Assessing Confused Patients
Year: 2001
Type: article
Abstract: The approach to a patient who is confused demands the same principles of assessment that would be applied to other situations in neurology or medicine. The doctor requires knowledge, skill, and most of all experience, but can improve the chances of a correct diagnosis and appropriate management by careful history taking, examination, and observation. This is one area in which expensive investigations are difficult to perform and frequently unhelpful. The challenges are:
Although “confused” or confusional state are convenient descriptions to apply to a patient, they do not have a precise medical meaning and are best avoided as diagnostic terms. The term delirium is much better defined and accepted in the classification of mental disorders. It has been defined as: “an aetiologically non-specific organic cerebral syndrome, characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion and the sleep-wake cycle”.
An apparently “confused” patient may have an alternative diagnosis such as dysphasia, dementia or psychiatric disorder.
Delirium, as defined above, includes a range of different behaviours and may be subdivided into hyperactive or agitated delirium, and hypoactive or quiet delirium. The same patient can have both or neither subtype.
Delirium tremens is a specific term for the confusional state caused by withdrawal of alcohol.
The prevalence and incidence of delirium depend on the population studied. Prevalence in hospital ranges from 10–20% in medical wards and could become higher as the elderly population in hospital increases. The incidence during hospitalisation ranges from 4–30%, again depending on the population studied. About 25% of people over 70 years old admitted to hospital have delirium.
The history and examination should be directed to look at …
Author: Michael H Johnson
Institution: St James's University Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W1962397578