Altered mental status classification
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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
- Dementia is a slow and progressive disorder characterized by cognitive decline beyond what might be expected from normal aging. Dementia involves memory and at least 1 of the other domains, including personality, praxis, abstract thinking, language, executive functioning, complex attention, social and visuospatial skills.[1] Individuals usually present normal vital signs, normal level of conscioussness. Several diseases may cause dementia, being Alzheimer's disease the most common.[2]
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.[3][4] 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.[5]
Psychosis
- Psychosis is a generic psychiatric term for a mental state that results in a loss of contact with reality.[6] Psychosis is a common characteristic to many psychiatric, neuropsychiatric, neurologic, neurodevelopmental, and other medical conditions.[7] It caused most of the times by fluctuations of neurotransmitters such as dopamine, acetylcholine, gamma-amino-butyric acid (GABA), and glutamate, which ultimately results in in high levels of distress and deterioration of normal social functioning.[8]
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. Within this group there may be found subclassifications such as the levels of consciousness (confusional state, lethargy, obtundation, stupor, coma), vegetative state, locked-in syndrome, and brain death.[9]
References
- ↑ Buffington AL, Lipski DM, Westfall E (October 2013). "Dementia: an evidence-based review of common presentations and family-based interventions". J Am Osteopath Assoc. 113 (10): 768–75. doi:10.7556/jaoa.2013.046. PMID 24084803.
- ↑ Reitz C, Mayeux R (April 2014). "Alzheimer disease: epidemiology, diagnostic criteria, risk factors and biomarkers". Biochem Pharmacol. 88 (4): 640–51. doi:10.1016/j.bcp.2013.12.024. PMC 3992261. PMID 24398425.
- ↑ 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.
- ↑ van Os J, Hanssen M, Bijl RV, Vollebergh W (July 2001). "Prevalence of psychotic disorder and community level of psychotic symptoms: an urban-rural comparison". Arch Gen Psychiatry. 58 (7): 663–8. doi:10.1001/archpsyc.58.7.663. PMID 11448373.
- ↑ Jellinger KA (May 2012). "Cerebral correlates of psychotic syndromes in neurodegenerative diseases". J Cell Mol Med. 16 (5): 995–1012. doi:10.1111/j.1582-4934.2011.01311.x. PMC 4365880. PMID 21418522.
- ↑ Fiorentini A, Volonteri LS, Dragogna F, Rovera C, Maffini M, Mauri MC, Altamura CA (December 2011). "Substance-induced psychoses: a critical review of the literature". Curr Drug Abuse Rev. 4 (4): 228–40. doi:10.2174/1874473711104040228. PMID 21999698.
- ↑ Grover S, Kate N (August 2012). "Assessment scales for delirium: A review". World J Psychiatry. 2 (4): 58–70. doi:10.5498/wjp.v2.i4.58. PMC 3782167. PMID 24175169.