History

Until the nineteenth century delirium was used to indicate a disorder of thinking, but later there was considerable international confusion about overlapping terminologies. In the English literature it was applied to an organic brain syndrome with impaired consciousness. In contrast, in France délire was originally used to describe a primary disturbance of perception. In 1909 Bonhoeffer defined delirium as a clinical pattern of acute brain failure. Whilst the complexities of his classification have been abandoned, the central concept of an acute organic syndrome has been retained. It has often been seen as having several subtypes according to the degree of behavioural disturbance and psychotic symptoms. In clinical practice, during most of this century, the word delirium has generally been reserved for patients exhibiting disturbed overactive behaviour, often with pronounced visual hallucinations. (P

An important change was introduced in DSM-III, in which delirium was used to cover all types of acute disturbance of consciousness with general impairment of cognition, whether or not the patient was overactive and disturbed. This is in line with clinical experience that a delirious patient who is disturbed and hallucinating at one moment is often drowsy and inactive shortly later. This change of definition has gained general acceptance, so that both DSM-IV and ICD-10 use delirium in this wider sense. Nevertheless, other misunderstandings and confusions about terminology are common throughout medicine. It is important to emphasize that delirium is the preferred term and that it includes acute organic brain syndrome, acute organic mental disorder, and confusional state. 'Confusion' is best not used to denote delirium since in its lay meaning it may also be applied to patients with dementia, anxiety, severe depression, and other conditions.

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