In this article, we will discuss the Clinical Features of Acute Confusional State (Delirium). So, let’s get started.
Acute confusional state is a transient global disorders of attention and consciousness disorientation with hypoactive presentation is called confusion; while hyperactive disoriented patients are called delirious. Delirium has an acute onset and fluctuating course its characteristic features are:
1. Impaired consciousness or clouding of consciousness: Usually there is decreased awareness of surrounding, decreased ability to respond to external stimuli, disturbance in sleep-wake cycle (insomnia at night and daytime drowsiness).
2. Disturbance in memory: There is impairment of registration and retention of short-term memories and recall. Disorientation of time, place and person is the earliest on presenting manifestation, may be associated with attention and distractibility.
3. Disturbance in perception: Normal perceptions are distorted that is objects may appear larger (macropsia) or smaller (micropsia) in than normal. Illusions and visual hallucinations are common.
4. Thought disorder: Difficulty in thinking and slowness of thought is present. Fleeting delusions are common.
5. Psychomotor disturbance: Psychomotor activity is reduced. Speech is slow, slurred and incoherent. Motor and verbal preservation, agraphia and impaired comprehension are seen. Motor symptoms include tremors and myoclonus.
6. Emotional changes: There may be anxiety, irritability and depression. In severe cases, emotional responses become apathetic.
7. Autonomic disturbance: Pallor, sweating, tachycardia, dilated pupils, raised temperature, piloerection and G.I. disturbance may occur.
The average duration is about one week with full recovery in most of the cases.
- Neuropsychiatric examination
- Assessment of mental state (mini-mental state examination for orientation, language), screening for attention deficit etc
- Examine for new focal neurological deficit; (stroke, mass lesion, CVA)
- Look for signs of neurodegenerative conditions e.g. Parkinsonism (asterixis) and cognitive functions (Alzheimer’s disease, dementia)