Mental confusion is usually related to an organic cerebral disease (epilepsy,
stroke, encephalitis) or to a general illness (febrile infection, metabolic
imbalance, high glycemia). It also sometimes originates from an intoxication related to the
consumption of alcohol, drugs or drugs (amphetamines, barbiturates,
antidepressants, benzodiazepines, neuroleptics). Finally, it may result from a
particularly violent emotional shock (accident, catastrophe) or complicate an
evolving psychiatric condition. Mental confusion is a change in the mental state
in which a person is unable to think with his usual level of clarity. Frequently,
mental confusion leads to the loss of the ability to recognize people and places.
They are characterized by the concomitation of psychic and somatic symptoms:
1) impairment of the state of consciousness at various levels;
2) temporo-spatial disorientation of different degree;
3) the presence, even if not constant, of an oniroid type of experience or of a hallucinatory experience, delirious to a dream structure;
4) concomitance of a more or less serious compromise of the general state.
According to Bonhoffer, the S.A. (amential syndrome) is an exogenous, specific
and uniform acute reaction to an attack by S.N.C, which is independent of
personality, predisposition and the etiological agent.
- injuries
- medical conditions
- drugs
- environmental factors
- substance abuse
1) from exogenous causes: direct or indirect organic cerebral pain linked to
toxic, endogenous or exogenous toxic factors (alcohol, drugs, carbon monoxide),
deficiencies (porphyria, pellagra), dysmetabolic (diabetes), dysendocrine
(mixedema, Basedow), traumatic circulators. Cerebral disorders: epilepsy, tumors,
head trauma, progressive paralysis, senile degenerations.
2) idiopathic or cryptogenic: mind confusion in which provisional etiology is
doubtful or unknown.
3) periodicals of Meynert: they have a periodic course very similar to the
dysthymisms. The characteristics of these forms of periodic endogenous psychoses
defined as non-dysthymic are: a) the premorbid personality does not distinguish;
b) acute insurgency and without exogenous factors; c) polymorphic symptomatology
with coarctive and expansive counterpart aspects; d) characteristic features of
the individual episodes; e) complete resolution of the symptomatology; f)
periodic evolution with free intervals of months and years; g) favorable effect
of ESK therapy.
4) mental confusion syndromes associated with other psychiatric illnesses: a) manifest
themselves at the height of a melancholy with amazement and a furious mania; b)
in some catatonic schizophrenic forms and in some acute dissociative forms. In
these forms it is a particular. evolutionary learning mode of endogenous
psychosis.
Mental confusion translates into a weakening or subversion of all psychic
processes: diminution of vigilance (ebethism, numbness or torpor), inability to
coordinate ideas, disturbances of perception and memory, spatio-temporal
disorientation, anxiety, oneiric delirium with sensory hallucinations. The
patient is as lost, dazed, unable to orient himself and understand the
situation. Generally speaking, mental confusion is usually associated with
organic signs (fever, dehydration, and sickness) that can endanger the life of
the subject.
Whether the S.A. arises in the absence of somato-psychic factors antece teeth, whether it intervenes as a result of toxinfective states (pregnancy, puerperium, surgery, stress, head trauma), the beginning is always abrupt and sudden and rapidly progressive and invasive, such to reach the state period in a few days. It may be marked by generic somatic non-specific disorders: 1) insomnia, headache, disappointment, asthenia; 2) changes in the mood that becomes dlsforico, perplexity, anxiety, anguish, bliss, ecstasy, with abrupt oscillations, restlessness with excitam. and various behavioral disorders. Sometimes the prodromes may be missing. There will then be an acute psychotic invasion with a sudden hallucinatory-delusional state associated with the numbness of consciousness and disorientation. temporo-spatial.
Appearance of the patient: the mimic gives the impression of daze, ebetude, the
appearance is astonished, the look is far away, lost in the void, absent. The
patient is disinterested in the environmental situation. The physiognomy is
figée, inadequate to environmental circumstances. Behavior may be characterized
by a state of amazement with inhibition or agitation. The movements are clumsy,
uncertain, hesitant. The word is badly articulated. The patient is devoid of any
initiative, even the most basic. If he is excited, he is prey to a sterile and
auralistic state of agitation.
* Confusional state: it is the capital symptom.
- Lack of clarity and clarity of the field of conscience: perceptual activity is
deficient, the patient misidentifies the objects of the external world, does not
recognize those present and the people who treat him. It is incapable of making
a differentiation and a synthesis of the psychic contents that are confused and
agglutinated. The language is fragmentary and incoherent.
- Temporal-spatial disorientation: the patient can not tell the day, the place
where it is located, the date of entry.
- Memory disturbance: it concerns the memory of fixation and re-enactment.
- Oneiric delirium: not constant but very frequent. It is a delirious dreamlike
hallucinatory experience. Predominantly made up of visual hallucinations (kaleidoscopic
images). The patient actively and intensively participates in the delirious
experience. The most frequent themes are: a) dreamlike color scenes; b) oneiric
delirium with a pleasant or exalted hue; c) the so-called. occupational or
professional delirium (the patient lives a scene of his work or is struggling
with his usual occupations).
Target. General terms canceled; dry and chapped lips; sooty teeth; dry tongue,
reddened, patinosa, saburrale; anorexia. Cardiocirculatory: sinus tachycardia;
hypotension; acrocyanosis. Respiratory: polypnea (easy bronchopulmonary
complications). Genitourinary: incontinence or urinary retention (bladder bolo),
sometimes oliguria.
Light hyperthermia; high hyperthermia is a sign of complication in progress. The
patient is dehydrated; the mechanics of dehydration is as follows: first there
is fluid loss due to non-counterbalanced hyperseedure due to the reduced or
absent introduction of liquids; it establishes dryness of the skin and mucous
membranes, hyponatraemia and hypokalaemia, then it passes to an intra- and
extracellular dehydration with an increase in intracellular sodium. The blood
chemistry tests reveal: increase in ESR; increase in azotemia; ispissatio
sanguinis; electrolyte alterations; keto-acidosis.
1) Healing without relics
2) Sometimes delirium residual
3) Sometimes tendency to deterioration
Psychopathology
Substantial inability of the conscience to the elaboration. of perceptions nc_
space-time parameters. On this basis is structured the lived onirico that has
many similarities with the dream but, unlike the sleeper, the confused is not
only a spectator but an actor of the same experience.
1) Idiopathic idiopathic amence:
2) Acute delirium or deadly acute catatonia or hyperazotemic acute encephalitis:
the psychic and somatic symptomatology is the same as the typical, but much more
severe, amour. There is hyperthermia, hyperazotemia with serious risk of death
due to renal function blockage.
3) S. of Korsakoff (see Alcoholism)
4) Delirium tremens (see Alcoholism)
1) Demential states
2) Melancholy and stupefying mania
3) Acute dissociative syndromes
4) Brain tumors
5) Acute brain disorders
6) Epilepsy
7) Drug poisoning, drugs, poisons
8) Head injuries
The treatment is highly specialized and especially in conditions of sudden mental deterioration it is necessary to
hospitalize the patient and rule out causes of stroke or acute intoxications
from drugs.
Hospitalization. Rehydrating therapy, vitamin therapy Antibiotics. Cortisonici (Policort).
Psychotropics (benzodjazepine and neuroleptics if severe agitation).
ESK therapy
Other Potential Causes
Confusion can be caused by a number of different factors. Other potential causes
include:
fever
infection
low blood sugar
not getting enough sleep
lack of oxygen
rapid drop in body temperature
depression