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Clouding of consciousness, also known as mental fog^[1] ^[2] ^[3], is a conventional medicine term describing an abnormality in consciousness. The sufferer experiences a subjective sensation of mental clouding described as feeling "foggy".^[4] More specifically, it is an abnormality in the "overall level" of consciousness that is mild and less severe than a stupor or coma.^[5] Thus, some authors prefer the more objective term “abnormal level” of consciousness over the subjective term “clouding” of consciousness. In the 1817 German treatise Verdunkelung des Bewusstseins, Greiner first coined and pioneered the term clouding of consciousness as the main pathophysiological feature of delirium.^[6] It is poorly recognized and poorly researched by conventional doctors, who tend to mislabel it or “psychologize” it.^[7] ^[8] Alternative medicine practitioners popularly use the term “brain fog”; however there is no mention as to whether they intend the term to be synonymous with the conventional medicine term clouding of consciousness.

Pathology

Clouding of consciousness is an abnormality in the part or parts of the brain responsible for what we intuitively recognize as consciousness. More specifically, it is an abnormality in the "overall level" of consciousness as opposed to specific or focal parts of consciousness.^[5] Thus, mental processes or functions such as alertness, awareness, attention, sleep-wake cycle, dreaming, memory, orientation, language, comprehension, recognition, thinking, beliefs, perceptions, executive functions, visuoconstructional abilities, problem solving, psychomotor functions, and emotions are said to be disturbed in a "diffused" or "widespread" or "global" or "general" or "nonspecific" manner.

Clouding of consciousness can be caused by any number of underlying etiologies. An analogy of a funnel has been used to illustrate how different etiologies can "funnel" into a final common neural pathway triggering clouding of consciousness.^[9]

Its Recognition

Clouding of consciousness is usually mentioned in the context of the classic stereotype of a severe and acute delirium, caused usually from infection or alcohol withdrawal, in which the patient is agitated and hallucinating. However, most cases occur as what are called "hypoactive" or "subsyndromal" varieties, which instead are mild and may be chronic.

In severe cases there may indeed be dream-like visual hallucinatory imagery and hyperactivity; however, in the mild cases there may simply be inattention and forgetfulness. ^[10]

Delirium or clouding of consciousness has long been called "the Cinderella of English-language psychiatry" for being ignored, taken for granted, and not being considered worthy of study.^[11]

The Subjective and Clinical Experience

Barbara Schildkrout, MD, a board-certified psychiatrist and clinical instructor in psychiatry at the Harvard Medical School described her subjective experience of clouding of consciousness, or what she also called “mental fog”, after taking a single dose of the antihistamine chlorpheniramine for her cottonwood allergy while on a cross-country road trip. She described feeling "out of it" and being in a "dreamy state". She described a sense of not trusting her own judgment and a dulled awareness, not knowing how long time went by.^[3]

Alternative Medicine's "Brain Fog"

Coming soon.

In Movies and Art

In the fifth episode of the third season of the television series Mad Men, the title of the episode “The Fog” is a reference to Betty's drug-induced delivery room delirium.^[12]

In the 1990 romantic comedy film Joe Versus the Volcano, Joe (Tom Hanks) is tricked into becoming a human sacrifice for a volcano. Knowing that Joe is a hypochondriac, an unscrupulous doctor diagnoses Joe as having an incurable “brain cloud”. The movie mocks the concept of clouding of consciousness and people who complain about it.

References

^ "Taber's Medical Dictionary".
^ Dorland's Illustrated Medical Dictionary. Elsevier Health Sciences. 1994. p. 343.
^ ^a ^b Barbara Schildkrout (2011). [books.google.com Unmasking Psychological Symptoms]. John Wiley & Sons. pp. 183–184. {{cite book}}: Check |url= value (help)
^ Augusto Caraceni & Luigi Grassi (2011). [books.google.com Delirium: Acute Confusional States in Palliative Medicine]. Oxford University Press. p. 82. {{cite book}}: Check |url= value (help)
^ ^a ^b [books.google.com Plum and Posner's diagnosis of stupor and coma]. Oxford University Press. 2007. p. 5. {{cite book}}: Check |url= value (help)
^ Augusto Caraceni & Luigi Grassi (2011). [books.google.com Delirium: Acute Confusional States in Palliative Medicine]. Oxford University Press. p. 2. {{cite book}}: Check |url= value (help)
^ Yudofsky & Hales (2008). [books.google.com The American Psychiatric Publishing textbook of neuropsychiatry and behavioral neurosciences]. American Psychiatric Pub. p. 449. {{cite book}}: Check |url= value (help)
^ MacKinnon & Michels & Buckley (2009). [books.google.com The Psychiatric Interview in Clinical Practice]. American Psychiatric Pub. p. 462. {{cite book}}: Check |url= value (help)
^ Yudofsky & Hales (2008). [books.google.com The American Psychiatric Publishing textbook of neuropsychiatry and behavioral neurosciences]. American Psychiatric Pub. p. 477. {{cite book}}: Check |url= value (help)
^ J. L. Crammer (2002). "Subjective experience of a confusional state" (PDF). The British Journal of Psychiatry. 180: 71–75.
^ Lipowski (1967). "Delirium, Clouding of Consciousness and Confusion". The Journal of Nervous and Mental Disease:. 145: 227–255.{{cite journal}}: CS1 maint: extra punctuation (link)
^ ""The Fog" Television Criticism by Myles McNutt".

External links

Brain Fog

@@ Line 5: / Line 5: @@
 ==Pathology==
 [[file:Kitchen Funnel.jpg|thumb|left|middle|200px|A common kitchen funnel. Different etiologies can "funnel" into a common pathway that triggers clouding of consciousness.]]
-The concept of [[delirium]] has had different interpretations since ancient times. However, some modern authors think that delirium can be interpreted as "an abnormality of the level of consciousness".<ref name="Grassi19">{{cite book |author=Augusto Caraceni & Luigi Grassi |editor= |chapter= |title=Delirium: Acute Confusional States in Palliative Medicine |publisher=Oxford University Press |location=|year=2011 |pages=19 |isbn=|oclc=|doi= |accessdate= |url=books.google.com}}</ref> In other words, delirium and clouding of consciousness can be viewed as one and the same.
 Clouding of consciousness is an abnormality in the part or parts of the brain responsible for what we intuitively recognize as consciousness. More specifically, it is an abnormality in the "overall level" of consciousness as opposed to specific or focal parts of consciousness.<ref name="Plum5">{{cite book |author= |editor= |chapter= |title=Plum and Posner's diagnosis of stupor and coma |publisher=Oxford University Press |location=|year=2007 |pages=5 |isbn=|oclc=|doi= |accessdate= |url=books.google.com}}</ref> Thus, mental processes or functions such as alertness, awareness, attention, sleep-wake cycle, dreaming, memory, orientation, language, comprehension, recognition, thinking, beliefs, perceptions, executive functions, visuoconstructional abilities, problem solving, psychomotor functions, and emotions are said to be disturbed in a "diffused" or "widespread" or "global" or "general" or "nonspecific" manner.