Altered Mental Status Post Trauma

Introduction

Certain illnesses, chronic disorders, and injuries affect brain function, such as changes in consciousness, confusion, amnesia (memory loss), and symptoms that can affect many organ systems. Many of these symptoms are treatable and usually do not affect long-term well-being.

What Is Altered Mental Status (AMS)?

Altered Mental Status (AMS) is not a disease itself. It refers to general changes in mental functions, such as loss of consciousness and unusual behavior, that are caused due to chronic disorders, illness, or injury affecting the brain. It causes a change in awareness, movement, and behaviors. AMS can also be a result of emotional or psychiatric conditions.

What Are the Types of Altered Mental Status?

The types of altered mental status are described below-

1. Delirium:

It is a severe medical emergency. A person having delirium exhibits unusual behaviors, acts disoriented, is disturbed, etc. This type of altered mental status is reversible.

2. Dementia:

This progressive disorder leads to a decline in mental functions that affect daily life. It primarily affects older adults. A person may also lose awareness of their identity and surroundings later.

3. Psychosis:

It is caused due to a medical condition or medication in which a person loses touch with reality. It is a temporary condition. The person experiences disturbing thoughts, sounds, and sights that are not real.

What Are the Causes of AMS?

Mental decline is progressively seen as a natural course in people with dementia.

In the case of delirium and psychosis can be the suddenly altered mental status. These can be due to issues with nearly any organ system. Probable causes of these include-

Central nervous system issues:

• Brain Bleed: Bleeding between the brain tissue and skull or within the brain tissue. This can cause brain damage and can be a life-threatening condition. Some symptoms include headache, nausea, vomiting, sudden tingling, weakness, numbness, or paralysis of the face, arm, and leg.

• Brain Tumor: A brain tumor is an uncontrolled or abnormal growth of the cells in and around the brain. It can be malignant (cancerous) or benign (non-cancerous) and affects any age group.

• Hepatic Encephalopathy: It is a nervous system disorder that is caused by severe liver disease. If the liver does not work accurately, toxins start developing in the blood. These toxins can reach the brain and hinder brain functioning.

• Seizure: A seizure is a sudden brain burst or uncontrolled electrical activity. This causes changes in behavior, movements, feelings, and levels of consciousness.

• Stroke: Stroke is a condition that occurs when there is insufficient blood flow to the heart. It is an immediate medical condition that can be life-threatening.

Metabolic disorders:

• Dehydration: Dehydration is the loss of fluid from the body. It can cause severe conditions like dizziness, fatigue, and headache.

• Hypothermia: Hypothermia occurs after exposure to cold, wet, and windy conditions. Eventually, with continued exposure to cold, the body uses its stored energy, and the temperature begins to fall.

• Low blood oxygen levels (hypoxemia).
• Low blood sugar level (hypoglycemia).
• Low sodium levels in the blood (hyponatremia).
• Low calcium levels in the blood (hypocalcemia).
• Underactive thyroid (hypothyroidism).

Adverse reactions to prescription drugs:

• Antiseizure medications.
• Anticholinergic medication is a group of drugs that control involuntary muscle movements.
• Corticosteroids: These are the types of anti-inflammatory drugs.
• Sedatives: help people to relax.
• Sleeping Pills: They are used in treating cases of insomnia by making a person feel drowsy and relaxed.

Infections:

• Urinary tract infections.
• Encephalitis: Infection of the brain that is a serious medical condition.
• Meningitis: Infection of the meninges(outer covering of the brain which protects it from any shock or injury).
• Pneumonia: Lung inflammation or fluid accumulation caused due to bacterial or viral infection.

Some of the other causes include -

Cardiogenic or other types of shock, Traumatic brain injury, and overdose from opioids, alcohol, and other controlled substances.

What Are the Signs and Symptoms of Altered Mental Status?

The signs and symptoms associated with altered mental status can be categorized into a broad range. Some of them are as follows-

Change in cognitive function and awareness-

• Altered consciousness, which may include coma.

• Disorientation.

• Confusion.

• Forgetfulness.

• Hallucination.

• Delusion.

• Slow response to questions or to stimuli.

• Incoherent or nonsensical speech.

• Mood and mental health issues-

• Agitation and irritability.

• Anxiety.

• Depression.

• Emotional outburst.

• Euphoria is a feeling of extreme happiness.

• Unusual behavior.

• Avoiding interactions with people or social withdrawal.

• Some additional symptoms, such as respiratory, shortness of breath, fatigue, and hyperactivity, can be noticed.

How Is AMS Diagnosed?

AMS is diagnosed thoroughly according to the underlying cause. The patient's history is taken, and an initial medical examination is started.

• Checking for ABCs (Airway, Breathing, and Circulation).

• Neurological Deficits: Evaluating the level of consciousness and screening for neurological problems like paralysis on one side of the body.

• Exposure: Performing a head-to-toe physical examination to check for the signs of injury. As per the cause, some other tests are prescribed, such as

• X-rays.

• CT Scans (Computed Tomography).

• Urine tests.

• Blood tests.

• Blood sugar test.

How Is AMS Treated?

Altered mental status is treated based on its cause and type. Some of the treatment options available are-

• Antibiotics for infection.

• Change of medication for AMS due to prescription drug reactions.

• Glucagon injections for hypoglycemia.

• Intravenous fluid for dehydration.

• Naloxone for narcotic overdose.

• Rescue medications for seizures.

• Anxiolytics or antipsychotics.

• Surgery to remove hemorrhage or to relieve pressure on the brain.

• Supplemental oxygen for hypoxia.

Conclusion

This article gives details of AMS (Altered Medical Status), its causes, signs, symptoms, and treatment. AMS is a condition that results in an alteration of mental status and general changes in brain function, such as confusion, loss of memory, loss of alertness, poor regulation of emotions, etc. These are the characteristics of emotional and physiatrist issues, But they are also the result of chronic illness, injuries, and other long-term diseases. It shows various signs and symptoms, such as dementia, amnesia, loss of consciousness, unusual behavior, etc.

The treatment is possible as per the underlying cause. The patient usually requires hospitalization in severe cases, such as a stupor, delirium, coma, etc. Some of the medications that aid in the treatment are antibiotics, antipsychotics, Glucagon injections, etc. Surgery is recommended in case of hemorrhage.