[Acute confusional states in the elderly (author's transl)]

It is described that the acute confusional state in elderly people can be regarded as the combination of a catastrophe-reaction, superimposed on the primary symptoms of an underlying physical disorder. The catastrophe-reaction, the secondary symptoms, are described as the manifestation of the failure of the hypothalamo-hypophyso-adrenocortical axis, comparable with a relative glucocorticosteroid deficiency. The therapy of an acute confusional state should aim at the treatment of the underlying physical disorder and at the treatment of the catastrophereaction by injecting intramuscularly for two days high doses of methyl-prednisolon. It is demonstrated that frequently in elderly people a subacute confusion can be developed, due to a catastrophe-reaction, superimposed on an underlying masked depression. A combined treatment, giving for two days high doses of methyl-prednisolon in order to treat the catastrophe-reaction and giving low doses of tricyclic anti-depressants to treat the depression, seems to result in amazing improvement.