International psychogeriatrics
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While all delirious patients have clouding of consciousness (alteration of attention) and cognitive dysfunction, the level of alertness of different patients may range from stuporous to hyperalert. We, therefore, developed an analog scale to rate the alertness of delirious patients, and a separate scale to rate the severity of their clouding of consciousness. Based on these scales, patients were categorized overall as relatively "activated" (relatively alert despite clouding of consciousness), or "somnolent" (relatively stuporous along with clouding of consciousness). ⋯ These data indicate that phenomenologic subtypes of delirium can be defined on the basis of level of alertness. These subtypes are validated in part by their differing associations with symptoms unrelated to alertness. These subtypes may have different pathophysiology, and thus, potentially different treatments.
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The development of the concept of delirium spans nearly 2,500 years. Its core clinical features were recognized at least as early as the 16th century, while its management reflected a humane approach from the beginning of the modern era. ⋯ These and other developments are discussed in this article. A list of proposed research priorities is included.
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Comparative Study
The concept of delirium in German-speaking psychiatry.