The Demented or Delirious Patient

Demented patients have lost previously acquired intellectual function, most typically memory. Delirious patients have a disorder of consciousness that does not allow them to interact correctly with the surroundings. Demented patients frequently become more confused when taken out of their normal environment, especially at night. The term sundowning is used in such circumstances. Fear is common in both types of patients. In interviewing these patients, clinicians must try to be sensitive to their emotions as much as possible, and above all, try to allay their fears. Interviewers must be particularly aware of questions that may be possibly threatening to the patient.

Patients with an organic mental syndrome present a special problem. At times, these patients seem lucid;at other times, they are disoriented with regard to person, place, or time. If the patient is able to answer some of the questions, the interviewer should record the answers. The same questions should be asked again later to determine whether the patient will respond similarly. These patients have defects in attention span, memory, and abstract thought. Interviewers should be alert to inconsistent and slow, hesitant responses. On occasion, patients may interject some humor to try to cover up for their difficulty in memory. A careful mental status examination indicates the problem. It maybe useful to remind the patient of your name and tell him or her that you will ask for the name in a few minutes. Frequently, such patients have forgotten it. Furthermore, the histories these patients give may not be reliable.

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