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Query: UMLS:C0009676 (confusion)
 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An acute psychosis characterized by auditory hallucinations and paranoid delusions developed in a 19-year-old man with temporal lobe epilepsy after he had a cluster of seizures when antiepileptic drugs (AEDs) had been gradually discontinued. Continuous sterotactic depth and epidural EEG recordings confirmed that this was a postictal rather than an ictal event. Acute postictal psychosis is a self-limited condition phenomenologically distinct from ictal or postictal confusion.
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PMID:Acute postictal psychosis: a stereo EEG study. 218 Jun 91

Delirium, an acute confusional state, is an organic brain syndrome that manifests deficits in attention, irrelevant or rambling speech, and other cognitive deficits. Its symptoms often fluctuate over the course of the day, and patients may be hyperactive--for example, restless and screaming--or hypoactive--for example, quiet, inactive, and stuporous. Occurring in approximately 20% of hospitalized elderly patients, delirium is the most common psychiatric syndrome in acutely ill general medical and surgical patients. Fifteen to 30% of delirious patients expire, and others are prone to a variety of complications: falls, pressure ulcers, oversedation, dehydration, and others. Almost any acute illness can cause delirium in the elderly, but the most common offenders are acute infections and drugs. Many patients have a pre-existing dementia. The first step in arriving at a correct diagnosis is to distinguish delirium from other psychiatric syndromes that can cause confusion, such as dementia, depression, schizophrenia, and mania. Once delirium is established, a comprehensive general examination and a mental status examination is required. Routine laboratory and radiologic tests are directed at the common metabolic and infectious disorders that precipitate delirium. Treatment is directed at the underlying acute illness. In all patients, it is important (1) to treat the underlying acute illness, (2) to provide appropriate fluid and electrolytes, (3) to discontinue any unnecessary drugs, and (4) to allay the patient's fear and agitation through the use of simple, repetitive instructions, orientation cues, and by limiting the use of physical restraints. If psychotropic medications are needed to treat psychotic symptoms, to prevent patients from harming themselves or others, or to facilitate necessary diagnostic and therapeutic interventions, then haloperidol is the drug of choice in most instances. Drugs with anticholinergic properties should be avoided.
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PMID:Delirium in the elderly. 218 81

Twenty-nine patients with major depression, with and without psychosis, were randomly assigned to bilateral conventional electroconvulsive therapy (ECT) or modified multiple monitored ECT (MMECT) limited to two seizure inductions in a session. From pretreatment to after the fourth treatment session, modified MMECT was associated with more rapid amelioration of depressive symptoms on the basis of blindly rated Hamilton Rating Scale for Depression scores. No medical complications occurred. Sixty-two percent of patients in the modified MMECT group had posttreatment confusion, whereas 15% of patients treated with conventional ECT were confused. Modified MMECT appears to confer some clinical advantage over conventional ECT in the treatment of major depression while carrying an increased risk of treatment-related reversible confusion.
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PMID:An efficacy study of single- versus double-seizure induction with ECT in major depression. 222 83

In a long-term psychiatric setting, self-induced water intoxication may be a life-threatening situation. At first glance, the symptoms or behaviors of self-induced water intoxication are similar to schizophrenia, i.e., inappropriate behavior, delusions, hallucinations, confusion, and disorientation. In some cases, the symptoms of water intoxication mimic schizophrenia and thus, are disguised as a part of the psychoses. Affected individuals develop polydipsia, which is accompanied by overhydration and dilutional hyponatremia. If untreated, the symptoms may progress from mild confusion to acute delirium, seizures, coma, or death (Ripley, Millson, & Koczapski, 1989). Under normal circumstances there is a delicate balance of water requirement and water intake. If the balance of water is altered, electrolyte imbalance can occur. The recognition of water intoxication or self-induced water intoxication and psychosis among chronic, institutionalized patients may prevent their death or the development of neurological damage (Arieff, 1985). Because self-induced water intoxication often goes unrecognized in its early stages and may have irreversible or fatal complications, early detection is crucial. This article will discuss the etiology, nursing assessment, and interventions associated with patients suffering from self-induced water intoxication.
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PMID:The water-intoxicated patient. 226 Aug 89

Very little has been written about mania in the elderly population. Most authors of the 1960s and 1970s situate the age of onset of affective disorders well before the geriatric period. In the 1980 some authors reached quite different conclusions about the age of onset. One study calculated an increased frequency of manic psychosis with advanced age. However, it seems difficult to compare these studies. A few cases of primary mania in the elderly have been published and it is important that more of these cases be reported. Mania diagnosis in this group of patients is not easy to make: past history may be difficult to assess, false first diagnosis may still occur in some cases, the course and the presentation of the illness may be less typical, there may be a picture of pseudodementia, confusion, depressed mood, etc. Mania may be secondary to physical illness (organic affective syndrome). Moreover, a frank manic picture may be mistaken for dementia (or for organic brain syndrome) even if it is indeed a primary affective illness.
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PMID:[Manic disorder in the aged: a review of the literature]. 188 46

Corticosteroid therapy may induce numerous psychiatric disorders. Minor changes of the euphoric mood type are observed in 75% of the patients under treatment. Major adverse effects are encountered in not more than about 5% of the cases. They consist of acute polymorphous psychotic manifestations which may be manic or depressive or, when high doses of corticosteroids are taken, of the organic confusion type. Such manifestations are particularly frequent in women and in some diseases such as lupus erythematosus or pemphigus. In the vast majority of cases they follow a favourable course when corticosteroids are reduced or discontinued and a symptomatic treatment with neuroleptic drugs is prescribed. Psychic dependence on corticosteroids and withdrawal syndromes have also been reported.
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PMID:[Psychiatric complications of corticotherapy]. 232 Aug 83

The authors present typical observations of behavioural adverse effects induced by anti-hypertensive drugs and reported to the Marseilles Regional Center of Pharmacovigilance. These effects include: sleep disorders, confusion, psychotic reactions and depression. Surprisingly, these effects seem to be very rarely reported; this is perhaps due to a tricky assessment of the causal relationship: many factors (hypertension, other diseases, other drugs) can have an influence on these troubles.
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PMID:[Psychic effects of drugs prescribed for hypertensive patients. An experiment of the Regional Drug Monitoring Center in Marseilles]. 234 34

A case of toxic psychosis due to cycloplegic eyedrops is reported. The characteristic mental symptoms of atropine intoxication include confusion with vivid visual hallucinations, restlessness, muscular incoordination, and later emotional lability. These symptoms and a short period of retrograde amnesia occurred in our patient. The adverse drug reaction was confirmed following rechallenge. The possible preventive measures against intoxication caused by atropine eyedrops are described. All healthcare professionals should be aware of the possible temporal relationship between the appearance of pathology and the administration of a drug.
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PMID:Toxic psychosis following cycloplegic eyedrops. 237 43

DSM-III-R divides schizophreniform disorder into 2 subtypes with and without good prognostic features. The 4 prognostic features have been selected based on the literature, and the presence of at least 2 should indicate a good prognosis. The predictive value of the good prognostic features was tested in a sample of 16 untreated patients with DSM-III-R schizophreniform disorder with known long-term outcome based on personal follow-up examination. No correlation between the presence of 2 or more features and favorable outcome was observed. Confusion, disorientation or perplexity at the height of the psychotic episode was the only feature consistently associated with a favorable outcome in this sample. The introduction of good prognostic features of schizophreniform disorder by DSM-III-R has been done without due consideration of the methodological problems of prediction research.
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PMID:Predictive value of the four good prognostic features in DSM-III-R schizophreniform disorder. 239 16

Minor episodes of aggressive behavior are relatively common in some populations of patients with epilepsy. However, they are probably no more common than in populations who are socially disadvantaged or who have brain damage. The confusion that commonly follows seizures can lead to apparently aggressive behavior. Rarely, the seizure itself may lead to directed aggression; very rarely does it lead to murderous attacks. Although post-ictal psychotic aggression is usually not severe, when it is driven by prominent delusions and hallucinations, it can result in self-destructive acts or serious violence. Clearly, however, it is quite unfair to globally classify epileptics as aggressive, and the time has come to abandon this stereotype.
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PMID:The nature and management of aggression in epilepsy. 252 Oct 95


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