Altered mental status history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]

Patient in an altered mental status may not be able to provide history. Collateral information from relatives, and out patient care providers must be attempted. As altered mental status has very diverse etiology, careful history can prover an essential tool for focused physical examination and investigations of the patient.

Following are a few clues to illicit relevant history.

• Onset, duration and progression of current illness and altered mental status.
• History of intoxication e.g. recreational drugs, alcohol.
• Environmental exposure to toxins.
• Fever
• Visual changes, seizures, syncope, changes in gait or speech
• Chest pain, palpitation, perspiration
• Nausea, vomiting, changes in bowel bladder habbits
• Changes in sleep awake cycle.
• Recent change in medication, anticoagulants, hypoglycemic agents, anticholinergic medications, sedatives and prescription pain medications and past history of overdosing.

• Past episodes of similar illness
• Past history of other illness like, chronic conditions e.g. HIV, stroke, seizures or CNS disorders, neurosurgery, psychiatric illness etc.

• Conditions causing altered mental status, seizures, psychiatric disorders, endocrine disturbances

• Living conditions and ADLs
• Access to care
• History of sexual practices
• Drug abuse^[1]

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