There are hundreds of possible individual causes of confusion. Patients with acute confusion are usually elderly and often present out of hours via a call from an anxious relative or neighbour. The dementias constitute the chronic confusional states, which are not considered here.
This common and vague symptom can mean different things to different people. It is treated here as being a sense of light-headedness without the illusion of movement characteristic of vertigo. This is a useful distinction in practice as the causes of true vertigo are different – see Vertigo section. Dizziness tends to be a heartsink symptom as it is so common, has so many diagnostic possibilities, is so often linked with anxiety and other symptoms – and very often the exact cause remains obscure.
A hallucination is a sensory perception occurring without any external stimulus. This distinguishes it from an illusion, which is a distortion of a sensory perception. Hallucinations can occur in any sensory modality and may present in isolation or as part of a larger clinical problem (particularly an acute confusional state). A hallucination is often a very frightening experience for the sufferer.
There are almost as many causes for headache in medicine as there are disorders. This universal symptom presents a challenge to all GPs because it is common, very often non-organic, but seriously pathological just often enough to merit a thorough and usually negative examination. The chance of asinister hidden problem is always there, but the known vast majority of benign headaches can put the clinician off guard.
This problem is commoner in women, and commonest in the elderly. Normal sleep requirement varies widely. A few people need only 3–4 h per night and the average amount of sleep needed declines with age. Self-reporting of time taken to get to sleep and hours slept are said to be inaccurate, but it is the change from the individual’s normal pattern that is significant in practice.
Loss of sex-drive can be a daunting presentation for established GP and registrar alike. This universal problem spans adulthood in both sexes. Conventional medical school teaching seems to fail to prepare the generalist; however, the didactically taught approach of systematic enquiry and examination is the key to successful management.
Memory loss is a distressing and perilous symptom for both sufferers and caring relatives. It may be due to organic or non-organic causes. Memory is classified into immediate, short-term (or recent) and long-term (or remote) memory. The type of loss varies according to the cause. Memory loss is also a feature of any cause of acute confusion; this problem is covered in the 'Confusion, acute' section.
Vertigo is an illusion of movement of either the patient or his or her environment. This is both visual and positional. Associated nausea or vomiting are common and, in its acute form, it is a severe and completely disabling symptom. It must be distinguished from ‘light-headedness’ (see section on Dizziness).