ACUTE CONFUSIONAL STATE

Nani Zaitun

Kursus Penyegar Dokter FKTP I

Hotel Banjarmasin Internasional
24 November 2018
Introduction
• Acute confusional states (ACS) encompass a
range of clinical syndromes, variably labeled as
encephalopathy or delirium.
• The dominant clinical sign is inattention
• Nearly all other cognitive functions will also
appear to be impaired.
• The etiologies of ACS are diverse and
multifactorial and often reflect the
pathophysiological consequences of an acute
medical illness, medical complication or drug
intoxication.
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Definition
• Acute confusional state (ACS) is characterised by a
disturbance of consciousness and a change in cognition
that develop over a short period of time.
• Acute confusional state (ACS) is a neuropsychiatric
syndrome characterised by acute onset of fluctuating
cognition and inattention linked to triggering factors
• Subtypes:
 Hyperactive delirium – restless, agitated, delusional,
risk of harm
 Hypoactive delirium – lethargic, monosyllabic, often
overlooked
 Mixed type.
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• Acute confusional state is very commonly
encountered in hospital medicine:
Complicating at least 10% of all medical
admissions
20-30% prevalence on medical wards
15-53% of patients postoperatively
70-87% of those in intensive care

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Risk Factors of Delirium

(Clinical Guideline Delirium.NHS.2013)

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Precipitating Factors Delirium

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(Clinical Guideline Delirium.NHS.2013)
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The causes of Acute confusional state
Systemic medical conditions, such as
infectious processes, metabolic
derangements, toxins, and the effects of
medications
Some primary pathologies of the brain can
produce acute confusional states
primary psychiatric illnesses that impair
attention and concentration

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(Clinical Guideline Delirium.NHS.2013)
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The Pathophysiology of Delirium

https://www.ncbi.nlm.nih.gov/entrez/eutils/elink
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Clinical Features of Delirium

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(Clinical Guideline Delirium.NHS.2013)
Diagnosis
Confusion Assessment Method (CAM)

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 DECISION MAKING IN
ACUTE CONFUSIONAL STATE

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(Muhsin S, Geene H. Decision Making in Medicine. 2010)
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(Muhsin S, Geene H. Decision Making in Medicine. 2010)

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(Muhsin S, Geene H. Decision Making in Medicine. 2010)
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(Muhsin S, Geene H. Decision Making in Medicine. 2010)
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Terima kasih

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Glasgow Coma Scale (GCS) Assessment

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• The neurologic examination can be
particularly valuable
• Focal neurologic signs such as hemiparesis,
visual-field defects, asymmetric reflexes, an
upgoing toe, or hemineglect suggest the
presence of focal brain lesions, which may
produce confusional states

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 The mental status examination
• The Mini Mental State Exam
• a continuous performance test
• the timed recitation of days of the week or
months of the year—first forward and then
backward

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• Additional neurologic symptoms or signs present
• Cerebrovascular risk factors
• Medications (particularly those with prominent
anticholinergic effects) may adversely affect
cognitive function. Neuroleptic malignant
syndrome must be considered in patients
receiving these medications or in patients
withdrawn rapidly from levodopa or dopamine
agonists.
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 ???
• in patients who use alcohol include
intoxication, withdrawal, and Wernicke’s
encephalopathy (classically ophthalmoplegia,
ataxia, and encephalopathy, but often
presenting without the full triad)

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