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Fortschr Neurol Psychiatr 2018; 86(10): 616-623
DOI: 10.1055/a-0586-3369
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Inzidenz und Behandlung des nicht stoffgebundenen Delirs in deutschen Haus- und Facharztpraxen

Incidence and treatment of non-substance-induced delirium in general and specialist practices in Germany
Jens Bohlken
1   Neurologisch-psychiatrische Praxis Dr. med. Dr. phil. Jens Bohlken, Demenz Referat im Berufsverband Deutscher Nervenärzte
,
Walter Hewer
2   Klinik für Gerontopsychiatrie, Klinikum Christophsbad, Göppingen, Deutschland
,
Karel Kostev
3   Epidemiologie, IQVIA, Frankfurt, Germany
› Author Affiliations
Further Information

Publication History

eingereicht 30 November 2017

akzeptiert 27 February 2018

Publication Date:
10 August 2018 (online)

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Zusammenfassung

Ziel Über die Häufigkeit und die medikamentöse Behandlung des nicht stoffgebundenen Delirs in deutschen Haus- (HA) und Facharzt-Praxen (FA) ist wenig bekannt. Ziel der Studie war die Bestimmung der Delir-Inzidenz und der Delir-Behandlung mit Neuroleptika und Benzodiazepinen in HA.- und FA-Praxen.

Methoden In dem Zeitraum von 2012 bis 2015 wurden 2.999 Patienten > 65 Jahre in 1.262 HA- und 1.425 Patienten in 203 FA-Praxen mit erstmaliger Delir-Diagnose (ICD 10: F05) ausgewählt und hinsichtlich der Verordnung von Neuroleptika (EphMRA ATC: N05A) und Benzodiazepine (N06C) untersucht, die direkt nach der Diagnosestellung des Delirs erfolgte.

Ergebnisse Die kumulative 1-Jahres-Inzidenz des Delirs betrug in HA-Praxen 0,6 und in FA-Praxen 1,9 Patienten pro Praxis. Keine Delir-Diagnose wurde in mehr als 40 % der Praxen gestellt. Im Heim erfolgte die Behandlung bei 31 % der HA- und 21 % der FA Patienten. Häufigste HA-Verordnung: Melperon (9,4 % zu Hause bzw. 13,7 % im Heim), FA: Risperidon (4,3 % zu Hause bzw. 13,4 % im Heim). Die antidelirante Medikation war positiv mit männlichem Geschlecht (OR = 1.26), Wohnen im Seniorenheim (OR = 1,74) Demenz (OR = 1.55) und Depression (OR = 1.32), und negativ mit FA-Behandlung (OR =  0.73) assoziiert.

Schlussfolgerung Die Delir-Diagnose und seine medikamentöse Behandlung ist in deutschen Arzt-Praxen ein relativ seltenes Ereignis. Die Ursachen für die im internationalen Vergleich niedrige Prävalenzrate im ambulanten Versorgungsbereich sollte intensiver untersucht werden.

Abstract

Aim Little is known about the incidence and medical treatment of non-substance-induced delirium in general practitioner (GP) and specialist (SP) practices in Germany. The aim of the study was to determine the incidence of delirium and its treatment with neuroleptics and benzodiazepines in GP and SP practices.

Methods Between 2012 and 2015, 2,999 patients > 65 years and 1,425 patients > 65 years were selected from 1,262 GP and 203 SP practices, respectively. These patients had an initial diagnosis of delirium (ICD 10: F05) and were examined with regard to treatment with neuroleptics (EphMRA ATC: N05A) and benzodiazepines (N06C) prescribed immediately after delirium was diagnosed.

Results The 1-year delirium incidence was 0.6 patients per GP practice and 1.9 patients per SP practice. In more than 40 % of practices, no delirium diagnosis was made. In total, 31 % of GP and 21 % of SP patients were treated in the nursing home. The most common prescription in GP was melperone (9.4 % at home and 13.7 % in the nursing home) and in SP risperidone (4.3 % at home and 13.4 % in the nursing home). The use of these agents was positively associated with male gender (OR = 1.26), residence in nursing homes (OR = 1.74), dementia (OR = 1.55), and depression (OR = 1.32) and negatively associated with treatment in SP practices (OR = 0.73).

Conclusion: Diagnosis and treatment of delirium are relatively rare in medical practices in Germany compared to international standards. The reasons for the low incidence of delirium in the outpatient care sector should be investigated more thoroughly.

Stichworte

Delir - Antipsychotika - Neuroleptika - Benzodiazepine - ambulante Versorgung

Key words

delirium - antipsychotics - neuroleptics - benzodiazepines - outpatient care
 

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