Diagnosis and differential diagnosis

It is important to consider delirium in any psychiatrically disturbed patient who has evidence of physical disorder. The diagnosis is mainly clinical. It consists of two components. First, the diagnosis of delirium itself, and second, the diagnosis of the cause. Cognitive testing must be carried out if the diagnosis is not readily apparent. It is essential that assessing psychiatrists are able quickly and accurately to assess cognitive function at the bedside, using clinical methods (see below). Otherwise, many cases of delirium may be missed or the diagnosis delayed. Atypical clinical patterns are frequent.

It is unusual for patients with delirium to seek medical attention themselves; the main exception being the alcoholic who notices the emergence of visual hallucinations whilst withdrawing. Rather, drowsiness or disturbed behaviour will alert others. Disturbed behaviour may include agitation at the presence of delusions or hallucinations, or the expression of false ideas, for example that a carer or family member is trying to harm them. The presence of a diminished level of consciousness may be obvious in some cases, but can easily be missed if it is mild and not associated with overactive behaviour disturbance. A common presentation to liaison psychiatry is for general hospital ward staff to refer a patient as '?psychotic', on the basis of apparent delusions or hallucinations. The task here includes distinguishing a new episode of functional psychosis (uncommon) from delirium (common in this situation).

Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

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