Example Conditions in Which Capacity Can Fluctuate Because of Treatment Nonadherence
| Condition | Treatment Being Declined | At-Risk Mental State |
|---|---|---|
| Conditions Leading to Delirium-Spectrum States | ||
| Hypertensive urgency or emergency | Antihypertensive, typically parenteral | Hypertensive encephalopathy with or without posterior reversible encephalopathy syndrome |
| Severe infection, especially sepsis | Antibiotics, typically parenteral | Septic encephalopathy |
| Acute or decompensated kidney failure | Renal replacement therapy | Uremic encephalopathy |
| Acute or decompensated liver failure | Lactulose, rifaximin, et al. | Hepatic encephalopathy |
| Brain metastases | Corticosteroids | Increased intracranial pressure presenting with delirium, seizures, or brain herniation |
| Severe chronic obstructive pulmonary disease | Home oxygen | Hypoxic encephalopathy |
| Insulin-dependent diabetes (“brittle diabetes”) | Insulin, dietary discretion | Diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome, either presenting with seizures or delirium |
| Congestive heart failure | Diuretics, fluid discretion | Delirium because of several different electrolyte disturbances |
| Active substance use disorder | A range of potential offerings (e.g., rehabilitation) | Intoxication or withdrawal, either of which could present with delirium |
| Primary Psychiatric Conditions | ||
| Schizophrenia with thought disorganization | Antipsychotic medications | Thought disorganization |
| Psychiatric disorder presenting with catatonia | Lorazepam | Catatonia |