Confusion and Confusional States

The concept of confusion was originally developed in France (confusion mentale) and later in Germany (Verwirrtheit) in the nineteenth century (Berrios, 1981).

It is purely a descriptive word and does not only apply to clouding of consciousness Opens in new window.

Confusion occurs with impairment of consciousness Opens in new window in acute organic states and with disruption of thought processes due to brain damage in chronic organic states, but it is also seen in non-organic disturbance.

The confusion may be acute or chronic. Delirium Opens in new window is a state of acute mental confusion in which the activity of the brain is affected by fever, drugs, poisons or injury.

Chronic confusional states may be the product of long-term use of anxiolytics, dementia Opens in new window or some other organic disorder. Confusion of thinking, then, may occur as part of the picture in functional psychoses and also in association with powerful emotion in neurotic disorders.

Confusion of thinking can be described as occurring either when the individual describes his own thinking as being confused or when the external observer considers that the thought processes are disturbed and confused.

Organic confusion represents the mildest level of impairment. Responses to stimuli, including verbal stimuli, are slower than usual, and questions of any complexity may provoke signs of perplexity and irritation.

• Spontaneous speech may be rambling and pointless.
• Attention is no longer flexible, with the patient showing either distractibility (the inability to maintain attention in the face of multiple stimuli) or fixation on a single subject from which he cannot be distracted.
• Sensorimotor coordination is somewhat impaired so that gait is unsteady and speech is slightly slurred.

• Orientation, particularly for time, may be impaired, with the patient unable to correctly state the time of day or month. It should be noted that orientation, while usually described as a sensorial function, also involves memory operations.
• Memory and intellectual performance are also usually impaired in the organically confused patient and serve as confirmatory evidence of the nature of the problem.

The deficit of consciousness-sensorium itself, however, is most often the key to identifying the organic element in mild states of erratic behavior, because testing memory and intelligence depends more upon the frequently unavailable cooperation of the patient.