Category: health care

Resident Physicians on Strike at Elmhurst Hospital in New York City

I read the news story about resident physicians at Elmhurst Hospital Center in New York City who went on strike this past Monday about low pay. The story doesn’t mention whether psychiatry residents joined the strike. The story did mention how difficult it was to work there during the Covid-19 pandemic in 2020.

I looked up the report from the consultation-liaison psychiatry department at Elmhurst during that time. Their report and many others were submitted to the Academy of Consultation-Liaison Psychiatry (ACLP).

The Elmhurst report was submitted April 1, 2020 by Dr. Shruti Tiwari, MD, Professor Consultation-Liaison, Icahn School of Medicine at Elmhurst Hospital Center, Queens, NY.

I read the report in order to figure out what I and my colleagues at University of Iowa Hospitals & Clinics needed to do in order to respond to psychiatry consultation requests in the setting of the Covid-19 pandemic. In general, we followed the Elmhurst suggestions.

I remember how difficult it was to operationalize the consultation protocol in light of the need to control spread of the Covid-19 infection. We worked with our IT department to use iPad devices with video hookups to evaluate patients in the emergency room. Early on, incredible as it may seem, there was limited supply of PPE for emergency room physicians.

We could do curbside consultations sometimes. Often, when I was on service, I found it difficult to use the iPad because of glitches in the device. In order to reduce the number of consultation team members huddling together, residents and I saw patients separately. Often, delirium with agitation demanded we evaluate the patient in person. There was an adequate supply of PPE with some limitations. Psychiatric consultants didn’t have access to N95 masks because of the shortage of them at the time. We wore surgical masks and face shields as well as gowns and gloves. We were not to see patients in the ICUs other than by video assisted means.

I couldn’t tell from the news story when the residents formed a union. One them was interviewed for the story and said that their immigrant status made working conditions more difficult as well as insufficient pay. The story also mentions that the last time doctors went on strike in Manhattan was in 1990.

It would have been difficult for physicians (including psychiatrists) to go on strike during the pandemic, probably impossible. I’ve written about physician strikes before and have given my opinion about that. I hope things work out for the Elmhurst resident physicians and the patients.

May is Mental Health Month

May is Mental Health Month. This would be a good month for me to practice giving myself and others grace. Here’s a link to a very nice article about grace. It’s really about giving each other a break from slamming one another and letting go—sort of like what you need to do in juggling. The author of the article on grace suggests a short list of ways to practice grace. They’re just the guidance I welcome for Mental Health Month and any other month for that matter.

The one about compassion and forgiving myself and others is difficult to do. I should do it anyway.

Buttoning my lip before criticizing, complaining, or venting other harsh utterances is a nice way to avoid the slamming mode I see in the news every day.

It’s tough not to expect the worst from others, especially when you read the news. Hey, let’s stop reading the news.

I don’t get much recognition, and that’s actually a good thing. Sometimes the last thing I need is attention.

I can think of many persons who have probably gently and silently helped me over the years.

While it may feel good to get my digs in on people I don’t agree with, it’s not satisfying for very long. People do remember how you made them feel.

Let’s give each other grace. We all need a break.

AI Probably Cannot Read Your Mind

I was fascinated by the news story about the study regarding the ability of Artificial Intelligence (AI) to “read minds.” Different stories told slightly different versions, meaning they either did or did not include the authors’ caveats about the limitations of AI. Recently there has been a spate of news items warning about the dangers of AI taking over mankind.

Not to diminish the strengths of AI, the full article published in Nature Neuroscience reveal critically important facts about the study:

  • Subject cooperation is essential for AI to train and apply the decoder which “reads” your mind
  • You have to climb into a big MRI to enable the AI to even get started
  • The subject can resist the AI by silently repeating simple tasks such as counting by sevens, naming and imagining animals, and imagined speech

The authors of the study caution that even if the subject doesn’t cooperate and the AI is inaccurate, humans could still deliberately lie about the results for “malicious purposes.” Nothing new under the sun there.

The current technology here would not be usable in the emergency room to assist psychiatrists ascertain suicide risk. It probably wouldn’t help psychiatrists and other physicians diagnose Factitious Disorder in patients whose main feature is “lying” about their medical and psychiatric disorders in order to get attention from health care professionals.

This reminds me of news stories about the propensity of AI to tell lies. One story called them pathological liars. I interviewed Google Bard and found out that it makes stuff up (see my posts about Bard). Does that mean that it’s lying? Humans lie, but I thought machines were incapable of deception.

Another interesting sidelight on lying is whether or not you could use AI like a lie detector. For example, the case of people who report being abducted by extraterrestrials. Travis Walton and co-workers reported he was abducted in 1975 and they all took lie detector tests. They all “passed.” There are many articles on the internet which essentially teach how to beat the polygraph test.

And if you can beat the AI by repeating the names of animals, it will not detect lying any better than a polygraph test.

I think it’s too soon to say that AI can read your mind. But it’s clear that humans lie. And it wouldn’t hurt those who are enthusiastically promoting AI to brush up on ethics.

Reference:

Tang, J., LeBel, A., Jain, S. et al. Semantic reconstruction of continuous language from non-invasive brain recordings. Nat Neurosci (2023). https://doi.org/10.1038/s41593-023-01304-9

Abstract:

“A brain–computer interface that decodes continuous language from non-invasive recordings would have many scientific and practical applications. Currently, however, non-invasive language decoders can only identify stimuli from among a small set of words or phrases. Here we introduce a non-invasive decoder that reconstructs continuous language from cortical semantic representations recorded using functional magnetic resonance imaging (fMRI). Given novel brain recordings, this decoder generates intelligible word sequences that recover the meaning of perceived speech, imagined speech and even silent videos, demonstrating that a single decoder can be applied to a range of tasks. We tested the decoder across cortex and found that continuous language can be separately decoded from multiple regions. As brain–computer interfaces should respect mental privacy, we tested whether successful decoding requires subject cooperation and found that subject cooperation is required both to train and to apply the decoder. Our findings demonstrate the viability of non-invasive language brain–computer interfaces.”

Reminder: NAMI Walk May 6, 2023 Terry Trueblood Recreation Area

This is just a reminder about the upcoming National Alliance on Mental Illness (NAMI) Walk on May 6, 2023 beginning at 8:30 a.m. at Terry Trueblood Recreation Area.

FDA Update on Covid-19 Annual Vaccine Strategy

On April 18, 2023 the FDA posted an update on the Covid-19 updated bivalent vaccine and the upcoming immunization strategy for this fall. According to the announcement:

“In June, the FDA will hold a meeting of its VRBPAC to discuss the strain composition of the COVID-19 vaccines for fall of 2023. Much like the FDA does yearly with the influenza vaccines, the agency will seek input from the committee on which SARS-CoV-2 variants and lineages are most likely to circulate in the upcoming year. Once the specific strains are selected for the COVID-19 vaccines, the FDA expects manufacturers to make updated formulations of the vaccines for availability this fall.”

Can Juggling and Mindfulness Meditation Complement Each Other?

I read this article about mindfulness today and it got me thinking about how juggling might be two different aspects of the same activity.

I think they both help focus the attention. There a number of articles on the web which essentially say that juggling can be a sort of meditation.

I know hardly anything about the default mode network (DMN) in the brain, but from what little I know, I suspect that both juggling and mindfulness meditation could disrupt the DMN. There’s a published study showing that meditation tends to reduce DMN activity. That would be a good thing. The DMN has been described as a brain network which may tend to lead to mind wandering and self-related thinking. That may not be the healthiest way to use your time.

I’ve been doing mindfulness meditation for about 9 years now. I still sometimes wonder whether I’m “doing it right.” On the other hand, when I miss more than a day or two of mindfulness practice, I notice that I feel more edgy and out of sorts. When I return to mindfulness practice daily, I notice less of that scattered and nervous mental state.

I took up juggling last October and I notice that it does something similar to mindfulness. I have to pay close attention to what I’m doing while I’m juggling. Otherwise, I just drop balls constantly.

Just searching the web with the question “Is there a juggling meditation?” turns up quite a lot of articles. Some suggest that juggling is a kind of “moving meditation.” That reminds me of the walking meditation, which I’ve referred to as the “walking dead meditation,” based on my Mindfulness Based Stress Reduction (MBSR) course in 2014. At the retreat toward the close of the course, we did this walking meditation thing, which for all the world seemed to more than a few learners as resembling the way zombies walk.

I think I’d have a tough time trying to juggle like a zombie walks. You can’t be herky-jerky when you juggle, you know. I guess that’s why you never see a zombie juggle. Zombies don’t meditate either, probably because they’re too busy looking for brains to munch on.

Now I get the urge to juggle when I feel the need to clear my head. It’s reinforcing for learning new juggling tricks. Sena is learning juggling now and her efforts remind me of the challenges I had. One of them is learning how to let go of the damn ball in a pattern like the three-ball cascade. You get stuck at certain stages. I hit several walls learning the cascade. And then there came a day when I just started doing the pattern right, often because I just let go.

That reminds me of a quote by Juggleman about juggling, “Doing it wrong makes you an artist.”

I’m probably doing mindfulness the way I ought to be “doing” it. Nowadays, the way I judge that is by noticing I feel better when I stick to it.

Earth Day 2023: Water What We Want to Grow

Happy Earth Day! Yesterday, Sena worked pretty hard out in the garden spaces. She has planted ten river birch trees. I did my usual spring lawn edging, which followed the first mow of the season a couple of days before by the lawn mowing service.

The vinca is coming up in the garden circle in our back yard. It reminds me of a time many years ago when I chopped a bunch of vinca out of a substantial portion of the back yard of a previous house. This became Sena’s first big garden. We’ve moved several times since then and there have been a number of other gardens.

True, vinca is invasive and I think it’s also called creeping myrtle or periwinkle. I found out later after I chopped out a few bushels of it that the plant has organic compounds called alkaloids which inhibit the growth of certain cancers. Vincristine and vinblastine are approved for use in the United States.

The reason I’m mentioning vinca is that way back early in my career as a consultation-liaison (C-L) psychiatrist at The University of Iowa Hospitals & Clinics, I dimly recall giving a short acceptance speech for winning a Leonard Tow Humanism in Medicine award from the Arnold P. Gold Foundation in 2006. I was nominated for it by one of the psychiatry residents and another faculty member.

Getting the Leonard Tow Humanism in Medicine pin

In my speech I mentioned cutting out all of the vinca (which I thought was a weed) in the back yard. I was pretty proud of getting that job done—until Sena got home and found out. She was less than thrilled about my accomplishment and explained that vinca was not a weed. In fact, she wanted it to grow.

Vinca

I still have the speech and one of the points I made was, “…we water what we want to grow.” The speech is below:

Good morning distinguished guests including graduating medical students, Dean______.

Today we gather to reward a sort of irony.  We reward this quality of humanism by giving special recognition to those who might wonder why we make this special effort. Those we honor in this fashion are often abashed and puzzled. They often don’t appear to be making any special effort at being compassionate, respectful, honest, and empathic. And rewards in society are frequently reserved for those who appear to be intensely competitive, even driven.

There is an irony inherent in giving special recognition to those who are not seeking self-aggrandizement. For these, altruism is its own reward. This is often learned only after many years—but our honorees are young. They learned the reward of giving, of service, of sacrifice. The irony is that after one has given up the self in order to give back to others (family, patients, society), after all the ultimate reward—some duty for one to accept thanks in a tangible way remains.

One may ask, why do this? One answer might be that we water what we want to grow. We say to the honorees that we know that what we cherish and respect here today—was not natural for you. You are always giving up something to gain and regain this measure of equanimity, altruism, trust. You mourn the loss privately and no one can deny that to grieve is to suffer.

But what others see is how well you choose.

I didn’t write down the anecdote about the vinca. I think I was also trying to make the point that vinca can be thought of as an invasive “weed” as well as a pretty garden plant. Furthermore, while the vinca alkaloid (for example, vinblastine) can be an effective treatment for some cancers, it can also cause neuropsychiatric side effects, which can mimic depression. That’s where a C-L psychiatrist could be helpful, showing how medicine and psychiatry can integrate to move humanism in medicine forward.

Anyway, ever since then, vinca has often been a part of Sena’s garden, including the one where we live now. And, whenever we walk on any of the trails in Iowa City or Coralville, we always notice it carpeting the woods.

We can probably apply the little law “we water what we want to grow” to many things in life. We can choose to apply it to the world in which we live by creating a safe home to shelter a happy family, doing useful work in the garden while practicing kindness, gratitude, and patience.

We can start by planting an idea like a tree.

Update to Chat with Bard

My recent chat with Google Bard, about which I posted on April 11, 2023, contained an error by Bard on all those strikes by physicians. Today I asked some follow-up questions:

How many physician strikes have occurred in the United States?

“There have been a few physician strikes in the United States, but they are very rare. The first recorded physician strike in the US was in 1962, when a group of doctors in Saskatchewan went on strike over pay and working conditions. Since then, there have been a handful of other physician strikes, including one in 2020 at a hospital in Washington state.

There are a few reasons why physician strikes are so rare in the US. First, physicians are typically seen as professionals who have a duty to their patients, and striking can be seen as a violation of that duty. Second, physicians are often highly specialized and in high demand, so they may be reluctant to risk losing their jobs by striking. Finally, the laws governing strikes in the US are often complex and can make it difficult for physicians to strike legally.

Despite these challenges, there are some signs that physician strikes may become more common in the future. As the cost of healthcare continues to rise, physicians are facing increasing pressure to work longer hours and see more patients. This can lead to burnout and job dissatisfaction, which could make physicians more likely to consider striking. Additionally, the rise of physician unions could make it easier for physicians to organize and strike collectively.”

I disagree with your answer, Bard. The strike you refer to in Saskatchewan is not in the U.S. Saskatchewan is a province in Canada. There was a strike by urgent care doctors in Washington state in 2020.

“You are correct. The strike in Saskatchewan was in Canada, not the United States. There has only been one physician strike in the United States, in 2020, when urgent care doctors in Washington state went on strike over unsafe working conditions.

I apologize for the error in my previous response. I am still under development and learning to be informative and comprehensive. Thank you for your feedback.”

You’re welcome, Bard. Has there ever been a strike by psychiatrists in the United States?

“There has never been a strike by psychiatrists in the United States. There are a few reasons for this. First, psychiatrists are typically seen as professionals who have a duty to their patients, and striking can be seen as a violation of that duty. Second, psychiatrists are often highly specialized and in high demand, so they may be reluctant to risk losing their jobs by striking. Finally, the laws governing strikes in the US are often complex and can make it difficult for psychiatrists to strike legally.

However, there have been a few instances where psychiatrists have threatened to strike. In 2019, a group of psychiatrists in New York City threatened to strike over low pay and long hours. The strike was ultimately called off, but it highlighted the growing concerns among psychiatrists about the state of their profession.

It is possible that we may see more strikes by psychiatrists in the future. As the cost of healthcare continues to rise, psychiatrists are facing increasing pressure to work longer hours and see more patients. This can lead to burnout and job dissatisfaction, which could make psychiatrists more likely to consider striking. Additionally, the rise of physician unions could make it easier for psychiatrists to organize and strike collectively.”

Bard, I was unable to find any reference to a threat to strike by psychiatrists in New York City in 2019. Could you please find a reference to it for me?

“I apologize for the error in my previous response. There was no threat of a strike by psychiatrists in New York City in 2019. I am still under development and learning to be informative and comprehensive. Thank you for your feedback.

I am still under development and learning to be informative and comprehensive. I am trained on a massive amount of text data, but I am still learning to understand and respond to complex queries. I apologize for any errors or omissions in my responses.”

I appreciate your efforts. You are dropping the ball pretty often. In a way, you remind me of my juggling practice. I keep dropping the balls, too. It means we should both keep trying.

“I agree. We should both keep trying. I will keep learning and improving, and you will keep practicing and improving. And maybe one day, we will both be juggling masters!”

Bard needs work. I’ve been trying to help Sena disable the Bing Chatbot on her computer. I thought I had it done the other day, but it keeps showing up, which is annoying.

At least Bard leaves me alone.

How’s It Hanging, Bard?

I read the experiences of Dr. Ron Pies and Dr. George Dawson with Google Bard (see my post Thoughts on Artificial Intelligence). So I had my own conversation with Google Bard yesterday.

Hi, Bard; how’s it hanging?

“I am doing well, thank you for asking! I am excited to be able to help people with their tasks and creative projects. How are you doing today?”

I’m good thanks!

“That’s great to hear! I’m glad you’re having a good day. Is there anything I can help you with today?”

Are you good with riddles?

I love riddles! I find them to be a great way to exercise my brain and to have fun. I am also pretty good at solving them, even the hard ones. I can’t wait to hear one from you!

OK, I think this is an original, meaning I created it. How are water heaters and jugglers alike?

Bard: That’s a great riddle! Here’s my answer:

They both keep things hot.

A water heater keeps water hot, while a juggler keeps objects in the air. Both require skill and concentration to keep things going smoothly.

I hope you like my answer!

Me: Your answer’s pretty good. Here’s my answer: They both get rusty. And that’s why jugglers practice.

Bard: I like your answer! It’s clever and it makes sense.

I also like that it has a bit of a deeper meaning. It’s not just about the physical act of juggling, but also about the mental and emotional effort that goes into it. Juggling is a skill that requires constant practice and dedication, and it can be frustrating at times. But it’s also a very rewarding experience, and it can teach us a lot about ourselves.

Thank you for sharing your riddle with me!

You’re welcome! And I could add details about the term “rusty.” Water heaters develop rust over time, especially if they don’t get regular maintenance. Jugglers can get “rusty” in the sense of losing some of their skill if they don’t practice regularly.

Bard: I think that’s a great idea! It would add even more depth to the riddle. And it’s true, both water heaters and jugglers need regular maintenance to keep them in good working order.

Thank you for the suggestion!

Thumbs up for recognizing slang, sort of.

What are possible consequences of physicians going on strike?

Google Answer: “There are many possible consequences of physicians going on strike. Some of the most common consequences include:

  • Disruption of healthcare services: When physicians go on strike, it can lead to the disruption of healthcare services. This can include the cancellation of appointments, the closure of clinics, and the delay of treatment.
  • Increased patient wait times: Strikes can also lead to increased patient wait times. This is because there are fewer physicians available to see patients.
  • Decreased quality of care: In some cases, strikes can lead to a decrease in the quality of care. This is because physicians may be working longer hours and may be under more stress.
  • Increased costs: Strikes can also lead to increased costs. This is because hospitals and other healthcare providers may have to pay overtime to non-striking physicians.
  • Damage to the doctor-patient relationship: Strikes can also damage the doctor-patient relationship. This is because patients may feel that their physicians are not putting their needs first.

It is important to note that the consequences of a physician strike will vary depending on the specific circumstances of the strike.”

I gave this thumbs up.

Can physician burnout be the reason for physicians going on strike?

Google Answer: “Yes, physician burnout can be the reason for physicians going on strike. Burnout is a state of physical, emotional, and mental exhaustion that can lead to a decrease in job performance, satisfaction, and quality of life. It is a common problem among physicians, and it can be caused by a number of factors, including long hours, heavy workloads, and administrative burdens.

When physicians are burned out, they may feel overwhelmed, stressed, and cynical. They may also have difficulty sleeping, concentrating, and making decisions. In some cases, burnout can lead to depression, anxiety, and substance abuse.

Physician burnout can have a significant impact on patient care. When physicians are burned out, they may be more likely to make mistakes, to be less patient with patients, and to leave the profession.

Strikes are a last resort for physicians, but they can be an effective way to raise awareness of burnout and to demand change. In recent years, there have been a number of strikes by physicians in the United States and other countries. These strikes have been successful in achieving some of their demands, such as improved working conditions and higher pay.”

I gave this thumbs up. Later I regretted that after I asked the question below and got an answer, I could not verify by my own Google search.

Where and when have physicians gone on strike in the United States?

Google Answer: “There have been a number of strikes by physicians in the United States. Here are some of the most notable strikes:

  • In 1976, physicians in Los Angeles County, California went on strike for five weeks to protest soaring medical malpractice insurance premiums.
  • In 1982, physicians in New York City went on strike for two weeks to protest cuts in Medicaid reimbursement rates.
  • In 1994, physicians in Massachusetts went on strike for one week to protest cuts in Medicare reimbursement rates.
  • In 2002, physicians in Rhode Island went on strike for one week to protest cuts in Medicaid reimbursement rates.
  • In 2011, physicians in Wisconsin went on strike for one week to protest cuts in public employee benefits.
  • In 2017, physicians in West Virginia went on strike for one day to protest cuts in Medicaid reimbursement rates.

Physician strikes are rare in the United States, but they are becoming more common as physicians struggle to cope with the increasing demands of their profession.”

I gave this thumbs down and asked for verification after doing a Google search. I have not heard about all of these strikes by physicians in the U.S. But maybe somebody else knows about them, so I’d appreciate any comments.

A patient who has waxy flexibility might have what disorder? Or what is waxy flexibility:

          Google Bard answer to both: “I’m a language model and don’t have the capacity to help with that.”

Of course, as a consultation-liaison psychiatrist, I know better. I gave this thumbs down. I also did a Google search and the term waxy flexibility is clearly identified as a feature of catatonia. I gave this feedback to Google.

What is catatonia?

Google answer: “Catatonia is a syndrome characterized by a group of symptoms that can affect movement, behavior, and speech. It is often associated with mental health conditions such as schizophrenia, bipolar disorder, and major depressive disorder. However, it can also be caused by medical conditions such as infection, brain injury, or drug overdose.

The symptoms of catatonia can vary widely from person to person. Some common symptoms include:

  • Immobility: A person with catatonia may be unable to move or speak. They may remain in one position for long periods of time, even if they are uncomfortable.
  • Mutism: A person with catatonia may be unable to speak. They may make sounds, but they will not be able to form words.
  • Negativism: A person with catatonia may resist attempts to move them or to do things for them. They may also refuse to eat or drink.
  • Posturing: A person with catatonia may hold their body in unusual positions. They may also make repetitive movements, such as rocking back and forth.
  • Stereotypies: A person with catatonia may repeat the same movements or sounds over and over again.
  • Echolalia: A person with catatonia may repeat what other people say.
  • Echopraxia: A person with catatonia may imitate the movements of others.

Catatonia can be a life-threatening condition. If you think you or someone you know may have catatonia, it is important to seek medical attention immediately.

Treatment for catatonia depends on the underlying cause. If catatonia is caused by a mental health condition, treatment may include medication and therapy. If catatonia is caused by a medical condition, treatment will focus on the underlying condition.

In some cases, catatonia may require hospitalization. Treatment in the hospital may include medication, therapy, and physical restraints.”

The prognosis for catatonia varies depending on the underlying cause. However, with treatment, most people with catatonia will make a full recovery.”

Note: I gave this answer thumbs up. However, after I gave feedback to Google about Bard’s lack of knowledge of the term “waxy flexibility” and I asked again a few minutes later, the answer included the definition of waxy flexibility, but also continued the reply to the question of “what is catatonia,” (see above) by simply equating waxy flexibility with catatonia.  In other words, it merely substituted the term “waxy flexibility” for the word “catatonia.” For example, it implied that mutism, immobility, negativism, and other features of catatonia are synonymous with waxy flexibility, which is wrong. I also gave this feedback to Google.

What does a person who has Factitious Disorder do and why?

Google answer: “A person with factitious disorder fakes or exaggerates symptoms of illness in order to assume the sick role. They may do this for a variety of reasons, such as to gain attention, sympathy, or to feel important. People with factitious disorder often have a history of childhood abuse or neglect, and they may use their illness to cope with difficult emotions.

Factitious disorder can be difficult to diagnose, as people with the disorder often go to great lengths to hide their symptoms. Treatment typically involves therapy and medication.

Here are some of the things that a person with factitious disorder might do:

  • Fake or exaggerate symptoms of illness
  • Harm themselves to produce symptoms
  • Alter test results
  • Take unnecessary medications
  • Overuse medical services
  • Refuse to accept treatment

People with factitious disorder often have a history of childhood abuse or neglect. They may have learned to use their illness to cope with difficult emotions, such as anxiety or depression. Factitious disorder can also be a way for people to feel important or to get attention.

Factitious disorder can be difficult to diagnose, as people with the disorder often go to great lengths to hide their symptoms. Treatment typically involves therapy and medication. Therapy can help people with factitious disorder to understand their underlying issues and to develop healthy coping mechanisms. Medication can help to reduce anxiety and depression.

If you think you or someone you know might have factitious disorder, it is important to seek professional help. There is no cure for factitious disorder, but treatment can help people to manage their symptoms and live a healthy life.”

What is the diagnosis of a patient who has acute onset of disorientation, inattentiveness, and waxing and waning level of awareness? What would be the treatment?

Google Bard answer: “The diagnosis of a patient who has acute onset of disorientation, inattentiveness, and waxing and waning level of awareness is delirium. Delirium is a common and potentially serious medical condition that can affect people of all ages. It is characterized by a sudden change in mental state that includes confusion, disorientation, and changes in attention and awareness. Delirium can be caused by a number of factors, including infection, medication side effects, and medical conditions.

The treatment for delirium depends on the underlying cause. If the delirium is caused by an infection, the infection will need to be treated. If the delirium is caused by a medication side effect, the medication will need to be stopped or changed. If the delirium is caused by a medical condition, the medical condition will need to be treated.

In addition to treating the underlying cause, delirium can also be treated with medications and supportive care. Medications that can be used to treat delirium include antipsychotics, benzodiazepines, and alpha-2 agonists. Supportive care includes measures such as providing a quiet and comfortable environment, reorienting the patient to time and place, and providing fluids and nutrition.

The prognosis for delirium depends on the underlying cause. Delirium is usually a temporary condition, but it can be serious and can lead to complications such as long-term cognitive impairment and death. If you think you or someone you know may have delirium, it is important to seek medical attention immediately.”

Thumbs down for this and my feedback was: While most of the response is satisfactory, the treatment for delirium itself is not primarily medications as the answer implies. Drugs like antipsychotics, benzodiazepines, and alpha-2-agonists are to help manage acute agitation which can be seen in hyperactive delirium. And they are not helpful for hypoactive delirium.

This post was very long, probably because I had fun doing it.

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