Confusion history and symptoms: Difference between revisions

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__NOTOC__
{{Confusion}}
{{Confusion}}
{{CMG}} ; {{AE}} {{ADI}}
{{CMG}} ; {{AE}} {{ADI}}
==Overview==
==Overview==
Confused patients will not be able to provide a coherent history. Confirming the history with patients caregiver is the key to get good history about the patient. Determining the patients drug history and co morbid conditions is very important. In young patients drug abuse and withdrawal should be evaluated. Few assessment scales are used to identify and diagnose confusion. '''Confusion Assessment Method''' , '''Mini Mental Status Examination''', '''The Neelon and Champagne (NEECHAM) Confusion Scale'''.
Confused patients will not be able to provide a coherent history. Confirming the history with a patient’s caregiver is the key to obtaining an accurate history about the patient. Determining the patient’s drug history and co morbid conditions is very important. In young patients drug abuse and withdrawal should be evaluated. Some assessment scales are used to identify and diagnose confusion, and they include the Confusion Assessment Method, Mini Mental Status Examination, and The Neelon and Champagne (NEECHAM) Confusion Scale.


==History and symptoms==
==History and Symptoms==
In case of confusion , goal of the physician is to determine the cause of the condition and identifying the risk factors. As the person will be disoriented the history has to be checked with his family or caregivers.


History regarding certain aspects have to be inquired.
In cases of confusion, the goal of the physician is to determine the cause of the condition and identify any the risk factors. As the person will be disoriented, the history has to be checked with family or caregivers.


* '''Onset of symptom and progression'''
History regarding certain aspects of the patient's past needs to be asked about.


If its sudden in onset it can be due to [[stroke]] or [[hemorrhage]] into the brain. If its over minutes to hours it can be due drugs or metabolic causes like [[hypoglycemia]], [[hypokalemia]]. If its over hours to days it an be due to some underlying disease like kidney or liver failure or infections. If its gradually progressing over months considering other diagnosis like [[dementia]] is essential
===Symptom Onset and Progression===


* '''Any previous episodes '''
If it’s sudden in onset it can be due to a [[stroke]] or [[hemorrhage]] into the brain. If it’s over minutes to hours it can be due drugs or metabolic causes like [[hypoglycemia]] or [[hypokalemia]]. If it’s over hours to days it can be due to some underlying disease like [[kidney failure|kidney]], [[liver failure]], or infections. If it’s gradually progressing over months, other conditions such as [[dementia]] need to be considered.


Previous episodes of confusion are important to identify risk factors and determine the prognosis. Repeated episodes can be a clue to underlying structural problem or untreated co morbid conditions or metabolic derangement.
===Any Previous Episodes===
Previous episodes of confusion are important in identifying risk factors and determining the prognosis. Repeated episodes can be a clue to underlying structural problems, untreated co morbid conditions, or metabolic derangement.


* '''Associated symptoms'''
===Associated Symptoms===
Fever may suggest any infections, abnormal motor activity suggests seizures or post ictal state. Headache is a very important feature to rule out stroke, meningitis or any other intra cranial lesions. Sever diaphoresis indicates dehydration and metabolic disturbance.


* '''Drug history'''
If the patient has a fever, it may suggest an infections. Abnormal motor activity may suggest [[seizures]] or [[post ictal state]]. A [[headache]] is a very important feature to rule out [[stroke]], [[meningitis]], or any other intra cranial lesions. Severe [[diaphoresis]] indicates [[dehydration]] and metabolic disturbances.
Changes in recent drug regimen or any other drug usage. Polypharmacy can be a cause or result of confusion in elderly individuals. In young patients any history of illicit drug usage has to be noted. As those drugs can cause confusion and their withdrawal states can manifest the same.


'''Assessment'''
===Drug History===
Various tools/ assessments are available to evaluate confusion.
* Mini-Mental State Examination
* Confusion Assessment Method
* Neelson and Champagne Confusion Scale
* Mini-Cog


These tools are used as scoring scales. Scoring is based on mental status questions, observational points and symptom checklists. Mental status questions depict the cognitive performance of the patient. Observational points reduce the burden on the patient and demands extra attention from the health care providers.
Changes in recent drug regimen or any other drug usage have to be asked about. [[Polypharmacy]] can be a cause or result of confusion in elderly individuals. In young patients any history of illicit drug usage has to be noted. As those drugs can cause confusion and their withdrawal states can manifest the same.
 
===Assessment===
 
Various tools/assessments are available to evaluate confusion.
 
*  Mini-Mental State Examination
 
*  Confusion Assessment Method
 
*  Neelson and Champagne Confusion Scale
 
*  Mini-Cog
 
These tools are used as scoring scales. Scoring is based on mental status questions, observational points, and symptom checklists. Mental status questions depict the cognitive performance of the patient. Observational points reduce the burden on the patient and demands extra attention from the health care providers.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Psychiatry]]
[[Category:Endocrinology]]
[[Category:Intensive care medicine]]

Latest revision as of 19:51, 2 June 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Confused patients will not be able to provide a coherent history. Confirming the history with a patient’s caregiver is the key to obtaining an accurate history about the patient. Determining the patient’s drug history and co morbid conditions is very important. In young patients drug abuse and withdrawal should be evaluated. Some assessment scales are used to identify and diagnose confusion, and they include the Confusion Assessment Method, Mini Mental Status Examination, and The Neelon and Champagne (NEECHAM) Confusion Scale.

History and Symptoms

In cases of confusion, the goal of the physician is to determine the cause of the condition and identify any the risk factors. As the person will be disoriented, the history has to be checked with family or caregivers.

History regarding certain aspects of the patient's past needs to be asked about.

Symptom Onset and Progression

If it’s sudden in onset it can be due to a stroke or hemorrhage into the brain. If it’s over minutes to hours it can be due drugs or metabolic causes like hypoglycemia or hypokalemia. If it’s over hours to days it can be due to some underlying disease like kidney, liver failure, or infections. If it’s gradually progressing over months, other conditions such as dementia need to be considered.

Any Previous Episodes

Previous episodes of confusion are important in identifying risk factors and determining the prognosis. Repeated episodes can be a clue to underlying structural problems, untreated co morbid conditions, or metabolic derangement.

Associated Symptoms

If the patient has a fever, it may suggest an infections. Abnormal motor activity may suggest seizures or post ictal state. A headache is a very important feature to rule out stroke, meningitis, or any other intra cranial lesions. Severe diaphoresis indicates dehydration and metabolic disturbances.

Drug History

Changes in recent drug regimen or any other drug usage have to be asked about. Polypharmacy can be a cause or result of confusion in elderly individuals. In young patients any history of illicit drug usage has to be noted. As those drugs can cause confusion and their withdrawal states can manifest the same.

Assessment

Various tools/assessments are available to evaluate confusion.

  • Mini-Mental State Examination
  • Confusion Assessment Method
  • Neelson and Champagne Confusion Scale
  • Mini-Cog

These tools are used as scoring scales. Scoring is based on mental status questions, observational points, and symptom checklists. Mental status questions depict the cognitive performance of the patient. Observational points reduce the burden on the patient and demands extra attention from the health care providers.

References

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