Evidence for the Diagnostic Criteria of Delirium

An Update

Dan G. Blazer; Adrienne O. van Nieuwenhuizen

Disclosures

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

In This Article

The Symptoms of Delirium

In the DSM editions since DSM-III, there has been a steady reduction in the number of symptoms included in the diagnostic criteria for delirium. Now, the challenge is to figure out which symptoms should be included as core diagnostic symptoms and which symptoms merely support, rather than confirm, a diagnosis of delirium. Meagher et al.[10] looked at the frequency of moderate to severe symptoms of delirium. To explore the neuropsychiatric and behavioral symptoms, they assessed that sleep–wake cycle disturbance (73%) was the most common symptom, whereas delusions (9%) were the least common symptom associated with delirium. Within the category of cognitive deficit symptoms, inattention was the symptom most commonly associated with delirium (73%), whereas disorientation (42%) was least commonly associated with it. Other symptoms in these two groups were moderately often associated with delirium, including visuospatial problems (64%), long-term (64%) and short-term (53%) memory problems, psychomotor retardation (37%) and agitation (27%), perceptual disturbances and hallucinations (26%), language disturbance (25%), thought process abnormalities (22%), and lability of affect (18%). Patients with psychosis had either perceptual disturbances or delusions but not both, and neither delusions nor hallucinations were associated with cognitive impairments.

Meagher et al.[11] also found that problems with attention were associated with the severity of other cognitive symptoms, whereas comprehension correlated most closely with noncognitive features of delirium. Delirium may uncover and exacerbate even psychotic symptoms. For example, Charlton and Kavanau[12] suggest that delirium may be a common cause of psychotic symptoms in less severe forms of delirium wherein the actual syndrome of delirium is missed due to the overt predominance of symptoms such as hallucinations, bizarre delusions, and thought disorder. These symptoms may arise due to underlying brain dysfunction such as sleep disturbance.

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