Altered mental status classification: Difference between revisions
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{{Altered mental status}} | {{Altered mental status}} | ||
{{CMG}}; {{AE}} {{PB}} | {{CMG}}; {{AE}}[[User:MoisesRomo|Moises Romo, M.D.]], {{PB}} | ||
==Overview== | ==Overview== | ||
[[Altered mental status]] | [[Altered mental status]], despite its frequency, the term is vague and has several synonyms such as [[confusion]], not acting right, confusional state, altered [[behavior]], [[generalized weakness]], [[lethargy]], [[agitation]], [[psychosis]], [[disorientation]], inappropriate [[behavior]], [[inattention]], and [[hallucination]]. Such lack of standardized terminology makes the assessment and appropriate management of patients with [[altered mental status]] difficult. It is important to ditinguish red flags, since [[acute]] [[altered mental status]] is a medical [[emergency]]. The first step in the evaluation of a patient with [[altered mental status]] is to establish the time course. [[Altered mental status]] may be classified as dementia, delirium, psychosis, and other [[neurological]] causes according to its origin. | ||
==Classification== | ==Classification== | ||
* Altered mental status may be classified according to its origin into 4 major groups: [[dementia]], [[delirium]], [[psychosis]], and [[Neurology|neurologic]] causes. | *Altered mental status may be classified according to its origin into 4 major groups: [[dementia]], [[delirium]], [[psychosis]], and [[Neurology|neurologic]] causes. | ||
=== Dementia === | ===Dementia=== | ||
* Typically, [[dementia]] is a slow and progressive decline in [[Cognition|cognitive function]] due to damage or [[disease]] in the [[brain]] beyond what might be expected from normal [[Ageing|aging]]. Individuals usually present normal [[vital signs]], normal level of conscioussness. | *Typically, [[dementia]] is a slow and progressive decline in [[Cognition|cognitive function]] due to damage or [[disease]] in the [[brain]] beyond what might be expected from normal [[Ageing|aging]]. Individuals usually present normal [[vital signs]], normal level of conscioussness. | ||
=== Delirium === | ===Delirium=== | ||
* [[Delirium]] is an acute and relatively sudden (developing over hours to days) decline in attention | *[[Delirium]] is an acute and relatively sudden (developing over hours to days) decline in [[attention]], [[Focusing|focus]], [[perception]], and [[cognition]] that usually appears in the elderly.<ref name="pmid30856524">{{cite journal |vauthors=Boltey EM, Iwashyna TJ, Hyzy RC, Watson SR, Ross C, Costa DK |title=Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation |journal=J Crit Care |volume=51 |issue= |pages=192–197 |date=June 2019 |pmid=30856524 |pmc=6625516 |doi=10.1016/j.jcrc.2019.02.028 |url=}}</ref><ref name="pmid30853380">{{cite journal |vauthors=Airagnes G, Ducoutumany G, Laffy-Beaufils B, Le Faou AL, Limosin F |title=Alcohol withdrawal syndrome management: Is there anything new? |journal=Rev Med Interne |volume=40 |issue=6 |pages=373–379 |date=June 2019 |pmid=30853380 |doi=10.1016/j.revmed.2019.02.001 |url=}}</ref> The [[Clinical|clinical presentation]] may vary from [[hyperactive]] or hypoactive [[Psychomotor agitation|psychomotor]] behavioral disturbances. Hypoactive delirium is oftenly missdiagnosed with other disorders such as [[depression]]; the rapidly fluctuating time course of [[delirium]] is used to help in the latter distinction.<ref name="pmid30852930">{{cite journal |vauthors=Michels M, Michelon C, Damásio D, Vitali AM, Ritter C, Dal-Pizzol F |title=Biomarker Predictors of Delirium in Acutely Ill Patients: A Systematic Review |journal=J Geriatr Psychiatry Neurol |volume=32 |issue=3 |pages=119–136 |date=May 2019 |pmid=30852930 |doi=10.1177/0891988719834346 |url=}}</ref> | ||
=== Psychosis === | ===Psychosis=== | ||
* Psychosis is a generic [[Psychiatry|psychiatric]] term for a [[Mental status examination|mental state]] often described as involving a "loss of contact with reality". ''Stedman's Medical Dictionary'' defines psychosis as "a severe mental disorder, with or without organic damage, characterized by derangement of [[personality]] and loss of contact with reality and causing deterioration of normal social functioning." | *Psychosis is a generic [[Psychiatry|psychiatric]] term for a [[Mental status examination|mental state]] often described as involving a "loss of contact with reality". ''Stedman's Medical Dictionary'' defines psychosis as "a severe mental disorder, with or without organic damage, characterized by derangement of [[personality]] and loss of contact with reality and causing deterioration of normal social functioning." | ||
=== Neurologic causes === | ===Neurologic causes=== | ||
* Some focal neurological deficits can produce changes in [[perception]], psychomotor skills or [[behavior]]. This group's presentation vary widely depending on the localization and cause of impairment. | *Some focal neurological deficits can produce changes in [[perception]], psychomotor skills or [[behavior]]. This group's presentation vary widely depending on the localization and cause of impairment. | ||
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Revision as of 19:47, 10 February 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo, M.D., Pratik Bahekar, MBBS [2]
Overview
Altered mental status, despite its frequency, the term is vague and has several synonyms such as confusion, not acting right, confusional state, altered behavior, generalized weakness, lethargy, agitation, psychosis, disorientation, inappropriate behavior, inattention, and hallucination. Such lack of standardized terminology makes the assessment and appropriate management of patients with altered mental status difficult. It is important to ditinguish red flags, since acute altered mental status is a medical emergency. The first step in the evaluation of a patient with altered mental status is to establish the time course. Altered mental status may be classified as dementia, delirium, psychosis, and other neurological causes according to its origin.
Classification
- Altered mental status may be classified according to its origin into 4 major groups: dementia, delirium, psychosis, and neurologic causes.
Dementia
- Typically, dementia is a slow and progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Individuals usually present normal vital signs, normal level of conscioussness.
Delirium
- Delirium is an acute and relatively sudden (developing over hours to days) decline in attention, focus, perception, and cognition that usually appears in the elderly.[1][2] The clinical presentation may vary from hyperactive or hypoactive psychomotor behavioral disturbances. Hypoactive delirium is oftenly missdiagnosed with other disorders such as depression; the rapidly fluctuating time course of delirium is used to help in the latter distinction.[3]
Psychosis
- Psychosis is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". Stedman's Medical Dictionary defines psychosis as "a severe mental disorder, with or without organic damage, characterized by derangement of personality and loss of contact with reality and causing deterioration of normal social functioning."
Neurologic causes
- Some focal neurological deficits can produce changes in perception, psychomotor skills or behavior. This group's presentation vary widely depending on the localization and cause of impairment.
References
- ↑ Boltey EM, Iwashyna TJ, Hyzy RC, Watson SR, Ross C, Costa DK (June 2019). "Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation". J Crit Care. 51: 192–197. doi:10.1016/j.jcrc.2019.02.028. PMC 6625516 Check
|pmc=value (help). PMID 30856524. - ↑ Airagnes G, Ducoutumany G, Laffy-Beaufils B, Le Faou AL, Limosin F (June 2019). "Alcohol withdrawal syndrome management: Is there anything new?". Rev Med Interne. 40 (6): 373–379. doi:10.1016/j.revmed.2019.02.001. PMID 30853380.
- ↑ Michels M, Michelon C, Damásio D, Vitali AM, Ritter C, Dal-Pizzol F (May 2019). "Biomarker Predictors of Delirium in Acutely Ill Patients: A Systematic Review". J Geriatr Psychiatry Neurol. 32 (3): 119–136. doi:10.1177/0891988719834346. PMID 30852930.