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PubMed1985

Stimulus parameters governing confusion effects in forward masking.

In forward masking, performance may be affected by confusion, that is, by the difficulty of discriminating a suprathreshold signal from the preceding masker. This study investigated confusion effects for forward maskers composed of repeated bursts of a 100-Hz sinusoid followed by sinusoidal signals; such "pulsing" maskers produce confusion when the properties of the signal are identical to those of an individual masker "pulse." The level, frequency, and duration of the signal relative to an individual masker pulse, as well as offset-onset delay, were varied to determine the minimum change necessary to eliminate confusion. For maskers composed of 20-ms pulses, confusion was eliminated by changes in signal level of 5 dB or changes in signal frequency of 30 to 40 Hz. For maskers composed of 10-, 20-, or 40-ms pulses, confusion was eliminated by signal delays of 8 to 16 ms or by signal durations less than half or greater than twice the masker-pulse duration. Results with adaptive procedures designed to measure confusion-free or confusion-determined thresholds suggest that confusion effects can be minimized or avoided by extensive listener training with a procedure in which the signal and masker are not presented at similar intensities.

Acoustic Stimulation↗
PubMed2006

Protracted ictal confusion in elderly patients.

BACKGROUND: Ictal confusion, particularly if protracted, often presents a diagnostic challenge. OBJECTIVES: To define protracted ictal confusion in elderly patients and to characterize its features and outcome. DESIGN: Case series. SETTING: Neurology outpatient and emergency departments at 2 tertiary care centers. PATIENTS: Consecutive series of 22 ambulatory patients with acute ictal confusion. MAIN OUTCOME MEASURES: Duration of ictal confusion was correlated with age and lesions noted on cerebral images and videoelectroencephalographic studies. RESULTS: The ictal basis underlying confusion was not recognized for up to 5 days in 22 patients (mean +/- SD age, 70 +/- 8.5 years). Twenty patients had partial complex status epilepticus, and 2 patients had newly diagnosed primary generalized status epilepticus. Motor movements were not present in either group, although reduced mood states and ictal neglect were noted in some patients. Fifteen patients had previous episodes (2-10) of protracted ictal confusion. Once identified, treatment reversed confusion, and eventually patients were discharged to home, although a few patients sustained persistent reduction in baseline cognition. CONCLUSIONS: Protracted ictal confusion is often not considered in the ambulatory elderly patient, with resulting delay in diagnosis. Electroencephalographic and videoelectroencephalographic studies performed while the patient is experiencing symptoms are crucial to early diagnosis and timely management.

Age Factors↗
PubMed2006

Inferential confusion and obsessive beliefs in obsessive-compulsive disorder.

The goal of the present study was to investigate whether inferential confusion could account for the relationships between obsessional beliefs and obsessive-compulsive disorder (OCD). The Inferential Confusion Questionnaire and the Obsessive Beliefs Questionnaire were administered to a sample of 85 participants diagnosed with OCD. Results showed that the relationship between obsessive beliefs and obsessive-compulsive symptoms decreased considerably when controlling for inferential confusion. Conversely, the relationship between inferential confusion and obsessive-compulsive symptoms was not substantially affected when controlling for obsessive beliefs. Since inferential confusion has an overlap with overestimation of threat, a competing hypothesis for the results was investigated. Results indicated that inferential confusion was factorially distinct from overestimation of threat, and that the independent construct of inferential confusion remains significantly related to obsessive-compulsive symptoms when controlling for anxious mood. These results are consistent with the claim that inferential confusion may be a more critical factor in accounting for OCD symptoms than are obsessive beliefs and appraisals.

Adolescent↗
PubMed2002

Four acute confusion assessment instruments: reliability and validity for use in long-term care facilities.

Frail older adults in long-term care (LTC) facilities are at high risk for acute confusion. This study evaluated the reliability and validity of four acute confusion instruments for use in LTC: the Clinical Assessment of Confusion-A (CAC-A), the Clinical Assessment of Confusion-B (CAC-B), the NEECHAM Confusion Scale (NEECHAM), and the Visual Analog Scale for Acute Confusion (VASAC). Seventy-four residents from two LTC facilities were evaluated for acute confusion using the four instruments as well as the Mini-Mental Status Examination (MMSE), the Geriatric Depression Scale (GDS), and Diagnostic and Statistical Manual for Mental Disorders (DSM IV) criteria for delirium. Coefficient alphas were .82 for the CAC-A, .86 for the CAC-B, and .80 for the NEECHAM. Interrater reliability on 30 paired evaluations was .90 for the CAC-B, .87 for the NEECHAM, and .80 for the VAS-AC. All instruments were correlated with the MMSE and the DSM IV criteria for delirium at the p < .001 level. Predictive validity was supported for the CAC-B, the NEECHAM, and the VAS-AC. Discriminant validity using the GDS was supported for the VAS-AC. Construct validity using confirmatory factor analysis was supported for the NEECHAM, with a two-factor structure. Based on this study, the VAS-AC is recommended for use as a general screening instrument and when it is positive for acute confusion, the NEECHAM should be used for a more indepth assessment.

Acute Disease↗
PubMed1998

Acute confusion among hospitalized elders in a rural hospital.

The NEECHAM Confusion Scale was used to study the incidence and severity of acute confusion among elders in a rural community hospital. Thirty-eight patients over the age of 64 were assessed for confusion within 48 hours of admission. The NEECHAM Confusion Scale was readministered to a sub-sample of 17 elders within 24 hours of pending discharge. The incidence of acute confusion was 81.5% at admission with a prevalence of 52.9% at discharge. Staff identified signs of acute confusion in 34.2% of the elders confused upon admission as indicated by the NEECHAM Confusion Scale. These findings have major implications for adult health nursing practice.

Acute Disease↗
PubMed2007

Acute confusion in patients with systemic cancer.

OBJECTIVE: To determine the incidence, the causes and the prognostic value for survival of acute confusion (delirium) in patients admitted to a general cancer hospital. PATIENTS: Hundred consecutive patients with confusion were examined; 78 had a metastatic disease, 11 had local tumor and 11 had no sign of tumor recurrence at admission. Patients with confusion represented 11.8% (95%CI: 9.7-14.2%) of admissions. Follow-up period lasted 18 months from the inclusion of the last patient. RESULTS: Structural brain lesions (SBL) were mostly metastatic and caused confusion in 36 patients. 57 patients had a toxic or metabolic encephalopathy (TME). The cause remained unexplained in 6 cases, and in one patient the final diagnosis was psychotic state. Most patients with TME had more than one abnormality which could cause confusion. Confusion was reversible in 34 patients, and the odds for its regression was 3-fold higher in patients with TME (P = 0.02). Survival was significantly shorter (P = 0.02) in patients with SBL (median: 3 weeks) than in patients with TME (median: 8 weeks). However, the survival was significantly longer (P = 0.007) in patients with only one toxic or metabolic disorder (median: 20.5 weeks) than in patients with multiple changes (median: 5 weeks). CONCLUSION: Confusion is common in general cancer population. TME is the leading etiology and it is due to multiple causes in most patients. SBL causes confusion in one third of the patients. Patients with TME have a greater chance to recover, and survive longer especially if they have only one toxic or metabolic change.

Adult↗
PubMed2001

Theoretical study of stability, structures, and aromaticity of multiply N-confused porphyrins.

The total electronic energy and nucleus-independent chemical shift (NICS) of 95 isomers of N-confused porphyrin (NCP: normal porphyrin (N(0)CP), singly N-confused porphyrin (N(1)CP), doubly N-confused porphyrin (N(2)CP), triply N-confused porphyrin (N(3)CP), and fully N-confused porphyrin (N(4)CP)) have been calculated by the density functional theory (DFT) method. The stability of NCP decreased by increasing the number of confused pyrrole rings. Namely, the relative energies of the most stable isomers in each confusion level increased in a stepwise manner approximately by +18 kcal/mol: 0 (N(0)CP1), +17.147 (N(1)CP2), +37.461 (N(2)CPb3), +54.031 (N(3)CPd6), and +65.636 kcal/mol (N(4)CPc8). In this order, the mean plane deviation of these isomers increased from 0.000 to 0.123, 0.170, 0.215, and 0.251 A, respectively. The unusual tautomeric forms of pyrrole ring with an sp(3)-carbon were found in the stable forms of N(3)CP and N(4)CP. The NICS values at the mean position of the 24 core atoms were nearly the same for the most aromatic isomers regardless of the confusion level: -15.1280 (N(0)CP1), -13.8493 (N(1)CP2), -13.7267 (N(2)CPd1), -11.7723 (N(3)CPb5), and -13.6224 ppm (N(4)CPa6). The positive correlation between aromaticity and stability was inferred from the plots of NICS and the relative energy of NCP for N(0)CP, N(1)CP, and trans-N(2)CP. On the other hand, the correlation was negative for cis-N(2)CP, N(3)CP, and N(4)CP isomers.

Journal Article↗
PubMed2000

Confusion and aggression in restrained elderly persons undergoing hip repair surgery.

The purpose of this pilot study was to observe and describe the behaviors of confusion and aggression in physically restrained elderly hospitalized persons following hip repair surgery. Five elderly persons who were 75-95 years of age and physically restrained following hip repair surgery comprised the sample of this descriptive study. Descriptive data including age, sex, medical diagnosis, current medications, serum electrolyte and arterial blood gas results, date/time of hip fracture, subsequent surgical repair, and restraint application were obtained from the medical record. Observations of behaviors associated with confusion and aggression were conducted at six separate observation times lasting approximately 20 to 30 minutes each. The observation periods were divided into two mornings, two afternoons, and two evening sessions. These behaviors were assessed by utilizing a combined observational tool developed by the researcher, and was created from the Clinical Assessment of Confusion--A, by Vermeersch, and Ryden Aggression Scale. After data analysis, three patterns of confusion emerged. These were the major pattern of confusion, the minor pattern of confusion, and pattern of confusion relative to time. All patients experienced low serum sodium levels immediately prior to the application of physical restraints. Based on the results of the pilot study, further investigation is needed.

Aged↗
PubMed2003

Postoperative confusion assessed with the Short Portable Mental Status Questionnaire.

BACKGROUND: Confusion is a common occurrence after cardiac surgery. However, there is great variability in the reported incidence of confusion in patients following cardiac surgery, mainly due to the diagnostic methods and instruments employed in assessing confusion. METHODS: Forty-eight cardiac surgery patients were assessed for postoperative confusion by a non-structured physician interview, and by the short portable mental status questionnaire (SPMSQ) administered by a medical student. RESULTS: The non-structured ward interviews detected confusion in one of the 48 patients (2%), whereas the SPMSQ diagnosed confusion in 15 of the 48 patients (31%). CONCLUSION: Unlike a subjective ward interview, the SPMSQ is a brief and objective diagnostic tool that can be used to measure accurately both the presence and severity of confusion in postoperative cardiac surgery patients.

Adult↗
PubMed1996

Disorientation in amnesia. A confusion of memory traces.

Disorientation is a common phenomenon in delirium and amnesia. It is thought to have an obvious explanation, i.e. disoriented patients fail to store the information crucial for the maintenance of orientation. In this study, we explored whether disorientation was indeed associated with a failure to learn new information or rather with a confusion of information within memory. Twenty-one patients with severe amnesia were examined. Orientation was tested with a 20-item questionnaire. Two runs of a continuous recognition task were used to test the ability to acquire information (first run of the task) and the tendency to confuse the temporal context of information acquisition (comparison of the second with the first run). We found that orientation was much better predicted by the measure of temporal context confusion (r = 0.90) than by the ability to simply acquire information (r = 0.54). Superimposition of neuroradiological scans demonstrated that increased temporal context confusion was associated with medial orbitofrontal or basal forebrain damage; patients with normal levels of temporal context confusion did not have damage to these areas. We conclude that disorientation more often indicates a confusion of memory traces from different events, i.e. increased temporal context confusion, than an inability to learn new information. Disorientation appears to reflect primarily a failure of the orbitofrontal contribution to memory.

Adult↗
PubMed1989

Acute confusion in elderly medical patients.

The acute confusional state (delirium) is a common presentation for a wide variety of medical conditions in the elderly. This paper reports a prospective study of acute confusion in elderly people admitted to general medical services in two acute care hospitals in Edmonton, Alberta. Eighty patients were studied, ranging in age from 65-91. Acute confusion was seen in one-fourth of these patients, who tended to be older, more ill, more likely to have chronic cognitive impairment and a higher mortality rate. In patients admitted with confusion, infection and congestive heart failure predominated. In those who developed confusion after hospitalization, iatrogenic disease was more common. Confusion was a sensitive sign of physical illness, and its resolution accompanied recovery. A diagnosis of the cause of the confusion state could be made in 22 of 24 cases. These findings support the aggressive investigation and treatment of acute confusion in the elderly.

Aged↗
PubMed2002

Schizophrenic patients who develop postoperative confusion have an increased norepinephrine and cortisol response to surgery.

The purpose of this study was to investigate the relationship between postoperative confusion and the plasma norepinephrine (NE), adrenocorticotropin (ACTH) or cortisol response to surgery in schizophrenic patients. We studied 50 schizophrenic patients and 35 control patients who underwent orthopedic surgery and perioperatively measured plasma NE, ACTH and cortisol levels. Postoperative confusion during 72 h after the end of the operation occurred in 14 of 50 schizophrenic patients (28%) and in 2 of 35 control patients (6%). Plasma NE levels 15 min after skin incision, the next day, the second day and the third day after operation in schizophrenic patients with postoperative confusion (668.0 +/- 59.2, 522.0 +/- 96.5, 463.2 +/- 71.2 and 398.9 +/- 56.2 pg/ml, respectively) were significantly higher than those in schizophrenic patients without confusion (524.1 +/- 62.6, 342.4 +/- 38.6, 311.2 +/- 58.3 and 314.1 +/- 77.1 pg/ml, respectively). Plasma cortisol levels 15 min after the skin incision and the next and second days after operation in schizophrenic patients with postoperative confusion (23.6 +/- 3.2, 21.1 +/- 4.3 and 19.9 +/- 4.4 microg/dl, respectively) were significantly higher than those in schizophrenic patients without confusion (15.2 +/- 4.5, 14.3 +/- 5.1 and 13.8 +/- 3.8 microg/dl, respectively). In conclusion, the occurrence of postoperative confusion in schizophrenic patients is associated with an increase in plasma norepinephrine and cortisol levels during and after surgery.

Adrenocorticotropic Hormone↗
PubMed2004

Postoperative confusion increases in elderly long-term benzodiazepine users.

We investigated the relationship between postoperative confusion and duration of benzodiazepine exposure, preoperative anxiety, depressive state, and cognitive function in elderly patients regularly taking benzodiazepines. We studied 328 patients ranging in age from 65 to 80 yr who underwent orthopedic surgery. Information on benzodiazepine use was obtained by face-to-face interview and visual assessment of the patient's medicine chest. Postoperative confusion was assessed by using a confusion-assessment method. The patients were divided into two groups: those who regularly took benzodiazepines and those who did not. Fifty-seven (17%) of 328 patients were treated with benzodiazepines. There were no significant differences in preoperative Mini-Mental State (MMS) scores, anxiety scores, or depression scores between benzodiazepine users and nonusers. Postoperative confusion occurred in 15 (26%) of 57 benzodiazepine users and in 34 (13%) of 271 nonusers (P < 0.01). The patients who had a score <23 on the MMS were 5 (9%) of 57 benzodiazepine users and 8 (3%) of 271 nonusers (P < 0.05). Postoperative confusion occurred in 13 (35%) of 37 long-term benzodiazepine users (daily use for >1 yr) and in 2 (10%) of 20 short-term users (daily use for <1 yr). The incidence of postoperative confusion was significantly more frequent in long-term than in short-term benzodiazepine users or nonusers of benzodiazepines. The patients who developed a score <23 on the MMS were 5 (14%) of 37 long-term benzodiazepine users and 0 (0%) of 20 short-term benzodiazepine users. In conclusion, the incidence of postoperative confusion was significantly more frequent in long-term benzodiazepine users.

Aged↗
PubMed2002

Psychoanalytic peregrinations. III: Confusion of tongues, psychoanalyst as translator.

A variety of problems cause a confusion of tongues between the psychoanalyst and the patient. In this sense the psychoanalyst faces the same problems as the translator of a text from one language to another. Examples are given of confusion due cultural differences, confusion due translation differences among translators, confusion due translator prejudice or ignorance, confusion due ambiguous visual cues and images, and confusion due to an inherently ambiguous text. It is due to this unavoidable confusion that the humanistic sciences cannot in principle achieve the mathematical exactness of the natural sciences and should not be expected to do so or condemned because they do not.

Communication Barriers↗
PubMed1996

The confused patient: nurses' knowledge and interventions.

The purpose of this study was to identify nurses' knowledge and experience about confusion and its treatment. A random sample of hospital-based, medical-surgical registered nurses (N = 100) was surveyed about their contact with confused patients and their knowledge about confusion. The findings suggest that nurses have regular and frequent contact with confused patients, caring for approximately three such patients in a week. They believe they are knowledgeable about confusion, rating their own knowledge on average as 2.96 on a scale ranging from 0 to 4. Restraint is the major treatment used for confusion, with 84% of the nurses reporting that the last confused patient they cared for was restrained. The high incidence data for use of restraints raise questions about what is a necessary restraint and whether restraints are overused in hospital settings. More attention needs to be directed toward finding alternatives to the use of restraints in the acute care hospital.

Adult↗
PubMed1987

Postoperative confusion after anesthesia in elderly patients with femoral neck fractures.

Fifty-seven patients, all over the age of 64, with femoral neck fracture were randomized to receive epidural or halothane anesthesia to see if the anesthetic technique influenced the incidence of postoperative confusion. All patients were lucid on admission. Using the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III) as criteria for confusion, we found that 44% of the patients developed confusion that correlated closely to a history of mental depression (P less than 0.01) and to the use of drugs with anticholinergic effect (P less than 0.005). There was no difference in the incidence of confusion between the two anesthetic groups. In patients given halothane, however, early postoperative hypoxemia was associated with confusion (P less than 0.05). Patients with confusion had significantly more postoperative complications and almost four times longer hospitalization times. It is concluded that anticholinergic medication and a history of mental depression are predominant risk factors for development of postoperative confusion and in this respect are more important than the anesthetic technique.

Aged↗
PubMed1995

Nipple confusion: toward a formal definition.

The purposes of this article are to introduce a formal definition of nipple confusion and to propose various hypotheses concerning its cause. The term nipple confusion refers to an infant's difficulty in achieving the correct oral configuration, latching technique, and suckling pattern necessary for successful breast-feeding after bottle feeding or other exposure to an artificial nipple. Many early breast-feeding failures are attributed to nipple confusion, although scientific data are lacking to document its prevalence, the mechanisms involved, or various factors that predispose an infant to this phenomenon. Two classifications of nipple confusion are recommended to distinguish the impact of artificial nipples during the newborn period from their influence after breast-feeding is well established. Maternal and infant risk factors making an infant more susceptible to nipple confusion are discussed. Future studies are planned to help elucidate the nature of nipple confusion and identify the circumstances under which infants are most vulnerable to this phenomenon. Meanwhile, it would seem prudent for clinicians to identify newborns at risk for nipple confusion and to minimize the use of bottle feedings in such babies. Medically indicated supplements in the early days of life could be provided by alternative methods, such as cup, spoon, or dropper feeding, until breast-feeding can be established.

Bottle Feeding↗
PubMed2001

Inverted meso-aryl porphyrins with heteroatoms; characterization of thia, selena, and oxa N-confused porphyrins.

Synthesis and characterization of inverted porphyrins containing S, Se, and O are reported. A simple 3 + 1 MacDonald-type condensation using modified tripyrrane containing the N-confused ring and diols afforded various N-confused porphyrins 6a-f in 19-30% yield. The single-crystal X-ray structure of 6b shows a ruffled conformation with tilt angles of 21.11 degrees and 31.23 degrees for the N-confused ring and the adjacent pyrrole ring III, respectively, revealing its severe nonplanarity. Significant changes in C alpha-C beta, C beta-C beta, and C alpha-X bond lengths are observed in 6b relative to free thiophene and pyrrole, suggesting the altered delocalization pathway in the modified N-confused porphyrins. The two molecules in the unit cell show a cyclophane-type noncovalent dimer with a face to face orientation of two N-confused pyrrole rings as a result of the presence of weak N-H...N and C-H...N intermolecular hydrogen bonds involving pyrrole-NH, the N atom of the N-confused ring, and the C atom of the pyrrole ring. A detailed 1H and 13C NMR study by 1D and 2D methods allowed assignments of all the peaks in the free base and protonated forms. NMR studies reveal the presence of three different tautomeric forms in solution for 6c in CDCl3 at low temperature. UV-visible studies reveal absorption band shifts upon heteroatom substitution, and the magnitudes of these shifts are dependent on the nature of the heteroatom. In all cases both monoprotonated and diprotonated species have been identified, and on addition of acid, the first proton goes to the outer N2 atom of the N-confused ring.

Journal Article↗