Subjective experience of a confusional state

Abstract

BackgroundConfusional states associated with medical and surgical conditions require more study and biochemical explanation.AimsTo understand impairment of consciousness, cognition and memory.MethodA psychiatrist reports experience of his changing mental state over 5 days from notes made immediately on recovery.ResultsA prodromal phase of declining consciousness, understanding and memory registration over perhaps 48 h was difficult to detect. During unconsciousness there were four brief partial reversals with arousal, and some mental functioning (memory, formation of beliefs) occurred.ConclusionsSelf-report can be a useful addition in clinical study and patients with renal failure require psychological and psychiatric study. Comparison with the mental effects of benzodiazepine or of an anaesthetic such as nitrous oxide might throw light on the pathology.

The delirium experience: what is the effect on patients, relatives and staff and what can be done to modify this?

“…This account neatly summarises the themes reported in the qualitative literature (Crammer, 2002). In this account, he describes delusional recollections of surgery in other countries, attempts to 'dispose of him' when treatment had failed, deception by nursing staff and religious references to a Catholic priest.…”

The delirium experience: A review

“…The opinions of expert clinicians have differed regarding the extent to which people with delirium might recall their experiences [4,5]. However, people who have recovered from the condition have written of the unpleasantness of their experience [6,7], and psychological sequelae and even posttraumatic stress disorder (PTSD) have been reported [6,8,9]. A better understanding of what it means to a patient to be delirious has the potential to improve recognition, management, and treatment of delirium.…”

Psychological management in delirium

“…Dr Crammer is a psychiatrist who developed delirium due to renal failure. His description of experiencing delirium due to renal failure gives clear insight into these unconscious perceptions and the associative processes that take place during delirium (49). The delirious patient is very suggestible and experiences this state as 'dream-like' (50).…”

“…In delirium, the faculty of logic reasoning is dramatically weakened, the affect increases in strength and associations are made easily. This distortion leads eventually to the formation of delusional ideas (49). Impairment of understanding, disorientation and misidentification lead to associative recalls.…”

“…Impairment of understanding, disorientation and misidentification lead to associative recalls. Auditory and visual stimuli can cause associative recalls and delusional ideation without conscious perception (49). Dr Crammer is a psychiatrist who developed delirium due to renal failure.…”