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2015年5月15日号
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 せん妄は急性に発症(通常数時間から数日)し、意識、注意、知覚の障害が出現し、日内変動を示す症候群で、過活動型、低活動型、混合型に分類されます。過活動型は運動活動量の増加、活動性の制御喪失、不穏、徘徊などが認められた場合、低活動型は活動量の低下、行動速度の低下、状況認識の低下、会話量の低下、会話速度の低下、無気力、覚醒の低下などが認められた場合、混合型は24時間以内に、過活動型、低活動型両方の症状が認められた場合とされています。 せん妄の発症には、必ず直接原因としての身体的な障害が存在しています。ストレスだけではせん妄は発症しません。背景因子としての高齢、認知症などの存在、誘発因子としての断眠、疼痛、感覚遮断または感覚過剰、ストレスなどが著明なほど、せん妄は発症しやすくなります。せん妄が発症した場合には、何らかの身体症状の悪化、あるいは新たな身体疾患が存在しており、原因の検索が重要です。
 直接原因としては、脳血管障害(脳出血、梗塞…)、代謝性疾患(血糖異常、尿毒症、肝不全、電解質異常…)、腫瘍性疾患、薬物中毒、感染症、貧血、低酸素血症など多彩です。
 一般的に多く見られ注意が必要なのが薬物、依存性物質によるもので、抗コリン作用のある薬、ベンゾジアゼピン系(ある種の睡眠薬・安定剤など)、ステロイド、オピオイド、アルコール、覚せい剤などが原因になり得ます。
 せん妄の予防としては、直接原因となり得るものを避ける必要があります。たとえば、高齢者に対する不要・過剰な薬剤の中止・制限などです。脱水の予防も大切です。
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price of cialis 5 mg at walmart  治療は直接原因疾患の治療、原因薬剤の中止ですが、それでも即座にせん妄が改善するとは限らず、原因が特定できない場合も少なくありません。主に統合失調症の治療に使用される抗精神病薬が治療の主役ですが、特に高齢者ではこの薬自体のリスクもある程度あるため、リスク・ベネフィットを考慮して使用を判断します。