI=3.65~30.33, p<.001), education < high school graduation (OR=2.53, 95% CI=1.07~6.01, p=.035), unplanned ICU admission (OR=4.01, 95% CI=1.45-11.14, p=.008), and delirium in the ICU (OR=4.33, 95% CI=1.08-17.23, p=.038). Conclusion : ICU nurses should use preemptive strategies to reduce post-ICU cognitive impairment of patients with risk factors. It is necessary to frequently assess and detect early delirium in critically ill patients, while attempting various non-pharmacological interventions.
Title: Literature Review of Postoperative Delirium in Geriatric Patients After Elective Gastrointestinal Cancer Surgery

Purpose: Increasing number of older adults are receiving cancer surgeries especially for gastrointestinal cancers, which brings forth attention to age-related postoperative complication prevention. Postoperative delirium (POD) is a common complication that rises after surgical procedures involving general anesthesia, largely in the elderly population. Due to its sudden onset and fluctuating symptoms, POD often goes underdiagnosed and undertreated even though it may lead to various adverse outcomes. POD in GI cancer surgical elderly patients is poorly understood in terms of prevalence, pathophysiology, assessment, treatment and nursing management. We aimed to identify available literature and investigate study results to broaden our understanding of geriatric GI cancer POD. Methods: The search process involved six databases to identify relevant studies abided by inclusion criteria. Results: Eleven studies were selected for this review. Geriatric POD is closely related to frailty and surgical complications. Frailty increases vulnerability to surgical stress and causes cerebral changes that affect stress-regulating neurotransmitter proportions, brain blood flow, vascular density, neuron cell life and intracellular signal transductions. These conditions of frailty result in increased risks of surgical complications such as blood loss, cardiovascular events and inflammation, which all may lead to the POD. Mini Metal State Examination (MMSE), Confusion Assessment Method (CAM) and Delirium Rating Scale-revised-98 (DRS-R-98) are recommended for POD assessment to identify high-risk patients. Conclusion: The POD prevalence ranged from 8.2% to 51.0%. The multifactorial causative mechanism suggests nurses to identify highrisk elderly GI-cancer surgical patients by reviewing patient-specific factors and surgery-specific factors.
Title: P-20 Factors associated with physical function, memory and quality of life in ICU survivors

Introduction: There is a lack of data on the lives of intensive care unit (ICU) survivors in Korea. To study post-intensive care syndrome (PICS), we investigated ICU survivor’s memory, physical function, quality of life and associated factors with these three aspects of PICS. Methods: From the prospective cohort of medical ICU in Seoul National University Bundang Hospital since July 2016, we used data of ICU survivors who completed 1week follow up after hospital discharge. At 1 week follow up, ICU survivors completed a set of structured questionnaires, including ICU memory tool (ICUM), Barthel index, and EuroQol 5-Dimensions (EQ-5D). Results: From April 2016 to August 2017, thirty eight patients completed 1week follow up. Median age of the patients were 71.5 years (58.8-76.0) and 25 (66%) patients were men. Median APACHE II score was 21 (14.8-27.0) and median ICU stay was 5.5 (3.0-8.0) days. At 1 week after hospital discharge, median Barthel index and EQ-5D score were 69.9 (58.0-98.8) and 8 (6-9), respectively. According to ICUM, 10 patients (26%) had no memory of ICU. In admission characteristics, only delirium was associated with all three aspect of PICS; lower Barthel index, lower EQ-5D score and the absence of ICU memory. Conclusion: This study suggests that ICU delirium is important factor in all three aspects of PICS in ICU survivors. Further long term study is needed.
Title: Efficacy of low dose prophylactic quetiapine on delirium prevention in critically ill patients: A prospective, randomized, double- blind, placebo-controlled study

Background: Previous studies revealed quetiapine was effective in treating delirium in critically ill patients. However, there are no recommendations for pharmacologic prevention of delirium for them. We aimed to evaluate the efficacy of low dose quetiapine for delirium prevention in critically ill patients. Methods: A prospective, randomized controlled study was conducted in a medical intensive care unit(ICU) of Seoul National University Bundang Hospital from July 2015 to July 2017. Within 72 hours of ICU admission, patients were randomly assigned to receive either placebo or 1 dose of oral quetiapine(12.5 or 25mg) per day starting the randomization day and continuing until the 10th ICU day or ICU discharge before 10th ICU day. The primary predefined outcome was delirium diagnosed with the Confusion Assessment Method(CAM) within study period. Secondary measures were positive rate of CAM, mortality, successful extubation, and the use of rescue medication. Result: A total of 35 patients were included. The incidence of delirium during the 10 days after ICU admission was 46.7%(7/15) in the quetiapine group and 55.0%(11/20) in the control group(p=0.442). The rate of CAM positivity was significantly higher in the control group(37.4% vs. 13.5,p=0.035). More patients in the quetiapine group weaned mechanical ventilation successfully( 84.6% vs. 47.1%,p=0.040) and survived (80.0% vs. 45.0%,p=0.039) Conclusion: Our study suggests that prophylactic use of low dose quetiapine would be helpful for preventing delirium in critically ill patients. Further large prospective study is needed.
Title: 중환자실 환자의 수면증진 중재가 수면의 질 및 섬망발생에 미치는 효과

Purpose: The purpose of this study is to investigate the effect of eye-shields and sleep-inducing music application on sleep quality and incidence of delirium for intensive care unit (ICU) patients. Methods: This study was a untreated control group design with pretest and posttest. The data was collected in the ICU of D University Hospital in Busan, from June to September 2011. Thirteen subjects were assigned to eye-shields and sleep-inducing music intervention and 15 subjects were in the control group. Results: Eye-shields and sleep-inducing music application was effective for improving the quality of sleep in ICU patients. There was no statistically significant difference in the incidence of delirium between the two groups. Conclusion: The sleep improvement intervention with eye-shields and sleep-inducing music would be a meaningful part of nursing intervention programs to enhance the quality of sleep in ICU patients.