#Altered mental status series

Only recently has evidence on their relationship progressed beyond case series and reports. These syndromes share tremendous overlap: the historical catatonia-related terms 'delirious mania' and 'delirious depression' bespeak of literal confusion differentiating them. We also juxtapose clinical features of these syndromes and outline a structured approach to catatonia evaluation and management in acute medical settings. We conducted a systematic literature review of MEDLINE, EMBASE and PsycINFO on the relationship between catatonia and delirium. Catatonia may co-occur with or be preferentially diagnosed as delirium. Furthermore, catatonia often meets delirium criteria due to incoherence, altered awareness and behavioral change. Further studies are needed to confirm the possible benefits of HDIV thiamine for patients with suspected thiamine-deficient encephalopathy.Д¬atatonia is seldom considered in evaluation of altered mental status (AMS) in medical settings. In a large, public academic hospital, guideline-concordant thiamine supplementation is rare and HDIV thiamine is infrequently prescribed to patients with encephalopathy. In multivariable models, the association between HDIV thiamine and decreased in-hospital mortality did not meet statistical significance (p=0.061). In bivariable analyses, HDIV thiamine was associated with surgical services (p=0.001), psychiatric consultation (p<0.001), and decreased mortality (p=0.004). In patients with encephalopathy who received IV thiamine (n=432), HDIV thiamine was administered to 20% (n=86) and only 2.1% (n=9) received dosing consistent with Royal College of Physicians guidelines. lower doses of IV thiamine.ДЄmong the total 5,236 thiamine orders, 29% (n=1,531) were IV 10% (n=150) of IV orders met HDIV criteria. Chi-square tests, Wilcoxon Rank Sum tests, and logistic regression were used to compare clinical variables in patients with encephalopathy who received HDIV thiamine (в‰Ґ 200 mg twice daily) vs. To describe thiamine prescribing practices at a large, public academic hospital and investigate clinical characteristics and outcomes associated with HDIV thiamine in patients with encephalopathy who received IV thiamine.Д®lectronic medical records of hospitalized patients who received thiamine between and were reviewed. A longstanding dosing strategy for WE is 100 mg daily, yet updated clinical guidelines suggest using high dose intravenous thiamine (HDIV).

There is no consensus regarding thiamine dosing when WE is suspected. WernickeвЂІs encephalopathy (WE) is a common neuropsychiatric syndrome due to thiamine deficiency. This chapter will cover several causes of altered mental status that are foundational in consultation-liaison psychiatry, illustrate approaches to some common conditions with overlapping and nonspecific neuropsychiatric findings, and highlight strategies to address provider biases and concerns while treating patients with comorbid psychiatric and medical conditions who present with altered mental status. In their role as liaison, the psychiatrist can also identify and assist with the challenging patient-provider dynamics that can arise in response to acute behavioral and cognitive symptoms, particularly in the context of uncertainty in diagnosis and medical management. The consultation-liaison psychiatrist is uniquely positioned to assist the medical team in navigating the often complex interplay of medical, psychiatric, and environmental factors that might contribute to a change in the patientвЂ™s mental status. Psychiatric consultation for patients with altered mental status can be particularly helpful for diagnostic clarification or management of agitated and aggressive behaviors that are interfering with safety and effective provision of care. It can initially have a broad differential diagnosis, including a range of medical, neurological, and psychiatric disorders, as well as neuropsychiatric effects of medications, substance intoxication, and withdrawal. Altered mental status describes an acute change in a patientвЂ™s level of consciousness, psychomotor activity, cognition, and sensorium.