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Evidence for the diagnostic criteria of delirium: an update

Blazer, Dan G.a; van Nieuwenhuizen, Adrienne O.b

Current Opinion in Psychiatry: May 2012 - Volume 25 - Issue 3 - p 239–243
doi: 10.1097/YCO.0b013e3283523ce8
NEUROPSYCHIATRY: Edited by Perminder Sachdev

Purpose of review Since the publication of DSM-III in 1980, the essential criteria for delirium have been reduced progressively through DSM-III-R to DSM-IV. As the field moves toward DSM-V and ICD-11, new data can shed light on the nosological changes that are needed so that diagnostic criteria can reflect empirical data. In this study, we reassess the existing or potential criteria for delirium.

Recent findings Phenomenological studies in recent years have informed the criteria for delirium, including the appropriateness of the term ‘consciousness’ as a core symptom of the diagnosis, additional symptoms of delirium that are frequent but are not currently part of the diagnostic criteria, subsyndromal delirium, motoric subtypes of delirium (hyperactive, hypoactive), and the association of delirium with dementia.

Summary Recent studies suggest that motoric subtypes should be included as a subtype for delirium but that subsyndromal delirium, although a useful research construct, should not be included in clinical diagnostic criteria given the frequent fluctuation in symptoms over short periods. In addition, though the core symptoms are probably adequate to make the diagnosis, clinicians must be aware of the frequency of other symptoms, for symptoms such as profound sleep disturbance or psychotic symptoms may dominate the clinical picture.

aDuke University Medical Center, Durham, North Carolina, USA

bCambridge University Clinical School of Medicine, Cambridge, UK

Correspondence to Dan G. Blazer MD, PhD, JP Gibbons Professor of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3003, Durham, NC 27210, USA. Tel: +1 919 684 4128; fax: +1 919 684 8569; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.