Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · May 2003
Review[Summary of the Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'].
The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people' contains a number of key messages. These are: Consider the diagnosis of delirium in the case of changes in consciousness and attention, incoherent thinking or disorientation, if this picture developed over a short period of time (hours to days) and if the symptoms vary over the 24-hour period. Delirium is provoked by one or more somatic disorders; investigation and treatment of these disorders is an essential part of managing delirium. ⋯ Although delirium is generally reversible, the prognosis in the elderly is relatively poor. If delirium is accompanied by fear or agitation, haloperidol is the drug of first choice, but in delirium induced by alcohol withdrawal or benzodiazepine withdrawal, a short-acting benzodiazepine such as lorazepam or oxazepam is indicated. Part of the treatment, but also prevention of delirium is focused on inducing factors that can provoke a delirium, such as medication with an anticholinergic effect, polypharmacy, inadequate nutrition, dehydration, sleep deprivation, immobility and sensory handicaps.
-
Ned Tijdschr Geneeskd · May 2003
[The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'; response from psychiatry].
Delirium is a common psychiatric illness among the medically ill and is associated with significant morbidity and mortality. Although delirium may develop at any age, the elderly are particularly vulnerable. Since the number of elderly with chronic diseases, dementia, sensory handicaps and the use of several (anticholinergic) medications--all predisposing factors for delirium--is rising, it is essential that general practitioners can recognise, adequately diagnose and treat delirium. ⋯ Evidence on clinical features, differential diagnosis, prevalence, course, aetiology, and risk factors for delirium in primary care is lacking. In general hospitals, the prevalence of delirium in the elderly is about 10-40%; it is probably much less in primary care. This guideline does not provide an adequate description of the clinical presentations of delirium, and does not sufficiently stress the importance of recognising any new behavioural problem in an elderly patient as an indication of possible delirium.
-
Ned Tijdschr Geneeskd · May 2003
Comment[The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'; response from clinical geriatrics].
Delirium in elderly people is a severe condition that requires vigorous medical attention. Therefore, the Dutch College of General Practitioners has duly chosen to develop a practice guideline 'Delirium in elderly people'. It is likely that many general practitioners are only partly familiar with delirium in elderly people because the prevalence of delirium in general practice is low. ⋯ However, several diagnostic issues merit further attention. For example, the guideline does not contain a diagnostic algorithm and the description of the clinical presentation of a delirium is brief. In addition, the guideline lacks a clear overview of the most important risk factors for a delirium as well as a careful description of the difference between delirium and dementia.
-
Ned Tijdschr Geneeskd · May 2003
[A welcome guide for evaluating medical research involving human subjects].
In 1999, the Dutch Medical Research Involving Human Subjects Act came into force. The principal aim of this Act is to provide protection for human subjects who take part in medical research. Medical research involving human subjects may only be carried out after it has been approved by a recognised medical ethics committee. ⋯ The CCMO has recently published a guide for the local medical ethics committees. It presents an excellent overview of all the legal and practical aspects of the work of medical ethics committees. The guide is highly recommended.