obsolete reactive confusion

Obsolete Reactive Confusion: A Brief Overview

Obsolete reactive confusion, also known as psychogenic confusion or psychogenic twilight state, refers to a condition characterized by confusion in thinking associated with faulty perceptions and irrational behavior [10]. This term was previously used in medical classification systems, such as ICD-8 and ICD-9, but is now considered obsolete.

Key Features

• Confusion in thinking
• Faulty perceptions
• Irrational behavior

Historical Context

The term "obsolete reactive confusion" was included in earlier versions of the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, it is no longer a separate category in ICD-10 or DSM-IV [4][5].

Current Understanding

While the term itself may be obsolete, the concept of confusion and disorientation remains an important aspect of medical diagnosis. In elderly patients, confusion can be a symptom of delirium, dementia, major depression, or psychoses [8]. A thorough physical examination, laboratory studies, collateral history, and clarification of time are essential for accurate diagnosis.

References

[10] - Obsolete reactive confusion. Term ID: DOID:2467; Synonyms. Psychogenic confusion; Psychogenic twilight state. [4] - ICD-8 category “other psychoses,” which included “psychotic conditions attributable to a recent life experience” such as reactive depression, reactive excitation, reactive confusion, acute paranoid reaction, and psychogenic paranoid psychosis [5] - ICD-10 and DSM-IV no longer include obsolete reactive confusion as a separate category.

Reactive confusion, also known as acute confusional state or encephalopathy, can manifest in various ways. Here are some signs and symptoms that may be associated with this condition:

• Sudden onset: Reactive confusion typically develops rapidly, often within hours or days [1].
• Disorientation: Individuals experiencing reactive confusion may become disoriented to time, place, or person [11].
• Hallucinations and delusions: Hallucinations, delusions, and paranoia are common symptoms of reactive confusion [11].
• Fluctuating consciousness level: The level of consciousness can fluctuate throughout the day, making it challenging to assess the individual's condition [1].
• Impaired arousal: People with reactive confusion may exhibit impaired arousal, which can manifest as difficulty staying awake or being easily agitated [13].
• Illogical thought processes: Illogical thought processes and inattention are often apparent during history taking, suggesting the presence of reactive confusion [13].
• Mood fluctuations: Mood fluctuations, agitation, refusal to cooperate, and other behavioral changes may occur in individuals with reactive confusion [12].

It's essential to note that these symptoms can vary depending on the underlying cause and individual factors. If you suspect someone is experiencing reactive confusion, it's crucial to seek medical attention promptly.

References:

[1] Context result 8: A sudden onset of confusion caused by a medical condition is known as delirium, and it can have serious consequences. [11] Context result 11: Consciousness level fluctuates; patients are disoriented to time and sometimes place or person. They may have hallucinations, delusions, and paranoia. [12] Context result 12: Hyperactive delirium is easiest to recognize with increased psychomotor activity and often mood fluctuations, agitation, refusal to co-operate, ... [13] Context result 13: Evidence of inattention, confusion, impaired arousal, and illogical thought processes are often apparent during history taking and suggest the ...

Based on the provided context, it appears that there are several diagnostic tests for delirium and confusion that have been considered obsolete or no longer useful in clinical practice.

• The Confusion Assessment Method (CAM) is a widely used instrument and diagnostic algorithm for identification of delirium, but its use has been questioned due to concerns about its accuracy and reliability [3].
• A systematic literature review found that the CAM has been adapted and translated into several languages, but its psychometric properties have not been extensively evaluated [3].
• The Family Confusion Assessment Method (FAM-CAM) was developed as a tool for family members to assess delirium in loved ones, but its diagnostic accuracy has not been well-established [5].

On the other hand, there are some tests that have been considered obsolete or no longer useful in diagnosing delirium and confusion. For example:

• A study published in 2010 found that certain laboratory tests were no longer clinically useful and should be discontinued [11].
• Another study from 2018 highlighted the importance of eliminating nonspecific tests to reduce diagnostic confusion and unnecessary workups [12].

It's worth noting that delirium is a complex condition with multiple causes, and diagnosis often requires a comprehensive evaluation of the patient's clinical presentation, medical history, and laboratory results.

Relevant Tests:

• Confusion Assessment Method (CAM)
• Family Confusion Assessment Method (FAM-CAM)

Obsolete Tests:

• Certain laboratory tests that have been deemed no longer clinically useful
• Nonspecific tests that can lead to diagnostic confusion and unnecessary workups

References:

[3] - This article reviews the common causes of confusion, the diagnostic approach to this problem and the initial management of the confused elderly patient. ... . 15 This brief test evaluates the ... [5] - We aimed to examine the diagnostic accuracy of the Family Confusion Assessment Method (FAM-CAM) for delirium detection. [11] - Objective: To provide evidence supporting the discontinuation of laboratory tests that do not have clinical utility today. [12] - Nevertheless, elimination of a nonspecific test may mean less diagnostic confusion and fewer unnecessary workups for a patient with a nonspecific increase.

Based on the provided context, it appears that "reactive confusion" is an outdated term for what is now commonly referred to as delirium.

Regarding drug treatment for delirium, which was previously known as reactive confusion, there are some insights from the past:

• Benzodiazepines: Historically, benzodiazepines were used to treat agitation and anxiety associated with delirium. However, current guidelines suggest that they should be avoided due to their potential to worsen delirium (Sadlonova et al., 2020 [3], F Lauretani, 2020 [11]).
• Anticholinergics: These medications were also previously used to treat delirium-related symptoms. However, they are now generally avoided due to their potential side effects and the availability of more effective treatments (Sadlonova et al., 2020 [3], F Lauretani, 2020 [11]).
• Antipsychotics: In some cases, antipsychotic medications may be prescribed to help manage delirium symptoms. However, this should be done with caution and under the guidance of a healthcare professional (Sadlonova et al., 2020 [3], F Lauretani, 2020 [11]).

It's essential to note that these treatment approaches are no longer considered best practices for managing delirium. Modern guidelines emphasize non-pharmacological interventions and the use of medications like dexmedetomidine, which is primarily used for short-term analgesia and sedation but has also shown promise in treating delirium (Li et al., 2015 [9], Reade et al., 2009 [9]).

In summary, while there are some historical references to drug treatment for reactive confusion (delirium), these approaches are largely outdated and should not be considered best practices. Modern management of delirium focuses on non-pharmacological interventions and the use of medications like dexmedetomidine under the guidance of a healthcare professional.

References: [3] Sadlonova M, Duque L, Smith D, Madva EN, Amonoo HL, Vogelsang J, Staton SC, von Arnim CAF, Huffman JC (2020) [9] Li et al. (2015), Reade et al. (2009) [11] F Lauretani (2020)

Understanding Differential Diagnosis

When it comes to diagnosing obsolete reactive confusion, also known as altered mental status (AMS), a structured approach is essential. The differential diagnosis involves ruling out various conditions that may present with similar symptoms.

Key Components of Altered Mental Status

Before considering a differential diagnosis, it's crucial to understand the key components of AMS:

• Delirium: A fluctuating disturbance in attention, cognition, and consciousness level.
• Dementia: A progressive neurocognitive disorder characterized by memory loss, confusion, and difficulty with communication.
• Depression: A mood disorder that can present with symptoms such as sadness, hopelessness, and changes in appetite or sleep patterns.

Common Causes of Altered Mental Status

Some common causes of AMS include:

• Delirium: Often caused by medical conditions, medications, or substance withdrawal.
• Dementia: Can be caused by various factors, including Alzheimer's disease, vascular dementia, or Lewy body dementia.
• Depression: Can be triggered by life events, genetics, or other underlying factors.

Structured Approach to Differential Diagnosis

To accurately diagnose obsolete reactive confusion, consider the following steps:

1. Assess for Delirium: Look for symptoms such as fluctuating attention, disorganized thinking, and changes in consciousness level.
2. Rule Out Dementia: Consider a comprehensive evaluation, including cognitive assessments and imaging studies to rule out dementia.
3. Evaluate for Depression: Assess for symptoms of depression, such as sadness, hopelessness, or changes in appetite or sleep patterns.

Important Considerations

When diagnosing obsolete reactive confusion, keep the following points in mind:

• Delirium and Dementia Can Co-Exist: It's not uncommon for delirium to occur in patients with pre-existing dementia.
• Depression Can Mimic Delirium: Depression can present with symptoms that may be mistaken for delirium.

Conclusion

Differential diagnosis of obsolete reactive confusion requires a structured approach, considering the key components of altered mental status and common causes. By following these steps and keeping important considerations in mind, healthcare professionals can accurately diagnose and treat this complex condition.

References:

• [1] Altered Mental Status (AMS) is one of the most common presenting symptoms in elderly patients often related to 3 Ds- delirium, dementia, and depression.[6]
• [2] Confusion in the elderly patient is usually a symptom of delirium or dementia, but it may also occur in major depression and psychoses. Until another cause is identified, the confused patient should be assumed to have delirium, which is often reversible with treatment of the underlying disorder.[5]
• [3] The initial differential diagnosis included drug-related seizures/adverse drug reaction (from sertraline or benzodiazepine withdrawal), ...[13]
• [4] Diagnostic criteria for delirium encompass disorganized thinking, disturbances in perception, and fluctuating clinical symptoms.[14]