Evidence for the Diagnostic Criteria of Delirium

An Update

Dan G. Blazer; Adrienne O. van Nieuwenhuizen


Curr Opin Psychiatry. 2012;25(3):239-243. 

In This Article

Disturbances of Consciousness as a Core Symptom of Delirium

Delirium is typically characterized as an acute decline in both the level of consciousness and cognition with a particular impairment in attention.[7] DSM-III emphasized the construct 'clouding of consciousness' that was difficult to operationalize. DSM-III-R and DSM-IV de-emphasized 'clouding of consciousness' and emphasized a reduced ability to focus, sustain, or shift attention but maintained a 'disturbance of consciousness' as the overarching term for the core symptom of delirium. Consciousness, however, is the subjective experience or awareness or wakefulness or the executive control system of the mind.[8] It is an umbrella term that may refer to awareness, the ability to experience feelings, wakefulness, having a sense of selfhood, or as the executive control system of the mind.[9] The failure to reach a consensus about what is meant by 'consciousness' has limited its clinical utility. For this reason, the field of psychiatry may be better served by using the DSM-IV's operational terms to describe consciousness, namely awareness/attention. Attention/awareness can be assessed directly by administering simple bedside tests that include asking the patient to count backwards from a specific number, say the days of the week backwards, and say the months of the year backwards.


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