![]() Barbara Schildkrout, MD, a board-certified psychiatrist and clinical instructor in psychiatry at the Harvard Medical School described her subjective experience of clouding of consciousness, or what she also called "mental fog", after taking a single dose of chlorpheniramine an antihistamine for her allergy to cottonwood while on a cross-country road trip. ![]() Affected individuals compare their overall experience to that of a dream because as in a dream consciousness, attention, orientation to time and place, perceptions, and awareness are disturbed. Others may describe a "spaced out" feeling. One patient described it as "I thought it became like misty, in some way. The affected person experiences a subjective sensation of mental clouding described in the patient's own words as feeling " foggy". One is a stage on the way to coma, the other on the way to sleep which is very different. ![]() Lipowski points out that decreased "wakefulness" as used here is not exactly synonymous with drowsiness. Paradoxically, affected individuals say that they are "awake but, in another way, not". Patients may be awake (not sleepy) yet still have a clouded consciousness (disorder of wakefulness). It is not necessarily accompanied by drowsiness, however. This system of a sort of general activation of consciousness is referred to as "arousal" or "wakefulness". Various etiologies disturb this regulating part of the brain, which in turn disturbs the "overall level" of consciousness. The conceptual model of clouding of consciousness is that of a part of the brain regulating the "overall level" of the consciousness part of the brain, which is responsible for awareness of oneself and of the environment. The DSM-IV-TR instructs clinicians to code subsyndromal delirium presentations under the miscellaneous category of " cognitive disorder not otherwise specified". In clinical practice, there is no standard test that is exclusive and specific therefore, the diagnosis depends on the subjective impression of the physician. the general population but still more independence than full delirium. Among intensive care unit patients, subsyndromal subjects were as likely to survive as patients with a Delirium Screening Checklist score of 0, but required extended care at rates greater than 0-scoring patients (although lower rates than those with full delirium) or have a decreased post-discharge level of functional independence vs. ![]() The full clinical manifestations of delirium may never be reached. The significant clinical features of subsyndromal delirium are inattention, thought process abnormalities, comprehension abnormalities, and language abnormalities. Subsyndromal delirium differs from normal delirium by being overall less severe, lacking acuteness in onset and duration, having a relatively stable sleep-wake cycle, and having relatively stable motor alterations. Clouding of consciousness may be synonymous with subsyndromal delirium. Clouding of consciousness may be less severe than delirium on a spectrum of abnormal consciousness. However, the DSM-III-R and the DSM-IV replaced "clouding of consciousness" with "disturbance of consciousness" to make it easier to operationalize, but it is still fundamentally the same thing. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has historically used the term in its definition of delirium. The term clouding of consciousness has always denoted the main pathogenetic feature of delirium since physician Georg Greiner pioneered the term ( Verdunkelung des Bewusstseins) in 1817. People describe this subjective sensation as their mind being " foggy". They are not as aware of time or their surroundings and find it difficult to pay attention. Not to be confused with Brain fag or Mild cognitive impairment.Ĭlouding of consciousness, also called brain fog or mental fog, occurs when a person is slightly less wakeful or aware than normal.
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