confusion, agitation, irritability and fluctuates conscious

[Asclepius1]

A 60-year-old male executive with a history of angina pectoris and
depression had bypass surgery the previous day. His depression has
responded well to selective serotonin reuptake inhibitors (SSRIs)
and there is no history of psychosis in the past. He now presents
with confusion, agitation, irritability, and tries to remove his
IV lines. His level of consciousness fluctuates, and at times he
forgets who he is. He is given a neuroleptic drug, and appears
much improved. What is the most likely diagnosis?

A. Adjustment disorder
B. Delirium
C. Dementia
D. Exacerbation of depression with suicidal ideation and psychotic features
E. Schizophrenia

[Asclepius1]

I say he has delirium because of the fluctuaction in consciousness, along with irribility and agitation acutely. It is a medical emergency.

[quachtinh]

This person met the DSM IV criteria for delirium

* The patient has a reduced level of consciousness and difficulty focusing, shifting or sustaining attention.

* There has been a cognitive change (deficit of language, memory, orientation, perception) that a dementia cannot better explain.

* These symptoms develop rapidly (hours to days) and tend to vary during the day.

* History, physical examination or laboratory data suggest that a general medical condition has directly caused the condition.



It is important to compare to dementia:
* Level of consciousness is not reduced and attention is not shifting or no problem with focusing.... You might be fool thinking that the patient is normal but at the end your conclusion is "this person is full of crap"

* sysmptoms are progressively slow

[Asclepius1]

My answer is B. Delirium