Differentiating confusion from other symptoms: Difference between revisions

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==Overview==
==Overview==
Various conditions like [[dementia]], [[depression]], [[amnesia]] etc present as confusion. Clear history about the onset of symptoms and association with other symptoms helps in differentiating from other conditions.
Various conditions such as [[dementia]], [[depression]] and [[amnesia]] involve confusion as part of their presentation. Obtaining a clear history about the onset of symptoms, and the onset of confusion in association with other symptoms, helps in differentiating confusion from other conditions.


== Differentiating Confusion from other symptoms ==
== Differentiating Confusion from other Symptoms ==


'''[[Confusion]] :''' It is the inability to maintain coherent stream of thought or action. It can be caused by various conditions. Altered level of consciousness is seen in confusion. This can be predecessor for successive stupor or coma.
'''[[Confusion]] :''' Is the inability to maintain a coherent stream of thought or action. It can be caused by various conditions. An altered level of consciousness is seen in confusion. Confusion can be a predecessor for successive [[stupor]] or [[coma]].


'''[[Delirium]] :''' Acute impairment in attention with fluctuating course and altered level of consciousness caused by a medical condition. This is also called as acute confusional state and encephalopathy.
'''[[Delirium]] :''' Acute impairment in attention with fluctuating course and altered level of consciousness caused by a medical condition. This is also called an acute confusional state and [[encephalopathy]].


'''[[Dementia]] :''' Chronic degenerative condition affecting memory, behavior and cognition.
'''[[Dementia]] :''' Chronic degenerative condition affecting memory, behavior and cognition.
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'''[[Depression]] :''' A clinical term for a state of intense sadness, [[melancholia]] or despair that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living.
'''[[Depression]] :''' A clinical term for a state of intense sadness, [[melancholia]] or despair that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living.


'''[[Amnesia]] :''' A condition in which memory is disturbed or lost. It can be due to organic or functional.
'''[[Amnesia]] :''' A condition in which [[memory]] is disturbed or lost. It can be due to organic or functional.


'''[[Seizures]] :''' Certain seizures like absent seizures do present like confusion but they are not.
'''[[Seizures]] :''' Certain seizures such as [[absence seizure]] may appear to be similar to confusion.


Careful history from the attendants is required as the person will not be in correct mental status to give history. Certain key features like onset of symptoms, rapidity of progression are important in evaluating the confusion. Gaps in memory will be pointing more towards dementia and amnesia. Association of psychiatric symptoms will warrant further detailed history from the patient or his/her attendants. In children absent seizures may looked up as confusion because of vague and staring look into the space. Association of drugs , poisons or chemicals with the symptoms provide definitive clues for the diagnosis of confusion.
A few symptoms which help in differentiating confusion


Few assessment tools like '''Confusion Assessment Method(CAM)''' can be used to differentiate confusion from dementia. This tool is handy for physicians who are not quick in psychiatric assessment.<ref>http://www.guideline.gov/content.aspx?id=14340%20</ref>
* Worsening of symptoms at night time --> Sundowning


Few symptoms which helps in differentiating from confusion
* Rapid improvement over seconds  --> Post-syncope


* Worsening of symptoms at night time à Sundowning
* Rapid improvement over minutes to hours --> Post-ictal state


* Rapid improvement over seconds  à Post syncope
* Worsening of symptoms on standing --> [[Hypoperfusion]]


* Rapid improvement over minutes to hours à Post ictal state
Taking a careful history from the people that are with the patient will be important, as the patient themselves are not always able to give a good history due to their confused state. Key features include the onset of symptoms, what might have caused them, the speed of progression of symptoms, and whether this has occurred before. Chronic problems with memory point more towards conditions such as [[dementia]] and [[amnesia]]. The presence of psychiatric symptoms will warrant further detailed history from the patient or family members. In children, absence seizures may appear to be confusion, as it is accompanied by vague spells of staring and loss of attention. Finding a history of drugs, poisons or chemicals in concordance with the symptoms can provide definitive clues for the diagnosis of confusion.


* Worsening of symptoms on standing à Hypo perfusion
Some assessment tools, such as the Confusion Assessment Method (CAM), can be used to differentiate confusion from dementia. This tool is handy for physicians who are not quick in psychiatric assessment.<ref name="urlNational Guideline Clearinghouse | Acute confusion/delirium.">{{cite web |url=http://www.guideline.gov/content.aspx?id=14340%20 |title=National Guideline Clearinghouse &#124; Acute confusion/delirium. |format= |work= |accessdate=2013-02-08}}</ref>


==References==
==References==
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[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Psychiatry]]
[[Category:Endocrinology]]
[[Category:Intensive care medicine]]

Latest revision as of 19:21, 3 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

Various conditions such as dementia, depression and amnesia involve confusion as part of their presentation. Obtaining a clear history about the onset of symptoms, and the onset of confusion in association with other symptoms, helps in differentiating confusion from other conditions.

Differentiating Confusion from other Symptoms

Confusion : Is the inability to maintain a coherent stream of thought or action. It can be caused by various conditions. An altered level of consciousness is seen in confusion. Confusion can be a predecessor for successive stupor or coma.

Delirium : Acute impairment in attention with fluctuating course and altered level of consciousness caused by a medical condition. This is also called an acute confusional state and encephalopathy.

Dementia : Chronic degenerative condition affecting memory, behavior and cognition.

Depression : A clinical term for a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living.

Amnesia : A condition in which memory is disturbed or lost. It can be due to organic or functional.

Seizures : Certain seizures such as absence seizure may appear to be similar to confusion.

A few symptoms which help in differentiating confusion

  • Worsening of symptoms at night time --> Sundowning
  • Rapid improvement over seconds --> Post-syncope
  • Rapid improvement over minutes to hours --> Post-ictal state

Taking a careful history from the people that are with the patient will be important, as the patient themselves are not always able to give a good history due to their confused state. Key features include the onset of symptoms, what might have caused them, the speed of progression of symptoms, and whether this has occurred before. Chronic problems with memory point more towards conditions such as dementia and amnesia. The presence of psychiatric symptoms will warrant further detailed history from the patient or family members. In children, absence seizures may appear to be confusion, as it is accompanied by vague spells of staring and loss of attention. Finding a history of drugs, poisons or chemicals in concordance with the symptoms can provide definitive clues for the diagnosis of confusion.

Some assessment tools, such as the Confusion Assessment Method (CAM), can be used to differentiate confusion from dementia. This tool is handy for physicians who are not quick in psychiatric assessment.[1]

References

  1. "National Guideline Clearinghouse | Acute confusion/delirium". Retrieved 2013-02-08.

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