DELIRIUM AND OTHER CONFUSIONAL STATES Flashcards
__________ is a general term denoting the patient’s incapacity
to think with customanJ speed, clarity, and coherence.
Confusion
Confusion is also a characteristic feature of the
chronic syndrome of ___________, where it is the product of a progressive failure of cognition, language, memory, and other intellectual functions
dementia
_______________ is characterized by a prominent disorder
of perception; hallucinations and vivid dreams; a kaleidoscopic
array of strange and absurd fantasies and delusions;
inability to sleep; a tendency to twitch, tremble,
and convulse; and intense fear or other emotional reactions.
delirium
Delirium is distinguished not only by extreme inattentiveness but also by a state of heightened ____________
alertness
The failure in the amnesic state is one of ____________ and must be distinguished from states of drowsiness, acute confusion, and delirium, in which information and
events seem never to have been adequately perceived
and registered in the first place.
retention, recall, and reproduction
the term dementia (literally, an undoing of the mind) denotes a deterioration of all intellectual
or cognitive functions with little or no disturbance of ___________
consciousness or perception
Memory may be arbitrarily subdivided into several parts: 1 2 3 4
( 1 ) registration; (2) fixation, mnemonic integration, and retention; (3) recognition and recall; and (4) reproduction
In the _____________, newly presented
material appears to be correctly registered but cannot be
retained for more than a few minutes (an terograde amnesia, or failure of learning
Korsakoff amnesic syndrome,
defect in the recall and reproduction of
memories that had been formed several days, weeks,
or even years before the onset of the illness
retrograde amnesia
Intact retention with failure
of recall (retrograde amnesia without anterograde
amnesia) when it is severe and extends to all events of
past life and even personal identity, is usually a manifestation of ________________
hysteria or malingering
___________ the highest order o f intellectual activity,
remains the most elusive of all mental operations
Thinking,
Disorders of thinking are quite prominent in delirium
and other confusional states, in ______, ________ and __________
mania, dementia, and schizophrenia
This overall reduction in thought and action is
the most prominent feature of diseases that damage the
_____________
frontal lobes
A related condition of slowed thought, or ______________is comparable to the bradykinesia of extrapyramidal
disorders
bradyphrenia,
When a false belief is
maintained in spite of convincing evidence to the contrary,
the patient is said to have a _______
delusion
Also diagnostic of some forms of __________are distortions of logical thought, such as gaps in sequential thinking, intrusion of irrelevant ideas, and condensation of associations
schizophrenia
Affective displays that are excessively labile and poorly
controlled or uninhibited are a common manifestation
of many cerebral diseases, particularly those involving
the _______ and ________
corticopontine and corticobulbar pathways.
Affect being the external appearance of
emotional life, the __________is characterized by
a relative disconnection between the patient’s reported
emotional feelings and the outward display, most often
being in the same general direction
pseudobulbar state
it is convenient to divide emotionality
into ______ and_______
mood and affect
By ________ is meant the prevailing
internal emotional state of an individual.
By contrast, ____________ (or feeling) refers to the outward emotional reactions evoked by a thought or an environmental stimulus.
mood
affect
Disorders of these parts of
the motor system interfere with voluntary or automatic
movements, much to the distress of the patient
Distu rba n ces of I m p u lse (Conati o n )
a n d Activity
With certain cerebral
diseases the disinclination to move and act may reach
an extreme degree, to a point where a person who is
wide awake and perceptive of the environment does not
speak or move for weeks on end. What is this condition?
akinetic mutism
Profound depression or other psychosis
is the usual cause of _____
catatonia
completely inert catatonic patient develops a high fever,
collapses, and dies
lethal catatonia
In
abulia, catatonia, and depression, the mind is usually
sufficiently alert to record events and later to recount
them, which differentiates these states from _______
stupor
Akathisia refers to constant restless movements and
inability to sit still; in some patients, this is a consequence
of the prolonged use of ______
phenothiazines, butyrophenones,
newer anti psychosis drugs, and L-dopa,
In the __________
(and to a lesser extent in hypomania), continuous activity
and insomnia are added to the flight of ideas and the
euphoric (although somewhat irritable) mood
manic form of bipolar disease
From the neurologic perspective, the generic term
________applies to states of confusion in which elements
of hallucinations, delusions, and disordered thinking
comprise the prominent features
psychosis
Characteristically, these abnormalities fluctuate in
severitt;, typically being worse at night_______
(“sundowning” ) .
This i s best depicted in the patient undergoing withdrawal from alcohol after a sustamed period of intoxication.
The symptoms usually develop over a period of
2 or 3 d.
The first indications are difficulty in concentration,
restless irritability; increasing tremulousness, and
insomnia.
Deliri u m
lesions associated with delirium
they tend to be localized in the rostral midbrain and hypothalamus or in the temporal lobes, where they involve the reticular activating and limbic
systems.
what kind of hallucination is this?
Subthalamic and midbrain lesions may give rise to visual hallucinations that are not unpleasant and are accompanied by good insight
(“peduncular hallucinosis” of Lhermitte
By contrast, in the toxic ________
associated with excessive doses of the newer antidepressant
drugs, salivation is normal, sweating is increased, and
the gut is hyperactive; diarrhea is common
serotonergic syndrome
Allied compounds
with sympathomimetic actions such as ______ and __________ produce a hallucinatory delirium and
yet others with different pharmacologic properties such as
glutaminergic activity may result in a variety of delirious
fragments or pure hallucinosis
cocaine
and phencyclidine
With regard to medications, those with __________have the highest tendency to cause confusion, but
others, even seemingly innocuous ones, may do the same
atropinic
effects
global confusional
state occurs in patients with severe burns (_________
burn
encephalopathy).
