Delirium

Clinic

• Also known as acute confusional state, is an organically caused decline from a previous baseline of mental function that develops over a short period of time, typically hours to days.
• It may also involve other neurological deficits, such as
  • Psychomotor disturbances (e.g. hyperactive, hypoactive, or mixed)
  • Impaired sleep-wake cycle
  • Emotional disturbances
  • Perceptual disturbances (e.g. hallucinations and delusions),
  • Although these features are not required for diagnosis
• In common usage, delirium is often used to refer to drowsiness, disorientation, and hallucination.
• In medical terminology, however, acute disturbance in Consciousness/ Attention and a number of different cognitive symptoms are the core features of delirium such as easy distraction, inability to maintain attentional focus, and varying levels of alertness.
• Onset is acute (from hours to days), representing a change from baseline mentation with fluctuations throughout the day
• At least one additional cognitive disturbance (in memory, orientation, language, visuospatial ability, or perception)

Signs and symptoms

Delirium exists as a stage of consciousness somewhere in the spectrum between normal awakeness/alertness and coma. While requiring an acute disturbance in consciousness/attention and cognition, delirium is a syndrome encompassing an array of neuropsychiatric symptoms.

The range of clinical features include:

• Poor attention/vigilance (100%)
• Memory impairment (64–100%)
• Clouding of consciousness (45–100%)
• Disorientation (43–100%)
• Acute onset (93%)
• Disorganized thinking/thought disorder (59–95%)
• Diffuse cognitive impairment (77%)
• Language disorder (41–93%)
• Sleep disturbance (25–96%)
• Mood lability (43–63%)
• Psychomotor changes (e.g. hyperactive, hypoactive, mixed) (38–55%)
• Delusions (18–68%)
• Perceptual change/hallucinations (17–55%)

Related entities

• Inattention: As a required symptom to diagnose delirium, this is characterized by distractibility and an inability to shift and/or sustain attention.
• Memory impairment: Memory impairment is linked to inattention, especially reduced formation of new long-term memory where higher degrees of attention is more necessary than for short-term memory. Since older memories are retained without need of concentration, previously formed long-term memories (i.e. those formed before the onset of delirium) are usually preserved in all but the most severe cases of delirium.
• Disorientation: As another symptom of confusion, and usually a more severe one, this describes the loss of awareness of the surroundings, environment and context in which the person exists. One may be disoriented to time, place, or self.
• Disorganized thinking: Disorganized thinking is usually noticed with speech that makes limited sense with apparent irrelevancies, and can involve poverty of speech, loose associations, perseveration, tangentiality, and other signs of a formal thought disorder.
• Language disturbances: Anomic aphasia, paraphasia, impaired comprehension, agraphia, and word-finding difficulties all involve impairment of linguistic information processing.
• Sleep changes: Sleep disturbances in delirium reflect disturbed circadian rhythm regulation, typically involving fragmented sleep or even sleep-wake cycle reversal (i.e. active at night, sleeping during the day) and often preceding the onset of a delirium episode
• Psychotic symptoms: Symptoms of psychosis include suspiciousness, overvalued ideation and frank delusions. Delusions are typically poorly formed and less stereotyped than in schizophrenia or Alzheimer's disease. They usually relate to persecutory themes of impending danger or threat in the immediate environment (e.g. being poisoned by nurses).
• Mood lability: Distortions to perceived or communicated emotional states as well as fluctuating emotional states can manifest in a delirious person (e.g. rapid changes between terror, sadness and joking).
• Motor activity changes: Delirium has been commonly classified into psychomotor subtypes of hypoactive, hyperactive, and mixed, though studies are inconsistent as to the prevalence of these subtypes. Hypoactive cases are prone to non-detection or misdiagnosis as depression. A range of studies suggest that motor subtypes differ regarding underlying pathophysiology, treatment needs, and prognosis for function and mortality though inconsistent subtype definitions and poorer detection of hypoactive subtypes impacts interpretation of these findings. Liptzin and Levkoff first described these subtypes in 1992 as following:
  • Hyperactive symptoms include hyper-vigilance, restlessness, fast or loud speech, irritability, combativeness, impatience, swearing, singing, laughing, uncooperativeness, euphoria, anger, wandering, easy startling, fast motor responses, distractibility, tangentiality, nightmares, and persistent thoughts (hyperactive sub-typing is defined with at least three of the above).
  • Hypoactive symptoms include unawareness, decreased alertness, sparse or slow speech, lethargy, slowed movements, staring, and apathy (hypoactive sub-typing is defined with at least four of the above).

Repertory

Etiology	Modality	Accompanied by
Abortion: Coloc Cold, catching; after: Op Dark, in: Calc-ar, Calc, Carb-v, Cupr, Stram Depletion, after: Chin Disappointed Maniacal love, from : Phos Epilepsy, after: Arg-met, plb Epilepsy, during: hyos, op Encephalitis with: Acon, Cocc, hell, Puls Fatigue, overexertion, study, from: lach Fear with: Acon Fruit, after sour: podo Gangrene; during: ran-b Hemorrhage, after:,arn, ars, chin, chinin-ar, ign, lach, lyc, ph-ac, phos, sep, squil, sul, verat Headache, from: atro, aur-m, Aur Hot weather: hyos Jealousy, from: HYOS, LACH Injuries to head: bell, hyos, op, stram, verat Meningitis cerebrospinalis: Apis, Chr-ac, Hell, naja, Nat-s, Sul, verat-v, Verat, zinc Menstrual difficulties, with: apis Mental exertion, from: Lach Lochia, during: verat Loss of fluids, from: Chin, Chr-ac, Hell, Lach, Nat-s, Sul, verat-v, Verat Music, from hearing: plb Pains, from: acon, ars, aur., BELL, bry, calc, Cham, chin, dulc, HYOS, ig, Iod, kali-c, nat-m, nux-v, OP, Ph-ac, plat, samb, STRAM, sulph, VERAT Pains - with the: acon, arg-met, arg-n, bov, dulc, tarent-c, Verat Paroxysmal: Bell, con, Gels, hyos, naja, phos, plb, sabad Periodical: Bell, samb Sepsis, from: anthraci, Bapt, Bar-c, crot-h, dor, Lach, mur-ac, Pyrog, Rhus-t, sec, tarent-c, ter, Verat-v, Verat, Vip Sleeplessness, from: Lach Vexation, from: bell, HYOS, plat Wandering pains, from: arg-met, cham	Closing the eyes, on: bapt, Bell, Bry, calc, graph, Lach, led.k pyrog, stram.sne sulph Convulsions: After: absin, arg-mur, bell, kali-c, kali-chl, oena, sec Before: Kali-m, op, sul-h During: acon, Aeth, amyg, ars, Bell, Camph, crot-h, cupr, Dig, dulc., hyos, Kali-ch, Kali-m, Mosch, op, plb Eating, amel: anac, bell Heat, gg.: bry, dulc, stram Menses - before: ars, bell, cocc, hyos, lyc, verat Menses, during: acon, apis, bell, cocc, hyos, lyc, nux-m, puls, stram, verat Perspiration, amel: aeth Sleep Going to sleep; on: Bell.k Bry.k cact.k calc.k camph.k caust.k Chin.k Gels.br1,k gins.k guaj.k ign.k merc.k ph-ac.k Phos.k rhus-t.k Spong.k Sulph After agg: Lach, petr Sleep, after, amel: bell,Cact, calad Sleep - during: APIS, BELL, BRY, ...	Abdomen colic, Alternating with: plb Limbs, pain Alternating with: plb Distension of abdomen and constipation; with: Acet-ac Carotids pulsating, with: Bell Coldness, with: lact, Verat Collapse, with: colch, cupr Coma vigil; with: cur, Hyos, Lach, mur-ac, op, phos Congestion, with: Apis, aur-m, BELL, brom, hyos, iod Eyes; with brilliant: ail Face, distorted; with: Plb Face, livid: Bell Face, pale: Hyos Face, red: Ail, Bapt, Bell, do, Gels, HYOS, op Teeth Grinding, with: BELL Headache, during: acon.k agar.hr1,k ail.hr1,kr1 arg-n.bg arn.bg ars.k Aur.hr1 bell.bg calc.bg cham, cimic, Colch, coloc, crot-h, crot-t.bg glon.k kalm.bg mag-c.k Meli, mosch.k nat-m, Nux-v, sep, stram, arent.k verat Envy, with: lyc Fantastic: alum.j ambr.j Bell.a1,k calc.j carbn-s.k cham.k con.k dulc.k graph.k hyos.k lyc.j nat-m.j nux-m.j op.k plat.j rhod.j sep.k sil.k spong.k Stram.k Sulph MIND - DELIRIUM - fierce: agar.k Bapt.hr1,kr1 bell.a1,h1,k hyos.k Stram Hot head, with: Bell, bufo Jerking, with: acon Jerking, with - angular: hyos Jumping, with: acon.a1 bell.a1 lact.a1 merc Perspiration, with: acon.bg2 ars.bg2 aur.bg2 BELL.bg2 bry.bg2 calc.bg2 Cham.bg2 chin.bg2 cinabg2 dulc.bg2 gal-ac.br1 granit-m.es1 Hyos.bg2 ign.bg2 iod.bg2 kali-c.bg2 nat-m.bg2 nux-v.bg2 OP.bg2 Ph-ac.bg2 plat.bg2 samb.bg2 STRAM.bg2 sulph.bg2 Verat Picking at nose or lips, with: Arum-t.hr1,k BRY.k camph.kr1 Carb-v.k Chel.k chin.k chlf.kr1 croc.k cupr.k HYOS.k hyosin.a1 kali-p.kr1 op.k past.a1 Ph-ac.k phos.k plb.k rhus-t.k sec.k tab.k valer.k verat.k Pupils, with dilated: acon, Bell, Cimic Perspiration - cold perspiration; with: Verat Shrieking; with: Agar, crot-h, cupr, merc Thirst, with: camph, Verat Tongue - brown discoloration: Phos Trembling, with: lact.br1 valer Twitching of muscles; with: hyos Vertigo - with - violent: nux-m

Restless	Apathetic, Slow, Sad	Anxious
Con, Bell, Stram, Hyos	Hyos, Ph-ac, Verat Agar, Puls, Stram	BELL, STRAM.
Arms - extends: sep, stram Arms - throws about: bell Bed - creeps about in: Bell, stram Bed - escapes, jumps up suddenly from bed: ACON, BELL, NIT-AC,,, Busy: arum-t, bapt, bell, Bry, camph, chlol, Hyos, kali-cy, rhus-t, Stram, sul Dancing; with: cic Exaltation of strength, with: Agar.h2,k Aur, bell.mrr1 hyos.k sec, stram.a1,k Tarent Convulsions; tetanic, Alternating with: stram Face - muscles constantly in play: Stram Home, wants to go: bell.a1 BRY, Cupr-act Moving - constantly from place to place; moving: Oena Restless: HYOS, ... Rocking to and fro: bell, hyos Rolling on floor: calc, Op Running: bell, con	Apathetic: ph-ac, verat Apoplectic: hyos, lach Answering, slowly: arn, bapt.bro1 diph.bro1 Hell.bro1 hyos, Ph-ac, phos, sulph Deep sleep Alternating with: acet-ac, atro, bell, cocc, Coloc, Lach, phos, plb, vip Exhaustion, with: agar, ail, am-c, Bapt, hyos, lyc Intoxicated, as if: Agar, agath-a.nl2 am-c.sf1.de carb-an.a1 chinin-s.kr1 cori-r.a1 vip Look fixed on one point: Acon.kr1 art-v.k bell.j bov.k camph.k cann-s.j canth.k cham.j Cic.j cupr.k dor.sf1.de guaj.j hell.j Ign.k,ptk1 kreos.j mez.j nat-c.j ran-b.k stram Look fixed on one point - wrinkled face; with: stram Mild: Apiskr1 BAPT.kr1 Ph-ac.kr1 Puls.kr1 pyrog.jl2 rhus-t, sec.j5.de STRAM.kr1 Valer, Vario.kr1 verat Muttering - slowly: ph-ac Nonsense, with eyes open: anac.k ars.k bapt.k Canth.k cham.k coll.k coloc.k crot-h.k Hyos.k op.k Stram.hr1,k tarent.k VERAT Quiet: BRY, HYOS Sadness, Alternating with: plb, tub Sad: acon.bg2,br1 bell, puls Silent: agar.a1,k sec Sleep, Alternating with : acet-ac.k atro.hr1 bell.a1 cocc.a1,k Coloc.hr1,k Lach.hr1 plb, vip Sleep, comatose Alternating with: bry, plb, Phos, plb, stram Sleep - during - comatose: acon, ant-c, arn.j5.de bry, camph.j5.de coloc.j5.de puls.j5.de sec Sleepiness, with: PULS, ... Sorrowful: acon.k agar.a1 bell.k dulc.k lyc.k puls Sopor, with: kali-c, Op, Verat Unconsciousness, Alternating with: Atro, cann-i.a1 Coloc.hr1	Anxious - fever; during: acon, bell, croc, Hyos.bg2 nux-v.bg2 Op, puls, sil, Stram Anxious - future; about the: bry.tl1 verat Alternating with - sleeplessness: Tub Alternating with - excitement: agar Anxious: Anxious - business; bry Business, talks of: Bry, HYOS, Rhus-t Crying, with: Acon.kr1 agar-pr.a1 agar.sf1.de apissf1.de atro.a1 bell.k Canth.kr1 Caust.k Chinin-s.kr1 Cinak crot-h.kr1 Cupr-act.kr1 dat-m.a1 ferr-p.sf1.de merc.sf1.de phos.a1 stram Crying, with - help, for: camph.ptk1 Canth.k ign.ptk1 plat.ptk1 stram Death, talks about: Acon Devils, sees: op Frightful: BELL, STRAM. Fire, talks of: Calc.k cupr Persecution in delirium; delusions of: ars.gl1.fr calc.gl1.fr hyos.gl1.fr lach.gl1.fr merc.gl1.fr nat-m.gl1.fr rhus-t.gl1.fr stram.gl1.fr verat Terror, expressive of: bell Sleeplessness - with: Alternating with - consciousness: acon, bell.a1 Phos Aroused, on being: dat-f.a1 hep.k phos.k sec Aroused, on being - answer questions; could be aroused to: Hyper

Angry	Maniacal	Foolish
Angry: Cocc.hr1,k zinc Answering - abruptly:cimic.bro1 Lach.bro1 stram.bro1 verat Bite, desire to: anthraci.vh BELL, Canth.hr1,kr1,sf1.de cupr.kr1,sf1.de hydr-ac.a1,kr1 lyss.hr1,kr1 STRAM Attacks people with knife: hyos Hysterical, almost: bell.a1,k Hyos.hr1,kr1 ign.k tarent.k verat Wild: Acon.bg2 anac.bg2 ars.bg2 atro.a1,sf1.de BELL.a1,bg2,k Bry.bg2,sf1.de Calc.bg2 calen.hr1,kr1 camph.a1,bg2,k cann-xyz.bg2 canth.br1,k,a1 chlol.k,hr1 cic.bg2 Cinabg2 colch.k,a1 coloc.bg2 cupr.k,bg2 gal-ac.a1 gels.kr1,hr1 hydr-ac.br1,k,a1 Hyos.bg2,hr1,k,a1 Kali-br.kr1,hr1 lach.k,bg2 lol.bg2 merc.bg2 nat-sal.a1 nux-m.bg2 Op.k1,st,bg2 PLB.k,bg2 rheumbg2 sec.bg2 STRAM.bg2,hr1,k,a1 Valer.kr1,hr1 Vario.kr1,hr1 Verat Quarrelsome:bell.a1 Chr-ac.hr1 nit-ac.ptk1 verat-v Furious: bell.ckh1,vh Bry.ckh1,vh,vh/dg,vhx1 canth.br1 verat-v.br1 verat Raging: Acon.bg2,br1,k Act-sp.k Aeth.k aetherckh1,k agar-pa.a1 AGAR.br1,k,mtf33,tl1 ail.kl alco.a1 anac.bg2,k ant-c.k ant-s-aur.k Ant-t.k apissf1.de arg-met.k arg-n.k ars-s-f.k2 ars.bg2,k atro.kr1 BELL.bg2,k bry.bg2,k calc.bg2,k Camph.bg2,k cann-i.k cann-s.a1 cann-xyz.bg2 CANTH.k Carbn-s.k chel.k chin.k chinin-s.k,gm1 cic.k,bg2 Cimic.k cinak,bg2 clem.kr1 colch.k coloc.k,bg2 cori-r.a1 cupr-act.a1 Cupr.k,bg2 dat-f.a1 dig.k dulc.k glon.k graph.k Hell.k hep.k HYOS.k,bg2 hyper.k jatr-c.k juni-v.a1 Kali-i.kr1 lach.sf1.de,bg2 lob.k lol.bg2 LYC.k merc-cy.k Merc.k,bg2 morph.a1 mosch.k mur-ac.a1 nat-m.k NIT-AC.k nux-m.k,bg2 nux-v.a1 Oena.k OP.k,bg2 par.k phos.k Plb.k,bg2 Puls.k rheumk,bg2 SEC.k,bg2 Sol-ni.k,br1 STRAM.k,bg2 sul-ac.k sulph.k Tab.k tarent.k trach-v.a1 trach.a1 verat-v.kr1 VERAT.k,tl1,bg2 vip.k zinc-p.k2 zinc Rabid: bell.k canth.k lyss.k Stram Violent: Acon.k aeth.ptk2 agar.k alum.kr1 alumn.hr1 Apisk ARS.a1,k atro.a1,k aur.hr1,kr1 BELL.a1,hr1,k,mtf33,tl1 camph.a1,k canth.br1,k,mrr1,tl1 chlf.hr1,kr1 con.a1,k Cupr.k dig.a1 HYOS.a1,k,tl1 Lach.hr1,k Op.a1,k phos.k plb.a1,k puls.k Sec.a1,k STRAM.a1,hr1,k,mrr1,tl1 verat-v.sf1.de verat.k zinc-p.k13,k2 zinc Wild - sudden: Canth	Erotic: camph.k cann-i.a1,k Canth.k Hyos.bro1,st1 kali-br.hr1,k Lach.k Phos.a1,k Plat.ckh1,vh,vh/dg,vhx1 Sec.st1 Stram.a1,k Tarent.vh,vh/dg,vhx1 verat Changing subject rapidly: LACH.k stram Constant: bapt.hr1,k bell.a1,h1,kl Canth.a1 con.a1,k Lach Extravagant language, with: bell Horses, talks about: Stram Irrational: stram Laughing: acon.k Bell.a1,hr1,k colch.k con.k Hyos.a1,k hyosin.a1 Ign.k lach.k lact.k op.k plb.k sal-ac.a1,tl1 sec.k sep.a1,k Stram.a1,hr1,k sulph.k theak verat.k zinc Mouth, puts stones in: merc Lips move as if talking: bell Loquacious: agar.k aur.hr1,k bapt.k bar-c.k Bell.a1,bg2,k bry.k camph.hr1,k cann-i.bro1 CIMIC.hr1,k Crot-h.hr1,k,tl1 Cupr.bg2,hr1,k dat-m.a1 dor.a1 gels.k HYOS.k,vh/dg,vhx2 LACH.bg2,hr1,k,tl1 LACHN.k lyss.hr1,k meli.a1,sne merc-cy.bro1 najak oena.a1,k Op.a1,bg2,k,mtf33 oper.br1,bro1 par.k petr.k Phos.a1,k Plat.k plb.a1,k podo.c1,mrr1 Rhus-t.bg2,k STRAM, Sulph.hr1,kr1 Verat Maniacal: acon.a1,k Aeth.k agar.ptk1 ail.k ant-c.k apiskr1 ars.k BELL.k bry.bg3 Camph.k cann-i.k Canth.k carbn-s.k chinin-s.k Cic.hr1,kr1 Coff.k colch.k con.k cori-r.a1,k crot-h.k Cupr.k dig.sf1.de glon.sf1.de Hell.k HYOS.k indg.k Kali-bi.hr1,kr1 Lach.sf1.de led.k lob.k lyc.k merc-c.k merc.k nat-m.k nit-ac.ptk1 nux-m.k Oena.a1,k Op.k plb.k rhod.k Sec.a1,k STRAM.a1,k tarent.k ter.k Verat.k zinc-act.sf1.de zinc Moving - queer; moving: STRAM Moving - rhythmical: stram Naked in delirium, wants to be: Bell.hr1,k,tl1 HYOS.k,tl1 merc.a1,k Phos.k phyt.k Sec.k stram Changeable: lach.ptk1 stram Singing: Agar.br1,sf1.de cic.br1,sf1.de lact.a1 stram Violent - restrained and calmed with great difficulty, is: zinc Vivid: bell.a1,k Stram.a1,hr1,k Water, jumping into: bell, sec Wedding, prepares for: Hyos MIND - DELIRIUM - wrongs, of imagined: hyos MIND - DELIRIUM - specters; sees: op MIND - DELIRIUM - urinating - pot; outside the: bell Delusions, with: absin.br1 aeth.bg2 agar.tl1 anac.jl3 Ars.sf1.de Bell.a1,bg2,hr1,sf1.de,tl1 camph.tl1 Cann-i.sf1.de,tl1 Cann-xyz.bg2 cham.bg2 croc.tl1 dig.sf1.de graph.bg2 Hyos.sf1.de,tl1,bg2 Kali-bi.kr1,hr1 op.sf1.de,tl1,bg2 petr.tl1,sf1.de plb.sf1.de,a1 sep.bg2 sil.bg2 spong.bg2 Stram.bg2,tl1,a1 Sulph	Bellows like a calf: cupr Comical: ant-c.c1 Hyos.a1,h1,k Stram.k verat Confused: coli Delusions, with - sees rolling live things: cocc Dogs, talks about: bell Embraces the stove and wishes to climb upon it as on a tree: hyos Foolish, silly: acon.k aeth.k agar.st1 bell.k calc-sil.k2 Cic, Hyos, merc.a1,k Op.k Stram.a1,hr1,k sulph Foreign - countries; talks of: cann-i Foreign - language; talks in a: lach.gk nit-ac.ptk1 Stram Gather objects off the wall, tries to: bell.a1,k hyos Gestures; with funny: cic Grimaces, with: Bell Stupid: Stram Religious: agar, alco, aur.k lach.k VERAT Romping with children: agar Rambling: atro.a1,k Bell.a1,h1,hr1,k chlol.a1 Chlor.hr1,kr1 hyos.k Nat-m.hr1,kr1 plb.a1,k sec.hr1,kr1 Sulph MIND - DELIRIUM - urinating - floor; tries to urinate on the plb

=== Loquacious ===	Confused	Reproaching
Moaning, with: bell.hr1,kr1 Crot-h Murmuring: arn.hr1,k calad.hr1,k Hyos.hr1,k Lyc.hr1,k ph-ac.k Phos.hr1,k rhus-t.k Stram.hr1,k tab.a1,k Zinc Murmuring - himself, to: hyos.k merc.a1 tab Murmuring - slowly: ph-ac Muttering: Agar.br1,bro1 Ail.a1,hr1,k,tl1 Amyg.hr1,kr1 Ant-t.br1,hr1,kr1 Apisk Arn.hr1,k ars.a1,k arum-t.k13,k2,sf1.de Bapt.bg2,br1,k,tl1 Bell.a1,bg2,k BRY.a1,h1,hr1,k calad.k,k2 calc-sil.k2 chel.k Cic.hr1,kr1 Colch.a1,k convo-s.jl,sp1 Crot-h.hr1,k dor.a1,k gels.hr1,k hell.k Hep.hr1,k HYOS.bg2,hr1,k Iriskr1 kali-br.k kali-cy.a1 Lach.hr1,k Lyc.hr1,k Merc.a1,hr1,k Mur-ac.k,tl1 nat-m.hr1,k nux-v.bg2,k Op.bg2,hr1,k ph-ac.k PHOS.hr1,k raja-s.jl3 Rhus-t.k Sec.a1,k STRAM.a1,bg2,hr1,k Sulph.hr1,kr1 Tab.k Tarax.hr1,k Ter.hr1,k Verat Muttering - himself, to: bell.a1,k hyos.hr1,k rhus-t.k tab.a1,k tarax.ptk1 Muttering - sleep, in:ant-t.hr1,k ars.a1,k bry.hr1,k Gels, sulph Noisy: agar.bg2 Bell.a1,k Camph.k Hyos.a1,k STRAM, verat Well, declares she is: apisk Arn.hr1,k Ars.hr1,k op	Recognizes no one: agar.hr1,kr1,tl1 AIL.hr1,kr1,tl1 bell.a1,k calad.k hyos.k merc.a1,k nux-v.k op.k stram.a1,k tab.k verat.k Recognizes no one - throws wine and medicine at nurse: agar Same subject all the time; talking about the: petr Repeats the same sentence: camph	Scolding: chr-ac.hr1,kr1 hyos.k merc.a1,k stram.a1,k verat-v Imperious: lyc Blames himself for his folly: op Reproachful: hyos.k lyc Alternating with - lamenting: bell

MIND - DELIRIUM - gay, cheerful

acon._bg2,k agar._k agath-a._nl2 ant-t._kr1 aur._k Bell._k,bg2 cact._k cann-s._k con._k hyos._k lact._k op._k,bg2 Stram._k sulph._k,bg2 verat._k,bg2

MIND - DELIRIUM - gay, cheerful - alternating with - sadness: agar._k

MIND - DELIRIUM - gay, cheerful - alternating with - singing: stram._k

MIND - DELIRIUM - groping as if in dark: plbMIND - DELIRIUM - shy, hides himself: STRAM

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