암환자에서 발생한 섬망 증상의 특성 및 진정수면제와의 연관성

Phenomenology of Delirium in Cancer Patients and Its Association with Sedative-Hypnotics

일 대학병원에 입원 중 섬망이 발생한 암환자 112명을 대상으로 DRS-R-98을 시행하여 섬망의 증상특성과 중증도를 파악하고 치료방법에 따라 비교하였다. 그 결과 신경정신의학적 증상 중에는 수면-각성 주기장애와 지각장애 및 환각이, 인지 이상 측면에서는 주의집중장애와 시공간능력장애가 가장 흔한 증상이었다. 연령이 높을수록 DRS-R-98 점수도 높았다. 수술, 항암치료, 방사선 치료에 따른 DRS-R-98점수의 차이는 유의하지 않았다. 진정수면제 사용 여부에 따라서도 DRS- R-98 점수 차이가 유의하지 않았지만, zolpidem사용군에서 점수가 상대적으로 높은 경향이 있었고 이는다른 변인들을 통제할 때 통계적으로 유의하였다. 향후 zolpidem과섬망의 관련성에 대한 보다 체계적인 연구가 계속될 필요가 있다.

Objective This study explored the phenomenology of delirium in cancer patients, and evaluated the severity of delirium according to the cancer treatment method and the use of sedative-hypnotics, including zolpidem. Methods This was a retrospective chart review study. Cancer patients with delirium, who were referred to the Department of Psychiatry at a National University hospital, were included in the analysis. In all subjects, the severity of delirium was assessed using the Delirium Rating Scale-Revised-98 (DRS-R-98). Results The analysis included 112 patients with delirium. Among the neuropsychiatric and behavioral symptoms, the most frequent ones were sleep-wake cycle disturbance (100.0%) and perceptual disturbances and hallucinations (95.5%). Among the cognitive symptoms, inattention (98.2%) was the most frequent. The older the patients were, the higher the DRS-R-98 total scores were. There was no significant difference in the DRS-R-98 scores among cancer treatment methods (operation, chemotherapy, or radiation therapy). However, the total DRS-R-98 scores in the zolpidem use group were higher than in control group, and the difference was significant after adjusting for age, sex, and type of cancer treatment. Conclusion Sleep-wake cycle disturbance, inattention, and perceptual disturbances were the most common delirium symptoms in cancer patients. The severity of delirium in patients taking zolpidem was significantly greater