59 Conversely, with delirium following drug withdrawal, the EEG may show fast activity Many of the typical differentiating features among psychosis, drug withdrawal, and delirium have been elaborated on by Lipowski.3,60-62 Some investigators have reported intermittent

bursts of bitemporal sharp activity on EEG in patients with rapid mood swings, psychotic episodes, depression, rage attacks, and Alectinib price suicide attempts,63 as well as in bipolar disorders and rapid mood cycling.64 Problems of differentiating delirium and seizures can stem from the paroxysmal nature of the altered mental status and behavior that can occur with Inhibitors,research,lifescience,medical delirium, which may be mistaken for the confusion and agitation of complex partial seizures, postictal states of confusion, or even NCSE. A frequent presentation of delirium is in the elderly patient in the postoperative period, who appears feverish, agitated with sleep-wake cycle inversions, hallucinosis, and confusion. Here, there can be interplay of multiple organ system Impairments Inhibitors,research,lifescience,medical or failures, including renal, hepatic, cardiac, respiratory, or

endocrine.65-69 Even when correctly Identified, delirium may carry a high morbidity and mortality, but when misidentified as psychosis, seizure, or attributed to a dementing process, there may be inappropriate management. An agitated, confused, and uncooperative patient presents major management, and diagnostic Inhibitors,research,lifescience,medical dilemmas to nursing and medical staff. Seizures and delirium It may be often difficult to differentiate ictal from a delirious cause of agitation and altered mental status, particularly in psychiatric patients who are prone to both seizures and delirium, Inhibitors,research,lifescience,medical let alone psychosis.70-77 An early delineation of a personality type, the so-called “temporal lobe personality,”78,79 underlies the concept of temporal-llmbic abnormality that may lead to either psychosis or epilepsy80 The older literature

describes an “epileptic delirium,” which is characterized Inhibitors,research,lifescience,medical by hallucinations and delusions, a diminished level of consciousness, and a confusional state.75 in the patient who may be delusional, agitated, or hypermanic, Landoldt described epileptiform discharges on the EEG with alternating dysphoria and psychosis.81 Directed violence in the context of an epileptic “delirium” has been used as an “epilepsy defense” in patients accused of violent crimes, but a study by Treiman revealed little evidence of increased MycoClean Mycoplasma Removal Kit violence among people with epilepsy compared with the general population.82 Violent behavior in this setting Is usually of a “resistive” character with the confused patient trying to break away from physical restraint. Among the different seizure types that may present with confusional states, those of complex partial seizures, whether repeated or prolonged, can result in marked agitation, at times with hypomania, hallucinations, illusions, and religiosity.