Box 41 ICD10 diagnostic criteria for delirium

For a definite diagnosis, symptoms, mild or severe, should be present in each one of the following areas:

1. Impairment of consciousness and attention (on a continuum from clouding to coma; reduced ability to direct, focus, sustain, and shift attention).

2. Global disturbance of cognition (perceptual distortions, illusions, and hallucinations - most often visual; impairment of abstract thinking and comprehension, with or without transient delusions but typically with some degree of incoherence; impairment of immediate recall and of recent memory but with relatively intact remote memory; disorientation for time as well as, in more severe cases, for place and person).

3. Psychomotor disturbances (hypoactivity or hyperactivity and unpredictable shifts from one to the other; increased reaction time; increased or decreased flow of speech; enhanced startle reaction).

4. Disturbance of the sleep-wake cycle (insomnia or, in more severe cases, total sleep loss or reversal of the sleep-wake cycle; daytime drowsiness; nocturnal worsening of symptoms; disturbing dreams or nightmares, which may continue as hallucinations after awakening).

5. Emotional disturbances, for example, depression, anxiety, or fear, irritability, euphoria, apathy, or wondering perplexity.

The onset is usually rapid, the course diurnally fluctuating, and the total duration of the condition less than six months. The above clinical picture is so characteristic that a fairly confident diagnosis of delirium can be made even if the underlying cause is not firmly established. In addition to a history of an underlying physical or brain disease, evidence of cerebral dysfunction (such as an abnormal EEG, usually but not invariably showing a slowing of the background activity) may be required if the diagnosis is in doubt.

between the two have been called into question.12 For instance, abrupt deterioration in cognitive state is typical of vascular dementia. Visual hallucinations and fluctuating cognitive states are typical of Lewy body dementia.13 Also some studies of prognosis of delirium have shown that symptoms can be more prolonged than previously acknowledged.14

In this chapter, symptoms and signs will be defined with regard to their clinical utility in diagnosing delirium. It should be borne in mind, however, that many terms such as "consciousness"15 and "memory"16 are used slightly differently

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