Superimposed delirium

Here it is mentioned only that subacute delirium superimposed on another condition is at risk of not being recognized because it is taken to be a manifestation of the underlying illness, usually dementia. This is particularly the case when a subclinical urinary tract infection occurs in a demented patient. It is of clinical relevance because treatment of the urinary tract infection results in a great improvement in the patient's mental state. On routine assessment particular attention should therefore be paid in the history to evidence of sudden worsening of a stable or only slowly deteriorating condition, and to nocturnal disturbance especially with (usually visual) hallucinations. On examination of the patient herself the level of consciousness, awareness of the environment, attention, and concentration should be noted.

Delirium is described in CMp,t§L4J 2., and special features in older people are considered in Ch§pt§L§.5:1. Reassessment after treatment

Because so much of psychiatry is practised in the community, it is impossible for all patients to be reassessed by a psychiatrist after treatment. In hospital or outpatient clinics it is feasible, but not for the majority of older patients who live at home. Furthermore, in areas where the population is geographically widespread, it is very difficult if not impossible for many older people, who may be frail and infirm, to travel long distances to attend clinics. Much of the follow-up assessment in old age psychiatric services is therefore carried out by other members of the multidisciplinary team, such as psychologists or occupational therapists, but mostly by community psychiatric nurses. It is essential for the psychiatrist to meet regularly with members of the team seeing patients in the community to discuss the progress of individual patients following treatment.

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