BACKGROUND: Confusional states associated with medical and surgical conditions require more study and biochemical explanation. AIMS: To understand impairment of consciousness, cognition and memory. METHOD: A psychiatrist reports experience of his changing mental state over 5 days from notes made immediately on recovery. RESULTS: A prodromal phase of declining consciousness, understanding and memory registration over perhaps 48 h was difficult to detect. During unconsciousness there were four brief partial reversals with arousal, and some mental functioning (memory, formation of beliefs) occurred. CONCLUSIONS; Self-report can be a useful addition in clinical study, and patients with renal failure require psychological and psychiatric study. Comparison with the mental effects of benzodiazepine or of an anaesthetic such as nitrous oxide might throw light on the pathology.
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