Archive for 'Anti-Psychotics'
DELIRIUM: DIFFERENTIAL DIAGNOSIS-DEPRESSION
When physicians request psychiatric consultation for unrecognized delirium, they often think that depression is the problem. This is likely to occur with hypoactive-hypoalert delirium, because the patient is withdrawn, uncommunicative, expressionless, slow, and lacking in motivation. Although these phenomena suggest major depression and related conditions, other aspects of the case should indicate the correct diagnosis. Depressive disorders are unlikely to have a rapid onset during hospitalization for medical or surgical illness. Even when they do occur in such a setting (e.g., following cerebrovascular accidents or treatment with corticosteroids), depressive disorders are not characterized by a disturbance of consciousness, disorientation to time and place, a waxing and waning course, or diffuse slowing of the EEG. Another useful point in differential diagnosis is that delirious patients, even those with dysphoric moods, seldom report the diminished self-esteem, hopelessness, and suicidal thoughts that are expected in depressive disorders severe enough to cause psychomotor retardation, poverty of speech, and social withdrawal. Although patients who are demoralized by medical or surgical illness can become apathetic, mute, and uncooperative, they have no disturbance of consciousness or cognition; indeed, they realize all too well what is happening to them. If a demoralized patient refuses cognitive testing and the issue of «depression» versus hypoactive-hypoalert delirium remains, an EEG should resolve the differential diagnosis.*25\172\2*