The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer

BMC Medicine

American Delirium Society¹  European Delirium Association¹ 

[1] MRC Unit for Lifelong Health and Ageing, University College London, 33 Bedford Place, London WC1B 5JU, UK

关键词: Diagnostic and Statistical Manual of Mental Disorders;    Attention;    Arousal;    Consciousness;    Delirium;   

Others  :  1121430
DOI  :  10.1186/s12916-014-0141-2

 received in 2014-04-30, accepted in 2014-08-01,  发布年份 2014

【 摘 要 】

Background

Delirium is a common and serious problem among acutely unwell persons. Alhough linked to higher rates of mortality, institutionalisation and dementia, it remains underdiagnosed. Careful consideration of its phenomenology is warranted to improve detection and therefore mitigate some of its clinical impact. The publication of the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) provides an opportunity to examine the constructs underlying delirium as a clinical entity.

Discussion

Altered consciousness has been regarded as a core feature of delirium; the fact that consciousness itself should be physiologically disrupted due to acute illness attests to its clinical urgency. DSM-5 now operationalises ‘consciousness’ as ‘changes in attention’. It should be recognised that attention relates to content of consciousness, but arousal corresponds to level of consciousness. Reduced arousal is also associated with adverse outcomes. Attention and arousal are hierarchically related; level of arousal must be sufficient before attention can be reasonably tested.

Summary

Our conceptualisation of delirium must extend beyond what can be assessed through cognitive testing (attention) and accept that altered arousal is fundamental. Understanding the DSM-5 criteria explicitly in this way offers the most inclusive and clinically safe interpretation.

【 授权许可】

   
2014 European Delirium Association et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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