In my opinion, there is no difference between patients with altered mental status and psychiatric patients. Psychiatrists do not have the interest or the ability to carefully work up these patients for physical problems and physical treatments. Psychiatric patients who are hospitalized, for days, weeks or months undergo NO medical investigations. What a waste! This might be the reason why psychiatrists say the medical causes of psychiatric illness have not been found; they have not used the many modern tests available in physical medicine to figure out the problem. Psychiatrists assume that the cause of the syndrome is behavioural.

Psychiatrists do not obtain a paediatric or adult medical history from their patients or from people close to the patients.

Psychiatrists do not get the vital signs of their patients; respiratory rate, blood pressure, heart rate , body temperature.

Psychiatrists do not screen their patients for mental disability.

Psychiatrists do not get their occupational therapists to assess Activities of Daily Living, even though all occupational therapists receive this training in school.

It seems that psychiatry is completely disconnected from the field of physical medicine and this is a shame.

The symptoms of altered mental status are the same as the symptoms of so called mental illness.

The workup for altered mental status is huge; there are many possible issues to look into;

Altered Mental Status: Symptoms & Signs

• Medical Author: Melissa Conrad Stöppler, MD

Medically Reviewed on 9/10/2019 https://www.medicinenet.com/altered_mental_status/symptoms.htm

An alteration in mental status refers to general changes in brain function, such as confusion,  amnesia (memory loss), loss of alertness, disorientation (not cognizant of self, time, or place), defects in judgment or thought, unusual or strange behavior, poor regulation of emotions, and disruptions in perception, psychomotor skills, and behavior. While an altered mental status is obviously characteristic of a number of psychiatric and emotional conditions, medical conditions and injuries that cause damage to the brain, including alcohol or drug overdose and withdrawal syndromes, can also cause mental status changes. Confusion, lethargy, delirium, dementia, encephalopathy, and organic brain syndrome are all terms that have been used to refer to conditions hallmarked by mental status changes.

Other causes of altered mental status

• Brain Infections/Abscesses
• Decompression Sickness
• Drug Overdose
• High Altitude Cerebral Edema
• Infection of the Brain or CNS
• Korsakoff Syndrome
• Lipid Storage Diseases
• Liver Failure
• Medications
• Poisoning
• Respiratory Failure
• Severe Hemorrhage
• Thyroid Storm
• Toxins
• Vascular Dementia
• Wernicke Syndrome
• Wilson Disease
• Withdrawal From Drug or Alcohol Dependence

While the patient is in the psychiatric ward, the nurses and the doctors have a fantastic opportunity to get a paediatric/adult medical history. This, plus the patient’s behaviour [lethargic, confused, anxious, quiet, agitated, excited, combative, etc…] will help narrow down the possible diagnosis. Simple tracking of breathing rates, blood pressure, heart rate, body temperature, body condition, appetite, signs of vasoconstriction or vasodilation, etc..all this will also narrow down the diagnosis.

I do not know why psychiatrists are not seriously treating mental illness as altered mental status.

I do not know why they are wasting everyone’s time doing things that mostly do not work.

They went to medical school. They know how to be doctors. Yet they use none of the modern tools to figure out what is causing altered mental status in these patients.

Why?

to be continued….