Clinical features

The cardinal feature is a reduced level of consciousness, although mild degrees of this can be easy to miss in clinical practice. The patient is confused and disoriented, often restless, overactive, and fearful, but sometimes underactive and withdrawn. Inattention, including reduced ability to focus, sustain, or shift attention, is common. Illusions; hallucinations of visual, auditory, or tactile type; and changeable paranoid delusions may be present.

Severity fluctuates, usually being worse at night, because when there is less light, the environment is more likely to be misinterpreted, curtains appearing as threatening monsters, for example.

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