FEATURES OF PATHOGENETIC MECHANISMS, CLINICAL PICTURE, TREATMENT AND PREVENTION OF DELIRIOUS DISORDERS ASSOCIATED WITH COVID-19
Relevance. Delirium is the most common cerebral dysfunction in the intensive care unit, but its adverse effect on prognosis has only recently been identified. The appearance of delirium in the intensive care unit increases mortality, length of stay in the hospital, treatment costs and the incidence of cognitive impairment. The research purpose is to study the clinical picture of delirium disorders based on the characteristics of pathogenesis, to identify the main mechanisms of changes in neurotransmission, and to analyze methods for the treatment and prevention of delirium associated with COVID - 19. Materials and research methods. The article analyzes current domestic and foreign literature data for the period from 2015 to 2022 on the role of neurotransmitter factors in the development of delirium disorders. It highlights the main clinical forms, treatment and prevention of delirium in association with COVID - 19. Results and its discussion. Delirium is characterized by a hallucinatory clouding of consciousness with a predominance of true visual hallucinations and illusions, figurative delirium, changeable affect, sudden onset (hours or days), unstable attention, change in consciousness. Delirium impairs the patient's ability to receive, process, store, and reproduce information. It is important to note that attention deficits and cognitive changes cannot be explained by concomitant neurocognitive impairment (eg, dementia) or a significant decrease in the level of consciousness (eg, sedation or coma). Considering the pathogenetic mechanisms of delirium, it should be noted that the theory of neurotransmitter imbalance is classical, suggesting the development of neuronal instability due to an excess of dopamine and a decrease in acetyl choline. In addition, there are changes in the metabolism of gamma - aminobutyric acid, serotonin, endorphin, glutamate and other neurotransmitters responsible for controlling the functioning of cognitive functions. Tryptophan and phenylalanine are responsible for increasing the level of dopamine and norepi nephrine. Fluctuations in the concentration of these neurotransmitters cause an imbalance in the system of normal regulation. No less significant is the theory of inflammation. In critical conditions, the production of inflammatory mediators of cytokines occurs, which penetrate the blood - brain barrier and cause an increase in the permeability of cerebral vessels, initiating a cascade of microvascular disorders. Conclusion. Violation of microcirculation leads to a decrease in cerebral oxidative metabolism, to an imbalance in neurotransmission. One of the manifestations of a decrease in metabolism is a diffuse slowdown in EEG activity. The progression of the process of imbalance of neurotransmission leads to cerebral insufficiency. The mechanisms of pharmacological correction of delirious states require further development and discussion.