Continuity syndrome

definition

Passage syndrome is a temporary form of organic psychosyndrome that occurs in connection with severe physical illness, intensive care treatment, and postoperatively. Over a period of hours or days, states of restlessness, confusion, impaired consciousness and disorientation occur spontaneously, accompanied by vegetative reactions such as sweating, palpitations and an increase in blood pressure.

introduction

A continuity syndrome is the occurrence of various and unspecifically triggered mental disorders. The syndrome is particularly common after major and prolonged surgical operations.

frequency

Temporary states of confusion are quite common in inpatient or postoperative patients. Due to the wide range of symptoms, however, it is difficult to give precise information, and the literature information varies widely. There seems to be a connection with the severity of the disease or the surgical procedure, as well as with personality (see also Personality disorder) and age of the patient, social environment and the level of detail of a preoperative information.

root cause

The triggers of one Continuity syndrome are unspecific and ultimately not clarified. It will be a special interplay stress suspected in connection with severe physical illness or surgery and existing fears of the patient. Since acute states of confusion can generally have a variety of causes, u. Comprehensive differential diagnostics may be required in order to rule out underlying threatening health disorders (see also dementia).

Passage syndrome after surgery

Passage syndrome occurs between 15 and 50 percent in patients after a major surgical procedure.
Postoperatively, there are acute disturbances in thinking, feeling and psychomotor functions in the patient. Those affected are confused about time and place and at the same time hyperactive, so that they often pull on catheters or tubes.

Changes in consciousness such as delirium can also occur. Symptoms such as confusion, visual hallucinations, anxiety and fearful states can occur. The patients are disoriented and they particularly suffer from physical restlessness.
Often good monitoring is necessary so that those affected do not injure themselves or pull important accesses. The performance is extremely limited.
People over the age of 60 are often affected by passage syndrome.

Read more about the topic here: postoperative delirium.

When the syndrome occurs can also be very different. Some patients wake up in the recovery room after the operation and are immediately suspicious. In other sufferers, the symptoms mentioned may only develop within the first few hours or even after days.
In addition, the symptoms can vary in severity.
Why the passage syndrome occurs is not yet fully understood. The causes include several factors that interaction can promote the development of a Delius.

Older people are more likely to develop the syndrome than younger people. This affects even more male patients. In addition, previous illnesses such as diabetes mellitus, high blood pressure (hypertension) and overweight (obesity) just as important a role as the type and duration of the operation.
After passage syndrome it is more likely to occur in operations on the heart or in the treatment of femoral neck fractures.

The causes are still being researched. It is believed that inflammatory processes take place in the brain as part of various underlying diseases during the operation. Because of this irritation, the immune system is permanently activated and overloaded. A surgical intervention on top of that leads to the complete overstrain of the immune system. This results in very strong defense reactions that also damage the brain, especially in the first few hours after the procedure.
In most cases, the continuity syndrome is a temporary condition. The symptoms regress and the patient clears up completely. Only in the rarest of cases does the adeptness and disorientation persist so that the patient becomes a permanent need for care.

Passage syndrome after heart surgery

A transit syndrome is a temporary mental disorder that can occur after major surgical interventions. Characteristic for this are disorientation, confusion, mood swings and hallucinations. An accompanying vegetative reaction with sweating, high blood pressure and palpitations often occurs. This phenomenon occurs more frequently, especially after heart operations; especially if the operation was performed using a heart-lung machine.

Passage syndrome after artificial coma

In an artificial coma, a patient is put into a state similar to general anesthesia for days or even weeks by medication. Consciousness and pain perception are switched off. This is achieved with anesthetics and painkillers that are continuously administered to the patient through the vein. Meanwhile, the patient is closely monitored in an intensive care unit. This is done after severe brain injuries, lengthy surgery, or severe infections when artificial ventilation is necessary. If the body recovers that far from the original basic problem, the intensive care physicians make the decision to reduce the drugs that keep the patient in this artificial permanent sleep. It is easy to imagine that continuity syndrome can occur during this waking up phase and afterwards. Patients are confused and disoriented, often aggressive. It takes time until they get used to the environment again and can classify what they have experienced.

Read more on this topic at: Artificial coma

Continuity syndrome after a stroke

A stroke causes a sudden circulatory disturbance in the brain, which leads to the death of nerve cells. Often those affected have to be treated in the intensive care unit for a period of time. This shows that these patients often experience temporary confusion or disorientation. This is called the passage syndrome. It is common with diseases of the brain and during an intensive care unit stay.

Read more on the topic: Stroke therapy

Passage syndrome after a heart attack

A heart attack suddenly develops circulatory disorders in the heart, which in turn leads to the death of myocardial cells. Life-threatening cardiac arrhythmias can result. Therefore, many patients are initially monitored in the intensive care unit. Passage syndrome can also occur here. The risk of this temporary disorientation is lower than with diseases of the brain or after surgery. However, the longer the intensive care unit stays, the greater the likelihood of developing a transitory syndrome.

Read more on the topic: Heart attack

Passage syndrome after bypass surgery

With a bypass operation, one tries to improve the blood flow situation in the heart by bridging narrow points in the coronary vessels with the body's own blood vessels. This is usually a routine intervention. However, the patient is usually connected to a heart-lung machine during the operation. This device can briefly take over the function of the heart and lungs. After interventions of this kind, however, patients have a significantly increased risk of developing what is known as a transit syndrome postoperatively.

You might also be interested in this topic: Cardiac bypass - when is it used?

Symptoms

The patients appear restless, sometimes disoriented and uncooperative. B. Remove catheter or infusion needles yourself. The consciousness is mostly slightly clouded, similar to a half-sleep state, but paranoid states and deceptions can also occur.

Concomitant sweating, rise in blood pressure (see high blood pressure) and palpitations (see cardiac arrhythmia) can occur as signs of activation of the autonomic nervous system (see nervous system).

Symptoms start suddenly, often with a delay of a few days after surgery in connection with surgery, and persist for hours to days with varying degrees of severity. In retrospect, those affected often cannot remember the episodes themselves.

Diagnosis

As the cause of acute organic psychosyndromes (see also Drug psychosis) in inpatients are e.g. B. Medication (side effects), metabolic and mineral disorders, infections but also psychological reactions to the perceived threat from the disease should be taken into account.

Due to their frequency and danger, in particular, z. Legs Hypoglycaemia of the patient (blood glucose control; see Diabetes mellitus) an oxygen deficiency (blood gas analysis) and systemic infections ("sepsis"; Control of inflammation values ​​in the blood sample and temperature measurement).

treatment

After the continuity syndrome has been clearly diagnosed, special treatment is required that focuses on stabilizing the patient's psychological well-being.

The extent to which treatment is required depends largely on the severity and severity of the passage syndrome.
In some patients, the confusion does not last long and good care is enough to help the patient again. Therapy with appropriate medication is usually still recommended by doctors, as they can prevent the condition from worsening.

The focus is on the patient being able to orientate himself again and largely be able to look after and care for himself as long as there is no other more serious illness. Patients with a continuity syndrome are given medication Neuroleptics treated.
This is a drug from the group of Psychotropic drugs. They are used for diseases that affect thinking and especially perception. Neuroleptics have a calming effect on sensory perception by preventing the transmission of excitation through the Neurotransmitters Dopamine inhibit in the brain at the synapses.
In the case of a continuity syndrome, they are often injected into the vein, so they have a quick effect in the acute situation and alleviate the symptoms. Medicines are often used in the clinic Haloperidol or Risperidone used.
They have a calming effect and also improve the patient's sleep, so that he can relax better and his symptoms also improve fundamentally.

If the patient also suffers from a depressive disorder, the neuroleptics can also be supplemented with psychotropic drugs. There will be Antidepressants or Benzodiazepines administered. The latter is also a sedative and sleeping aid that also works by inhibiting neurotransmitters at the synapses in the brain.

Furthermore, the symptoms that are triggered due to the patient's situation are treated. Appropriate drugs are given to counteract high blood pressure and pulse. If the person concerned is discharged despite a continuity syndrome because he can be adequately cared for by relatives at home, alcoholic beverages should still be avoided.
Because of the effects alcohol has on the brain, the symptoms can worsen again.

In most cases, however, continuity syndrome is preceded by major surgery, so the patient is often monitored and cared for in the hospital for longer. In the initial phase, intensive medical care is often necessary. The patient's condition is often incomprehensible to relatives and is a great burden. They also need support and guidance on how to best help and support the person affected. For many, dealing with someone who is not quite who they are is a challenge.

forecast

The prognosis is generally good, with symptoms receding for hours to days. However, it is important not to overlook any serious health disorder as a cause of an acute organic psychosyndrome.

Duration

How long a continuity syndrome usually lasts cannot be precisely defined, since the duration of the symptoms often also depends on the age of the patient and the severity of the previous operation.
In some cases, the delirium caused can only be weak, so that often no special treatment is necessary. The patient is observed and cared for and after a few days the symptoms can spontaneously resolve. If the continuity syndrome is more pronounced in an elderly patient, the symptoms can persist for up to several weeks.

Here it is important to carry out an appropriate therapy to prevent further complications. It should of course be absolutely prevented that the psychosis persists and does not turn into a chronic organic brain syndrome. In very rare cases, severe surgery can cause the mental disorder to linger, especially in an elderly patient.

Summary

As Continuity syndrome a temporary state of confusion in the wake of surgical interventions and in connection with inpatient treatment. Those affected are restless, clouded in consciousness, disoriented, and sometimes aggressive. The severity of the symptoms varies over time. The symptoms regress by themselves over hours to days, but other (dangerous) health disorders can be ruled out as the cause of the impaired consciousness.

Specific therapy for the continuity syndrome is not possible; the symptoms resolve on their own in the course of hours to days. To treat the accompanying physical symptoms, a drug such as B. Clonidine be given, which has a dampening effect on the vegetative nervous system, a close-knit Monitoring the circulatory parameter may be required.