Reference Standard for Delirium: DSM-5 Criteria
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DSM-5 Criteria
A) Disturbance in attention and awareness
- Attention: ie, reduced ability to direct, focus, sustain, and shift attention.
- Awareness: ie, reduced orientation to the environment.
B) Develops over a short period (hours to days)
- The disturbance develops over a short period of time (usually hours to a few days)
- Signifies acute change from baseline attention and awareness.
- Tends to fluctuate in severity during the course of a day.
C) Additional disturbance in cognition
- memory deficit
- disorientation
- language
- visuospatial ability
- or perception
D) Criteria A and C (attention and cognition)
The disturbances in Criteria A and C are
- not better explained by a pre-existing, established, or evolving neurocognitive disorder
- and do not occur in the context of a severely reduced level of arousal such as coma.
Key Point
Not feasible to perform in most EDs
Delirium is a clinical diagnosis. The reference standard for delirium is considered to be a psychiatrist evaluation using DSM-5 criteria, but it requires significant training to do reliably. A proper delirium evaluation can take approximately 30 to 45 minutes to perform. Therefore, detecting delirium using DSM-5 criteria is not feasible for most ED settings.
References
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth ed. Arlington, VA: American Psychiatric Association; 2013.
Abbreviations
DSM-5, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
ED, emergency department
VA, Virginia