2015 Volume 27 Issue 4 Pages 318-326
This article overviewed the diagnosis, etiology, and treatment for slight disturbance of consciousness and delirium. Clinicians especially pay attention to slight disturbance of consciousness, because it develops into delirium. We introduced the concept and definition of delirium proposed by two famous Japanese psychiatrists (Kenichi Harada and Joji Kandabashi) as well as DSM-5. We also referred to the reliability and validity of the delirium rating scale (DRS-R-98). We demonstrated that serum levels of MHPG, a major metabolite of norepinephrine, was significantly higher in delirious patients compared with those in healthy subjects, and surprisingly, serum MHPG levels in delirious patients were also higher before delirium had occurred. In short, over activity of noradrenergic neurons plays an important role for pathophysiology of delirium. Our series of previous studies elucidated that serum MHPG level is a biological marker for anxiety. Taking these findings into account, relief of patient’s anxiety might be an important factor in preventing delirium. Once delirium occurs, interventions with psychotropic drugs should be performed.
