This paper is a continuation of the author's work on the acute confusional state, employing case material from the psychoanalyses of eight adult patients. An attempt is made to recognize elements of the acute confusional state during psychoanalytic treatment and to correlate them with aspects of ego disintegration and reintegration. From previous work the acute confusional state is felt to be a transitory, self-limiting symptom complex occurring when the ego is overwhelmed by demands from internal or external sources. After a review of the literature on confusion and confusional states, four cases are described in some detail, and a series of factors which contribute to its development are discussed and related to anaclitic depression and schizophrenic processes.