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


A review of recent literature does not provide compelling evidence that the criteria symptoms for delirium are inadequate in either DSM-IV or ICD-10. What does emerge is that the presentation of delirium is much more complex than made apparent by the symptoms listed in DSM-IV. Recent studies suggest that motoric subtypes should be included as a subtype for delirium but that subsyndromal delirium, although a useful research construct, should not be included in clinical diagnostic criteria, given the frequent fluctuation in symptoms over short periods. Given that delirium fluctuates so dramatically over time, confirming a diagnosis which meets full criteria could depend on when the clinician 'catches' a window period of more severe symptoms. Even so, subsyndromal delirium has emerged as a condition of clinical interest given aggregate studies which predict outcomes that vary from those with full criteria and without symptoms of delirium.

In addition, though the core symptoms are probably adequate to make the diagnosis, clinicians must be aware of the frequency of other symptoms, for symptoms such as profound sleep disturbance or psychotic symptoms may dominate the clinical picture. Focus on these symptoms out of context may lead to a neglect of the underlying core symptoms of delirium. Finally, treating delirium (an acute state) and dementia (a chronic state) as mutually exclusive diagnoses does not do justice to the actual clinical picture, which is often mixed, possibly because these may be pathophysiologically related.


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