From the Research
Flocculation and carphologia are distinct abnormal movements that warrant immediate medical attention, with carphologia being a more severe manifestation associated with advanced delirium, hepatic encephalopathy, or terminal illness. These movements are observed in severely ill patients and differ in their presentation and clinical significance. Flocculation refers to small, irregular picking movements of the bedclothes or nearby objects, typically performed unconsciously by patients with delirium or encephalopathy. Carphologia, also known as "wool-gathering" or "lint-picking," is a more specific form of flocculation where patients appear to be picking at invisible objects in the air or plucking at their bedclothes. According to a study published in Age and ageing 1, carphology and floccillation are uncommon physical signs, but their presence is highly suggestive of delirium, with a sensitivity and specificity of 14 and 98%, respectively. The inpatient mortality rate in patients with carphology/floccillation was double the rate in patients without the behaviors, highlighting the importance of prompt medical attention. When observed, clinicians should perform a thorough neurological assessment, check vital signs, review medications, and assess for metabolic disturbances, infection, or organ failure. Treatment focuses on addressing the underlying cause, which may include correcting metabolic abnormalities, treating infections, or adjusting medications. Key considerations in management include:
- Identifying and treating the underlying cause of delirium or encephalopathy
- Conducting a thorough neurological assessment and reviewing medications
- Assessing for metabolic disturbances, infection, or organ failure
- Providing supportive care and monitoring for complications It is essential to prioritize the patient's morbidity, mortality, and quality of life when managing these abnormal movements, and to consider the latest evidence and guidelines in clinical decision-making.