Unfortunately, no pathognomonic diagnostic test is available; the assessment relies on a thorough physical and mental status examination, review of the history, and routine laboratory tests.
As a first step, the clinician should determine whether the patient is agitated, confused, or both. The differential diagnosis and treatment of the purely agitated state differ from that of confusion. A confusional state may change several times over a period of hours, requiring repeated assessments. Confusion can have an acute onset (in the hospital), may develop over weeks to years, and/or may be complicated by agitation.
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