Today at morning report we discussed the case of elderly patient presenting with altered mentation – flat affect and drowsiness compared to baseline combativeness. DDx is broad including medications, infections, structural and many MANY metabolic reasons.
We also discussed catatonia as possible presentation of pain / DD of altered mentation including physical exam signs of posturing, negativism, waxy flexibility etc.
On exam the only clue was RLQ TTP which resulted in imaging which showed right hydrourteteronephrosis secondary to nephrolithiasis. Pain by itself can cause changes in personality in patients who are non-verbal (fracture, pancreatitis and MI were mentioned as possible causes).
This table from nejmcp1605501 does a good job with DDx and management of delirium in hospitalized patients: