Delirium 182 awareness

The main disturbance in inhalant intoxication delirium is a reversible decrease in the level of consciousness and awareness of the environment, which includes an inability to focus, sustain, or shift attention. The intoxicated person is confused and easily distracted by irrelevant stimuli and difficult to engage in a meaningful conversation. He or she may also exhibit prominent disorientation, short- and long-term memory deficits, language disturbances, and perceptual disturbances that may include illusions and hallucinations. Other prominent features associated with inhalant intoxication delirium are... 

It is important to be aware of possible adverse drug withdrawal events (ADWE). These events may be caused by physiological withdrawal reaction, but it is also possible that the underlying disease is worsened. An example of ADWE is delirium or seizures that may occur after abrupt discontinuing of benzodiazepines or alcohol. 

Comment Blake is now fully delirious and will continue to be out of touch with reality for many hours, although brief moments of lucidity do occur from time to time. This is a characteristic feature of delirium - variability and occasional awareness of the environment, sometimes with surprisingly appropriate comments or behavior followed by a prompt lapse into total disorientation. As opposed to the normal awake state, in which thoughts and inner stimuli are sometimes distracting, in delirium, the opposite is the case the inner world (although confused) is sometimes invaded by the outer world. 

Comment After approximately 72 hours with little sleep, Burns is now intermittently in contact with his surroundings. He will spend much of the next 24 hours alternating between periods of sleep and semi-oriented wakefulness. Some episodes of delirium will continue, followed by a rapid return of awareness and improvement on his Number Facility and Speed of Closure scores, as well as his ability to conceptualize and draw a normal picture of a man. Incapacitation was longer in this case than in most, by at least 24 hours. A graphical illustration of his time course appears at the end of this chapter. 

Delirium is characterised by a reduction (clouding) in the level of conscious awareness, manifested as disorientation in time and space, or both. Fluctua-... 

Scopolamine and other antimuscarinic drugs produce delirium with fluctuating levels of awareness, disorientation, marked difficulty in thinking, marked loss of memory, and bizarre delusions. Most subjects, at least under experimental conditions, find these drugs to be unpleasant and have little desire to repeat the experience. 

Although diazepam does not have anticholinergic properties, it is possible to reverse diazepam-induced delirium by the use of cholinesterase inhibitors, such as physostig-mine however, physostigmine can on occasion induce severe arterial hypertension, especially if the dose exceeds 2 mg intravenously. In healthy volunteers sedated with diazepam, an increase in awareness was established with the use of physostigmine, but there was also a reduction in ventilatory drive (SEDA-10, 119). 

Delirium A state of altered consciousness characterized by occurrence of hallucinations, emotional instability, altered awareness of surroundings and sensory disturbances. Follows any serious chemical or physical injury to brain. 

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