Clinical Features of Acute Confusional State (Delirium)

In this article, we will discuss the Clinical Features of Acute Confusional State (Delirium). So, let’s get started.

Clinical Features

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.

Systemic findings

  • 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)
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