Mersey Care NHS Trust, EMI Directorate, Sir Douglas Crawford Unit, Mossley Hill Hospital, Park Avenue, Liverpool L18 8BU, UK
I read Dr Fleminger's (2002) article with interest and in particular his description of hypoactive delirious states, which he ascribed to Lipowski in 1990. They were, in fact, first described by me (Philpott, 1989) as attenuated or negative confusional symptoms in my chapter on Recurrent acute confusional states in The Clinical Neurology of Old Age. I emphasised that these are common, particularly when acute confusion occurs in the setting of patients with established dementia. Perhaps the fact that this is included in a textbook of neurology rather than psychiatry accounts for it being overlooked.
REFERENCES
Fleminger, S. (2002) Remembering delirium.
British Journal of Psychiatry,
180, 4-5.
Lipowski, Z. J. (1990) Delirium: Acute Confusional States. New York: Oxford University Press.
Philpott, R. (1989) Recurrent acute confusional states. In The Clinical Neurology of Old Age (ed. R. Tallis), pp. 453-466. New York: John Wiley & Sons.