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Obtundation is a decline from a patient's normal mental state, where a patient demonstrates a lower level of alertness and consciousness. While this term is often used in reference to people with mental illness in situations where they are acting with diminished capacity, it can technically be used to refer to anyone. There are some legal issues involved with a diminished mental state that must be considered when a patient who is experiencing obtundation is being asked to make decisions.
There can be a number of causes for obtundation, including head injuries, medications with neurological effects, drug overdoses, and fatigue. When people are in this state, their cognition tends to be slower and they are less aware of their surroundings. Patients can experience feelings of disorientation and confusion, even in familiar, normal environments. Sometimes, this results in behavioral problems, as patients often become agitated when they feel confused.
In a patient who is normally highly alert and aware and has no known problem that would lead to obtundation, this clinical sign is a cause for concern. It indicates that something may be going wrong in the brain, such as a stroke or a reaction to an injury. People sometimes experience profound obtundation when they switch medications, especially medications designed to act on brain chemistry like those used in the treatment of some mental illnesses. Diminished capacity and consciousness can be seen in places like mental institutions, where people are sometimes kept heavily medicated as part of their treatment.
When a patient is not operating with full mental capacity, the law generally determines that the patient does not have the ability to legally consent to medical procedures, suspension of legal rights, sexual activity, or anything else. A guardian may be appointed if someone is in an extended state of diminished consciousness to make decisions that cannot wait, with the understanding that the guardian makes decisions in accordance with the patient's known preferences and wishes. People who take advantage of individuals in a state of obtundation can be subject to legal penalties.
Patients arriving at a hospital for treatment are usually screened for cognitive abilities, both to check for brain injuries and to identify issues that may complicate treatment. Someone with untreated mental illness, for example, may collapse in a public place and require emergency medical treatment from care providers who are not familiar with the patient. Using a checklist to assess mental status allows doctors to determine how aware people are, and this information is important to have when communicating with patients.
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