Differential diagnosis of delirium

• Functional psychotic disorders can mimic the positive features of delirium, such as hallucinations. However, functional psychosis occurs in clear consciousness, and delirium's usual predominance of visual hallucinations would not be typical.

• Stupor due to severe depression or mania can be mistaken for a diminished level of consciousness. However, these states are now rare in developed countries; a gradual onset with worsening symptoms would differentiate from delirium.

• Dementia occurs, except in the terminal stages, in clear consciousness. Marked hallucinations would be unusual in early dementia. The combination of dementia and delirium is frequent in the elderly. Assessment of the relative importance of delirium and dementia may be difficult in the acute situation. However, the position usually declares itself with time.

• Amnestic disorders, such as Korsakov's syndrome, also occur in clear consciousness, but the cognitive deficits are concentrated in short-term memory. Immediate recall (e.g. digit span) is normal in amnestic disorders, and long-term memory is relatively preserved: both are impaired in delirium.

• Sleep disorders (e.g. narcolepsy) and various forms of epilepsy (e.g. the rare petit mal status epilepticus in children) may also need to be excluded.

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