Terminology

A general problem in psychiatry has been the complex etymology of clinical terms. This problem has been improved as a result of the move towards operational definitions in both the International Classification of Mental and Behavioural Disorders (ICD10; Box 4.1);7 and the American Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSMIV; Box 4.2).8

"Delirium" is now the accepted term for acute, transient, global, organic disorders of higher nervous system function involving impaired consciousness and attention. It is synonymous with the "acute confusional state" of ICD9,9 which has been replaced, and is also referred to as "acute organic reaction" and "acute brain syndrome". The DSMIV definition has changed markedly (Box 4.2). The aim of the change was to increase the accuracy of diagnosis.10 The new definition emphasises those symptoms most specific to delirium in the medically ill elderly (for example, perceptual disturbances and incoherent speech) instead of those found to be less specific (for example, sleep disturbance and psychomotor change).11

Definitions of delirium remain problematical, particularly with respect to dementia in the elderly. The distinctions

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