An unusual presentation of prolonged delirium

A woman in her 20s had a three week history of acute headaches, slurred speech, and unusual behaviour.

Neuropsychiatric symptoms were prominent, including confusion, confabulation, labile affect, persecutory beliefs, agitation, and aggression. No neurological deficits were present, her visual fields were normal, and she had no history of seizures.

Over the three weeks, her management had included: admission to neurology and discharge home; admission to psychiatry under the Mental Health Act and transfer back to neurology before discharge home again; readmission to psychiatry under the act.

Six months earlier she was investigated for hirsutism by her general practitioner: androgen levels were raised but pelvic ultrasonography did not show polycystic ovaries.

Moderate psychosocial stressors were present. She took no medication, had no psychiatric or substance misuse history, and had no relevant family history.

Routine delirium screen1—urinalysis, chest radiography, electrocardiogram, a computed tomography head scan, and blood tests (full blood count, …