9 Symptoms of Altered Mental Status (AMS): Causes & Treatments

Whispers of forgetful ramblings, vacant stares, and chilling shadows serve as mere glimpses into the unsettling realm of altered mental status (AMS). This captivating medical phenomenon has the power to entangle minds in confusion, conjure hallucinations, and inflict episodes of coma.

However, AMS does not present itself as a singular adversary. Rather, it adopts the guise of a chameleon, silently infiltrating various ailments such as infections, drug reactions, and neurological storms.

But fret not, for this article endeavors to shed light on this labyrinthine condition. We shall embark on a journey to decipher the cryptic messages embedded within altered thoughts, decode the hidden language of behavioral changes, and arm you with the tools to navigate this disconcerting terrain.

Whether personally grappling with AMS or observing its impact on a loved one, this expedition empowers you. So, delve into the intricate pathophysiology of altered mental status, where logical reasoning intertwines with delusion, and understanding blooms from the very heart of confusion.

What is an altered mental status?

Altered Mental Status (AMS) refers to a change in an individual’s cognitive functioning, behavior, or consciousness from their baseline or usual state. It is a broad term used to describe a spectrum of conditions that affect mental awareness, ranging from mild confusion to profound unconsciousness. 

People experiencing altered mental status may exhibit various symptoms, such as disorientation, agitation, lethargy, or difficulty in responding to stimuli.

AMS is not a specific diagnosis in itself but rather a symptom or sign of an underlying medical issue affecting the brain or other physiological systems. Identifying the cause of altered mental status is crucial for proper diagnosis and effective altered mental status treatment. 

The specific symptoms and severity of ‘what does altered mental status mean’ can vary depending on the underlying altered mental status causes.

What are the different types of altered mental statuses?

Altered mental status (AMS) can manifest in different ways, and there are several types that reflect various changes in cognitive function, behavior, or consciousness. Here are some common types of altered mental status:

1. Confusion

Confusion involves a state of mental disorientation where an individual may have difficulty understanding their surroundings, recognizing familiar people, or remembering basic information. They may exhibit impaired judgment and have trouble processing information.

2. Delirium

Delirium is characterized by acute and fluctuating changes in mental status. Individuals may experience hallucinations, extreme agitation, and an inability to focus or maintain attention. Delirium often has a rapid onset and can be reversible if the underlying cause is addressed.

3. Coma

Coma is a state of profound unconsciousness where an individual is unresponsive to stimuli, including pain. The eyes are typically closed, and there is an absence of purposeful movements. Coma can be caused by severe trauma, brain injury, or certain medical conditions.

4. Agitation

Agitation involves restlessness, heightened activity, and emotional distress. Individuals may exhibit increased motor activity, pacing, or fidgeting. Agitation can be challenging for both the affected person and those around them.

5. Stupor

A stupor is a state of near-unconsciousness where individuals are minimally responsive to stimuli. They may only respond to strong or painful stimuli and often display limited awareness of their surroundings.

Understanding the specific type of altered mental status is crucial for healthcare professionals to identify the underlying cause and implement appropriate interventions. It’s important to note that these categories are not mutually exclusive, and an individual may exhibit features of more than one type simultaneously.

These types of altered mental status can overlap or coexist, and the specific characteristics may vary depending on the underlying cause. For example, a person with a metabolic disorder may experience confusion, while someone with a severe psychiatric condition may exhibit agitation or stupor.

It’s important to note that the classification of altered mental status is not always clear-cut, and healthcare professionals often use a combination of clinical assessments, medical history, and diagnostic tests to identify the specific type and cause of AMS in an individual.

13 causes of altered mental status 

Altered mental status refers to a change in a person’s cognitive function, including changes in consciousness, alertness, orientation, or behavior. There are numerous potential reasons for altered mental status, and it is essential to consider a variety of factors when evaluating an individual. Some common causes include:

1. Infections, especially those affecting the central nervous system (such as meningitis), can lead to inflammation and swelling of the brain, causing altered mental status.

2. Metabolic disturbances, such as low sodium (hyponatremia) or high potassium (hyperkalemia), can disrupt the electrical signals in the brain. Glucose imbalances, as seen in diabetes or hypoglycemia, can also affect mental function.

3. Trauma to the head can result in direct injury to the brain or lead to bleeding within the skull, causing increased intracranial pressure and altered mental status.

4. Seizures can cause temporary alterations in consciousness, while strokes can damage specific brain areas, affecting cognitive function.

5. Mental health disorders can alter perception, mood, and thought processes, leading to changes in mental status. Acute episodes of psychosis, for example, can result in confusion and disorientation.

6. Substance abuse can directly impact brain function, leading to altered mental status.

Medical research also shows that withdrawal from certain substances can also cause symptoms ranging from anxiety to seizures.

7. Lack of oxygen, whether due to respiratory failure or cardiac arrest, can rapidly affect the brain, leading to confusion and unconsciousness.

8. Hormonal imbalances can affect brain function. For instance, severe hypothyroidism (underactive thyroid) can cause lethargy and cognitive impairment.

9. Heatstroke or Hypothermia can disrupt the body’s ability to regulate internal temperature. Studies show that heatstroke can lead to dehydration and organ dysfunction, including altered mental status.

10. Medication side effects, particularly those affecting the central nervous system, can cause drowsiness, confusion, or other cognitive impairments.

11. Electrolytes play a crucial role in nerve signaling. Abnormal electrolyte levels can disrupt the balance of electrical signals in the brain, affecting mental function.

12. Toxic ingestions of certain substances, such as drugs, chemicals, or poisonous plants, can lead to toxic effects on the central nervous system.

13. Severe dehydration can lead to reduced blood volume, compromising blood flow to the brain and causing confusion and lethargy.

9 symptoms of altered mental status

Altered mental status can manifest in various ways, and the symptoms may vary depending on the underlying cause. Here are nine general symptoms associated with altered mental status:

1. Confusion

Confusion is more than just momentary disorientation. It’s a significant reduction in cognitive abilities, including impaired decision-making and difficulty processing new information. Patients might seem perplexed by simple tasks or questions.

Confusion can be caused by a wide array of issues, such as neurological disorders like dementia, metabolic imbalances like hypoglycemia or electrolyte disturbances, infections like urinary tract infections (especially in the elderly), or even as a side effect of medication or drug intoxication.

2. Lethargy

Lethargy is a step beyond ordinary tiredness. Experts have identified that it is characterized by a profound lack of energy and an indifference to the environment.

A lethargic person might spend much of the time sleeping or in a state of near-sleep, showing little interest in physical activities or interactions. Causes can include severe systemic infections (sepsis), major organ failure, significant nutritional deficiencies, and certain endocrine disorders such as hypothyroidism.

3. Agitation or restlessness

The agitation symptom is marked by an inability to stay calm. Agitated individuals might be unable to sit still, may be irritable, and could have difficulty focusing. They might exhibit repetitive movements, verbal outbursts, or even aggressive behavior.

Causes range from psychological stressors and psychiatric conditions like bipolar disorder or severe depression to withdrawal from addictive substances (like alcohol or benzodiazepines), pain, or discomfort.

4. Unresponsiveness

Unresponsiveness is a severe and potentially life-threatening condition where the person does not react to verbal or physical stimuli. In extreme cases, this can progress to a coma.

The causes can be very serious, including major brain injuries, strokes, drug overdoses, or severe metabolic disturbances like diabetic ketoacidosis.

5. Inappropriate behavior

Inappropriate behavior involves behaviors that are markedly different from a person’s normal conduct. This might include inexplicable agitation, sexual disinhibition, or uncharacteristic aggression.

Causes can be diverse, including psychiatric disorders, frontal lobe damage due to a brain injury, or intoxication with substances that impair judgment and inhibition.

6. Memory impairment

Memory impairment involves difficulty recalling information. Short-term memory loss may manifest as forgetfulness about recent events, conversations, or instructions, as per experts. It can contribute to the overall confusion experienced by individuals with altered mental status.

While it’s common in aging populations as part of conditions like Alzheimer’s disease, memory impairment can also result from acute conditions like head injuries, strokes, or temporary effects of medications or intoxication.

7. Hallucinations

Hallucinations are a medical condition that involves perceiving sensory stimuli that are not present. This can include hearing voices, seeing things, or feeling sensations that others do not. Hallucinations can contribute to a distorted perception of reality.

Hallucinations are often associated with psychiatric illnesses like schizophrenia, but they can also result from high fever, sensory isolation, severe migraines, or the use of certain drugs like hallucinogens or even some prescription medications.

8. Difficulty speaking or slurred speech

Altered mental status can affect communication skills. Slurred speech or difficulty forming coherent sentences may be observed. This impairment in verbal expression can hinder effective communication.

It can be caused by neurological conditions affecting the speech centers of the brain (like after a stroke), muscle disorders affecting speech production, intoxication, or severe psychiatric conditions.

9. Altered level of consciousness

Changes in the level of consciousness indicate variations in awareness and wakefulness. This can range from mild drowsiness and reduced alertness to more severe states, such as stupor or unconsciousness.

It can be caused by brain injuries, drug intoxication or overdose, metabolic disorders like liver or kidney failure, severe infections, or major cardiovascular events like a heart attack or massive stroke. Each level of altered consciousness has its own set of potential causes and implications for treatment.

7 effective treatments for altered mental status 

The treatment of altered mental status depends on the underlying cause. Therefore, it’s essential to identify and address the specific reason for the change in mental status. Here are seven general approaches that healthcare professionals may consider based on the cause:

1. Medical stabilization

If altered mental status is due to a medical emergency, such as severe infection, head trauma, or metabolic disturbance, immediate medical stabilization is crucial. This may involve interventions to support vital functions, such as airway management, administration of intravenous fluids, or correction of electrolyte imbalances.

2. Medication management

Depending on the underlying cause, medications may be prescribed to address specific issues. For example, antibiotics may be used to treat infections, antiepileptic drugs for seizures, or medications to control symptoms in psychiatric conditions. In cases of intoxication, antidotes or supportive medications may be administered.

3. Monitoring and supportive care

Continuous monitoring of vital signs, neurological status, and other relevant parameters is essential. Supportive care, including maintaining adequate oxygenation, hydration, and nutrition, helps stabilize the individual while addressing the underlying cause.

4. Psychiatric interventions

If altered mental status is related to a psychiatric condition, such as depression, anxiety, or psychosis, psychiatric interventions may include counseling, psychotherapy, and medications. In severe cases, hospitalization in a psychiatric facility may be necessary.

5. Rehabilitation services

For individuals recovering from conditions such as traumatic brain injury or stroke, rehabilitation services may be beneficial. Physical therapy, occupational therapy, and speech therapy can help improve functional abilities and cognitive function.

6. Addressing substance abuse

If altered mental status is linked to substance abuse, interventions may involve detoxification, counseling, and rehabilitation programs to address the addiction and support recovery.

Watch this video to learn more about the ripple effects of addiction from Brennan Harlow:

7. Treat the underlying medical condition

Identifying and treating the specific medical condition causing altered mental status is crucial for long-term management. This may involve surgeries, interventions, or ongoing medical treatments tailored to the individual’s needs.

It’s important to note that these treatments are general principles and may be adapted based on the unique circumstances of each case. The healthcare team will determine the specific approach after a thorough assessment of the individual’s medical history, physical examination, and any necessary diagnostic tests.

Prompt medical attention is crucial in cases of altered mental status to determine the underlying cause and initiate appropriate interventions. If you or someone else is experiencing altered mental status, seek emergency medical care for a timely and accurate assessment.

FAQs

Navigating the complexities of altered mental status (AMS) is crucial for understanding its causes, symptoms, and treatments. Explore these questions to gain insights into diagnosis, prevention, and the impact on daily life.

• How is AMS diagnosed?

Altered Mental Status (AMS) is diagnosed through a comprehensive medical evaluation, including a thorough medical history, physical examination, and often imaging or laboratory tests. Identifying the underlying cause guides effective interventions for altered mental status.

• What can I do to prevent an altered mental status?

Preventing altered mental status involves maintaining overall health. Stay hydrated, manage chronic conditions, attend regular check-ups, and promptly address any concerning symptoms. Avoid substance abuse and protect against head injuries to reduce risk factors.

• What is living with an altered mental status like?

Living with altered mental status can be challenging, varying based on the underlying cause. Individuals may experience confusion, memory issues, or mood changes. Supportive care, therapy, and addressing the root cause are essential components of managing daily life.

• Is altered mental status dementia?

While altered mental status can share some symptoms with dementia, they are not the same. Altered mental status is a broad term encompassing various conditions causing changes in cognitive function, while dementia is a specific syndrome involving progressive memory and cognitive decline.

• Can depression cause altered mental status?

Yes, depression can lead to altered mental status, manifesting as cognitive impairment, lack of concentration, and memory issues. Addressing depression through therapy, medication, and lifestyle changes is crucial for improving mental well-being and cognitive function.

In a nutshell

Dealing with the complexities of altered mental status (AMS) demands a comprehensive understanding fueled by knowledge and empathy. Equipped with the knowledge provided in this article, individuals, caregivers, and healthcare professionals can collaborate to foster a more informed and compassionate approach to AMS. 

Individuals are empowered to seek timely medical attention, implement preventative strategies, and create supportive environments. Healthcare professionals, armed with a holistic understanding, can tailor interventions to address the full spectrum of needs faced by those experiencing AMS.

Ultimately, delving into AMS is not just about acquiring information; it’s a call for collective action. It compels us to move beyond the realm of observers and embrace the role of supportive companions on the path towards improved mental well-being.

For those touched by AMS, this journey represents a tapestry woven with threads of medical expertise, psychological insights, and unwavering social support, ultimately leading to a brighter future.