Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Semin Neurol. 2024 Dec;44(6):606-620. doi: 10.1055/s-0044-1791226. Epub 2024 Oct 3.
Consultation liaison psychiatrists are frequently asked to evaluate patients with altered mental status (AMS). Psychiatrists have unique perspectives and approaches to care for confused patients, particularly optimizing facilitation of care and maintaining vigilance for diagnostic overshadowing. Psychiatrists also offer expertise in primary psychiatric illnesses that can overlap with AMS, and the most common etiology of AMS is delirium. In this article, we provide a consultation liaison psychiatrist perspective on AMS and related psychiatric conditions in addition to delirium. Manic and psychotic episodes have primary and secondary etiologies, with some symptoms that can overlap with delirium. Catatonia, neuroleptic malignant syndrome, and serotonin syndrome are potentially fatal emergencies, and require prompt index of suspicion to optimize clinical outcomes. Trauma sequelae, functional neurologic disorders, and dissociative disorders can present as puzzling cases that require psychiatric facilitation of care. Additionally, AMS is sometimes due to substance intoxication and withdrawal in the hospital. A nonstigmatizing approach to evaluation and management of delirium and AMS can ensure optimal patient care experiences and outcomes.
会诊联络精神科医生经常被要求评估出现精神状态改变（AMS）的患者。精神科医生对治疗困惑患者有独特的视角和方法，特别是优化护理促进，并保持警惕诊断掩盖。精神科医生还提供与 AMS 重叠的原发性精神疾病的专业知识，AMS 的最常见病因是谵妄。在本文中，我们提供了会诊联络精神科医生对 AMS 及相关精神疾病的看法，除了谵妄。躁狂和精神病发作有原发性和继发性病因，一些症状与谵妄重叠。紧张症、恶性神经阻滞剂综合征和血清素综合征是潜在的致命紧急情况，需要迅速怀疑指数，以优化临床结果。创伤后遗症、功能性神经障碍和分离性障碍可能表现为棘手的病例，需要精神科的护理促进。此外，AMS 有时是由于医院内的物质中毒和戒断。对谵妄和 AMS 的评估和管理采取非污名化的方法可以确保最佳的患者护理体验和结果。
