A patient with pneumonia for 5 days is admitted to the hospital in altered sensorium. He suddenly ceases to recognize the doctor and staff. He thinks that he is in jail and complains of scorpion attacking him. His probable diagnosis is
B i.e. Acute delirium Delirium Acute confusional stateQ occurring in various medical, surgical, metabolic, toxic & post operative conditions. It is characterized by acute agitation, disorientation, and inability to sustain attention, form memories or reasonQ. Characteristic features include - Clouding of consciousnessQ (ie decreased awareness & decreased ability to respond to environmental stimuli) - DisorientationQ (in time > place > person) - Hallucinations (mostly visual) & illusionsQ - Autonomic dysfunctionQ, agitation, insomnia - Carphologia/floccillation (picking movements at clothes coversheets) & occupational delirium (pantomimes as if continuing the usual occupation in hospital bed) This patient in question has - disturbance in consciousness (altered sensorium) - disorientation - to place (thinks, he is in jail) - to person ( ceases to recognize the doctor & staff) - hallucination (complains of scorpions attacking him) - after acute medical illness. All these features are consistent with the diagnosis delirium. DSM-IV-Diagnostic Criteria of Delirium d/t General Medical Condition/Substance Intoxication/ or Withdral Disturbance of Consciousness (i.e. reduced clarity of awareness of the environment) with reduced ability to focus, sustain or shift attention. Change in Cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established or evolving dementia. or C. Disturbance develops over a sho period of time (usually hours to days) and tends to fluctuate during the course of the day. D. There is evidence from the history, physical examination or laboratory findings that the disturbance is caused by direct physiological consequences of general medical condition/ symptoms (A, B) developed during substance intoxication and medication use is etiologically related to the disturbance /or of symptoms (A & B) developed during or sholy after a withdraw! syndrome
Acute Dementia
Acute delirium
Acute schizophrenia
Acute paronia