Delirium diagnostic criteria: Difference between revisions
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{{Delirium}} | {{Delirium}} | ||
{{CMG}}; {{AE}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com]; {{AZ}}; {{JH}} | {{CMG}}; {{AE}} {{Sara.Zand}} {{PB}}; [[User:Vishal Khurana|Vishal Khurana]], M.B.B.S., M.D. [mailto:vishdoc24@gmail.com]; {{AZ}}; {{JH}} | ||
==Overview== | ==Overview== | ||
The DSM V, and ICD-10 have provided diagnostic criteria for delirium. | The DSM V, and ICD-10 have provided diagnostic criteria for [[delirium]]. Definition based on [[DSM-5]] include disturbance in [[attention]] and [[awareness]] (reduced ability to direct, focus, shift [[attention]] and reduced [[orientation]] to [[envinment]]), initiation of disturbance over a short period of [[time]] during several hours or days with fluctuation in severity over a day, disturbance in [[cognition]] ([[memory deficit]], [[disorientation]], [[language]], [[visuospatial]] ability, [[perception, disturbance other than evolving [[neurocognitive]] disorder, disturbance due to [[medical]] [[condition]], [[substance intoxication]], or withdrawal. Other definitions of [[delirium]] include disturbance in [[cognition]], | ||
impairment of [[immediate recall]] and [[recent memory]], [[disorientation]] to [[time]], [[place]], [[person]], disturbance in [[sleep wake]] cycle, [[Psychomotor disturbances]],[[emotional disturbances]] in a period of less than 6 months. | |||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
===DSM-V Diagnostic Criteria for Paranoid Personality Disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ===DSM-V Diagnostic Criteria for [[Paranoid]] Personality Disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ||
*A. A disturbance in attention ( | *A. A disturbance in [[attention]] ( reduced ability to direct, focus, sustain, and shift [[attention]]) and [[awareness]] (reduced [[orientation]] to the [[environment]]) | ||
: '''''AND''''' | : '''''AND''''' | ||
*B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day. | *B. The disturbance develops over a short period of [[time]] (usually hours to a few days), represents a change from baseline [[attention]] and [[awareness]], and tends to fluctuate in severity during the course of a day. | ||
: '''''AND''''' | : '''''AND''''' | ||
*C. An additional disturbance in cognition ( | *C. An additional disturbance in [[cognition]] ([[memory]] deficit, [[disorientation]], [[language]], [[visuospatial]] ability, or [[perception]]) | ||
: '''''AND''''' | : '''''AND''''' | ||
*D. The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma. | *D. The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving [[neurocognitive]] disorder and do not occur in the context of a severely reduced level of arousal, such as [[coma]]. | ||
: '''''AND''''' | : '''''AND''''' | ||
*E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal ( | *E. There is evidence from the [[history]], [[physical examination]], or [[laboratory]] findings that the [[disturbance ]] is a direct physiological consequence of another medical [[condition]], substance [[intoxication]] or [[withdrawal]] ( due to a drug of [[abuse]] or to a [[medication]]), or exposure to a [[toxin]], or is due to multiple [[etiologies]]. | ||
Specify whether: | Specify whether: | ||
: '''Substance intoxication delirium:''' This diagnosis should be made instead of | : ''' Substance [[intoxication]] [[delirium]]:''' This diagnosis should be made instead of substance [[intoxication]] when the [[symptoms]] in Criteria A and C predominate in the [[clinical]] picture and when they are sufficiently severe to warrant [[clinical]] attention. | ||
: '''''OR''''' | : '''''OR''''' | ||
: '''Substance withdrawal delirium:''' This diagnosis should be made instead of | : ''' [[Substance]] withdrawal [[delirium]]:''' This diagnosis should be made instead of substance withdrawal when the symptoms in Criteria A and C predominate in the clinical picture and when they are sufficiently severe to warrant [[clinical]] attention. | ||
: '''''OR''''' | : '''''OR''''' | ||
: '''Medication-induced delirium:''' This diagnosis applies when the symptoms in Criteria A and C arise as a side effect of a medication taken as prescribed. | : ''' [[Medication]]-induced [[delirium]]:''' This diagnosis applies when the symptoms in Criteria A and C arise as a side effect of a [[medication]] taken as prescribed. | ||
: '''''OR''''' | : '''''OR''''' | ||
: '''Delirium due to another medical condition:''' There is evidence from the history, physical examination, or laboratory findings that the disturbance is attributable to the physiological consequences of another medical condition. | : '''[[Delirium]] due to another medical [[condition]]:''' There is evidence from the [[history]], [[physical examination]], or laboratory findings that the disturbance is attributable to the [[physiological]] consequences of another [[medical]] [[condition]]. | ||
: '''''OR''''' | : '''''OR''''' | ||
: '''Delirium due to multiple etiologies:''' There is evidence from the history, physical examination, or laboratory findings that the delirium has more than one etiology (e.g. more than one etiological medical condition; another medical condition plus substance intoxication or medication side effect). | : '''[[Delirium]] due to multiple etiologies:''' There is evidence from the [[history]], [[physical examination]], or [[laboratory findings]] that the [[delirium]] has more than one etiology (e.g. more than one etiological [[medical condition]]; another [[medical condition]] plus substance intoxication or [[medication]] side effect). | ||
Specify if: | Specify if: | ||
| Line 56: | Line 57: | ||
Specify if: | Specify if: | ||
: '''Hyperactive:''': The individual has a hyperactive level of psychomotor activity that may be accompanied by mood lability, agitation, and/or refusal to cooperate with medical care. | : '''Hyperactive:''': The individual has a hyperactive level of [[psychomotor]] activity that may be accompanied by [[mood lability]], [[agitation]], and/or refusal to cooperate with [[medical care]]. | ||
: '''''OR''''' | : '''''OR''''' | ||
: '''Hypoactive:''': The individual has a hypoactive level of psychomotor activity that may be accompanied by sluggishness and lethargy that approaches stupor. | : '''[[Hypoactive]]:''': The individual has a hypoactive level of psychomotor activity that may be accompanied by sluggishness and [[lethargy]] that approaches [[stupor]]. | ||
: '''''OR''''' | : '''''OR''''' | ||
: '''Mixed level of activity | : '''Mixed level of activity'': The individual has a normal level of [[psychomotor]] activity even though attention and awareness are disturbed. Also includes individuals whose activity level rapidly [[fluctuates]]. | ||
===ICD-10 Diagnostic Criteria=== | ===ICD-10 Diagnostic Criteria=== | ||
To make a definite diagnosis, symptoms (mild, moderate or severe) must be present in the following criteria | To make a definite diagnosis, symptoms (mild, moderate, or severe) must be present in the following criteria: | ||
# Curtailment in the consciousness and consciousness (as a result of | # Curtailment in the [[consciousness]] and [[consciousness]] (as a result of clouding to coma; ( inability to direct, keep, transfer focus) | ||
# Universal | # Universal disruption in faculties of [[cognition]] (clouding of [[perception]], [[illusions]], and [[hallucinations]]— mostly visual; clouding of [[abstract thinking ]] and [[comprehension]], may or may not be accompanied by [[delusions]], some degree of incoherence is likely to be present; the reduced ability of immediate recall and of [[disturbance]] in the recent [[memory]] and relatively intact remote [[memory]]; lack of [[orientation]] to time and in more severe cases, to [[place]] and [[person]]) | ||
# Impairment in psychomotor | # Impairment in [[psychomotor]] activity (increased or decreased, which may shift from increased to decreased activity; raised reaction time; change in the flow of [[speech]], and an enhanced startle reaction) | ||
# Disruption of the sleep - wake cycle (which may range from | # Disruption of the [[sleep-wake cycle]] (which may range from complete loss of sleep, [[insomnia]] or reversal of the sleep - wake cycle; [[drowsiness]] during the day, [[nocturnal]] worsening of [[symptoms]], [[nightmares]], sometimes continuing as [[hallucinations]] after waking up) | ||
# Disruption in emotional state , e.g. depressed mood, [[apathy]] to [[euphoria]], [[anxiety]] or fear, [[irritability]], or wondering perplexity.<ref>{{Cite web | last = | first = | title = Delirium in elderly people. [Lancet. 2013] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/23992774 | publisher = | date = | accessdate =}}</ref> | # Disruption in [[emotional]] state , e.g. depressed [[mood]], [[apathy]] to [[euphoria]], [[anxiety]] or fear, [[irritability]], or wondering perplexity.<ref>{{Cite web | last = | first = | title = Delirium in elderly people. [Lancet. 2013] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/23992774 | publisher = | date = | accessdate =}}</ref> | ||
==Diagnosis in ICU== | ==Diagnosis in ICU== | ||
Patients admitted in the ICU should be screened for delirium twice a day. | *[[Patients]] admitted in the [[ICU]] should be screened for delirium twice a day. | ||
====Confusion Assessment Method for the ICU (CAM-ICU)==== | * The two most widely used are the [[Confusion]] Assessment Method for the [[ICU]] (CAM-ICU) and the [[Intensive Care]] [[Delirium]] Screening Checklist (ICDSC)..<ref name=Ely2001>{{cite journal |author=Ely EW |title=Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU) |journal=JAMA |volume=286 |issue=21 |pages=2703–10 |date=December 2001 |pmid=11730446|doi=10.1001/jama.286.21.2703 |url=http://jama.ama-assn.org/content/286/21/2703.long |author-separator=, |author2=Inouye SK |author3=Bernard GR |display-authors=3 |last4=Gordon |first4=S |last5=Francis |first5=J |last6=May |first6=L |last7=Truman |first7=B |last8=Speroff |first8=T |last9=Gautam |first9=S}}</ref><ref name=Bergeron2001>{{cite journal |author=Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y |title=Intensive Care Delirium Screening Checklist: evaluation of a new screening tool |journal=Intensive Care Med |volume=27 |issue=5 |pages=859–64|date=May 2001 |pmid=11430542 |doi=10.1007/s001340100909}}</ref> <ref name="icudelirium" / | ||
Patient is accessed on following 4 features | *> 75% of ICU [[delirium ]] may be missed by caregivers without these tools, which in-turn may increase duration of [[delirium]]<ref>{{cite journal|last=Jones|first=SF|coauthors=Pisani, MA|title=ICU delirium: an update.|journal=Current opinion in critical care|date=April 2012|volume=18|issue=2|pages=146–51|pmid=22322260|doi=10.1097/MCC.0b013e32835132b9}}</ref> | ||
* These tools can be easily administered at bedside by [[caregivers]], even if patient is not able to follow commands<ref name=icudelirium>{{cite web|last=Ely, E.W., et al|title=ICU Delirium and Cognitive Impairment Study Group|url=http://www.icudelirium.org|accessdate= }}</ref> | |||
* This has resulted in focused care and better outcomes to patients suffering from [[delirium]]. | |||
====[[Confusion]] Assessment Method for the [[ICU ]] (CAM-ICU)==== | |||
[[Patient]] is accessed on following 4 features: | |||
# Onset of symptoms, is acute(change from baseline) or fluctuating as calibrated by Richmond Agitation Sedation Scale or Glasgow Coma Scale | # Onset of symptoms, is acute(change from baseline) or fluctuating as calibrated by Richmond Agitation Sedation Scale or Glasgow Coma Scale | ||
# Inability to focus as measured by Attention Screening Examination | # Inability to focus as measured by [[Attention ]] Screening Examination | ||
# Thinking is not organized | # [[Thinking]] is not organized | ||
# Altered level of consciousness if Vigilant, Lethargic, Stupor, Coma | # Altered level of [[consciousness]] if [[Vigilant]], [[Lethargic]], [[Stupor]], [[Coma]] | ||
If feature 1 and 2 are present along with 3 or 4 then patient is assessed to have delirium by CAM-ICU scale. | If feature 1 and 2 are present along with 3 or 4 then [[patient]] is assessed to have [[delirium ]] by [[CAM-ICU]] scale.<ref name="pmid28263192">{{cite journal |vauthors=Khan BA, Perkins AJ, Gao S, Hui SL, Campbell NL, Farber MO, Chlan LL, Boustani MA |title=The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU |journal=Crit Care Med |volume=45 |issue=5 |pages=851–857 |date=May 2017 |pmid=28263192 |pmc=5392153 |doi=10.1097/CCM.0000000000002368 |url=}}</ref> | ||
====Intensive Care Delirium Screening Checklist (ICDSC)==== | ====Intensive Care [[Delirium ]] Screening Checklist (ICDSC)==== | ||
The criteria of the scoring system: | The criteria of the scoring system: | ||
# Inability to focus | # Inability to [[focus]] | ||
# Altered level of consciousness | # Altered level of [[consciousness]] | ||
# Not oriented to time, place and person | # Not oriented to time, place and person | ||
# [[Hallucination]]/ delusions/ psychosis | # [[Hallucination]]/ delusions/ psychosis | ||
| Line 93: | Line 98: | ||
# Speech or mood is not appropriate | # Speech or mood is not appropriate | ||
# Disturbance in sleep-awake cycle | # Disturbance in sleep-awake cycle | ||
# Fluctuation of symptoms. | # [[Fluctuation]] of symptoms. | ||
The interpretation of the scoring system: | The interpretation of the scoring system: | ||
*A score of ≥ 4 is considered positive for the delirium | *A score of ≥ 4 is considered positive for the delirium | ||
*Score more than 4 shows severity. | *Score more than 4 shows severity. | ||
*Scores between 1 and 3 is termed as | *Scores between 1 and 3 is termed as Subsyndromal [[Delirium]].<ref name="pmid29537480">{{cite journal |vauthors=Boettger S, Garcia Nuñez D, Meyer R, Richter A, Rudiger A, Schubert M, Jenewein J |title=Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): a re-evaluation of the threshold for delirium |journal=Swiss Med Wkly |volume=148 |issue= |pages=w14597 |date=2018 |pmid=29537480 |doi=10.4414/smw.2018.14597 |url=}}</ref><ref name="Reade-2014">{{Cite journal | last1 = Reade | first1 = MC. | last2 = Finfer | first2 = S. | title = Sedation and delirium in the intensive care unit. | journal = N Engl J Med | volume = 370 | issue = 5 | pages = 444-54 | month = Jan | year = 2014 | doi = 10.1056/NEJMra1208705 | PMID = 24476433 }}</ref> | ||
==Screening Instruments== | ==Screening Instruments== | ||
Most screening tools are designed in way nursing staff can use | Most screening tools are designed in a way [[ nursing]] staff can use them, as an availability of [[physician]] can be an issue.<ref name="pmid24175169">{{cite journal |vauthors=Grover S, Kate N |title=Assessment scales for delirium: A review |journal=World J Psychiatry |volume=2 |issue=4 |pages=58–70 |date=August 2012 |pmid=24175169 |pmc=3782167 |doi=10.5498/wjp.v2.i4.58 |url=}}</ref> | ||
:* Clinical Assessment of Confusion–A (CAC-A) | :* Clinical Assessment of Confusion–A (CAC-A) | ||
:* Confusion Rating Scale (CRS) | :*[[ Confusion]] Rating Scale (CRS) | ||
:* MCV Nursing Delirium Rating Scale (MCV-NDRS) | :* MCV Nursing Delirium Rating Scale (MCV-NDRS) | ||
:* NEECHAM Confusion Scale. | :* NEECHAM [[Confusion]] Scale. | ||
===Lay Interviewers and for Epidemiological Studies=== | ===Lay Interviewers and for Epidemiological Studies=== | ||
:* Delirium Symptom Interview(DSI). | :* [[Delirium]] Symptom Interview(DSI). | ||
===Delirium Diagnostic Instruments=== | ===[[Delirium]] Diagnostic Instruments=== | ||
:* Confusion Assessment Method (CAM) | :*[[ Confusion]] Assessment Method (CAM) | ||
:* Delirium Scale (Dscale) | :* [[Delirium]] Scale (Dscale) | ||
:* Global Accessibility Rating Scale (GARS) | :* Global Accessibility Rating Scale (GARS) | ||
:* Organic Brain Syndrome Scale (OBS) | :* Organic [[Brain]] Syndrome Scale (OBS) | ||
:* Saskatoon Delirium Checklist (SDC). | :* Saskatoon [[Delirium]] Checklist (SDC).<ref name="pmid33098368">{{cite journal |vauthors=Beishuizen SJ, Festen S, Loonstra YE, van der Werf HW, de Rooij SE, van Munster BC |title=Delirium, functional decline and quality of life after transcatheter aortic valve implantation: An explorative study |journal=Geriatr Gerontol Int |volume=20 |issue=12 |pages=1202–1207 |date=December 2020 |pmid=33098368 |pmc=7756254 |doi=10.1111/ggi.14064 |url=}}</ref> | ||
===Delirium Symptom Severity Rating Scales=== | |||
Often based both on behavioral symptoms and on confusion and cognitive impairment. They may be useful for monitoring the effect of an intervention or plotting the course of a delirium over time. These scales have also been used for the diagnosis of delirium. | ===[[Delirium]] Symptom Severity Rating Scales=== | ||
:* Delirium Rating Scale (DRS) | Often based both on behavioral symptoms and on [[confusion]] and [[cognitive]] impairment. They may be useful for monitoring the effect of an intervention or plotting the course of a [[delirium]] over time. These scales have also been used for the diagnosis of [[delirium]]. | ||
:* [[Delirium]] Rating Scale (DRS)<ref name="pmid11449030">{{cite journal |vauthors=Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N |title=Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium |journal=J Neuropsychiatry Clin Neurosci |volume=13 |issue=2 |pages=229–42 |date=2001 |pmid=11449030 |doi=10.1176/jnp.13.2.229 |url=}}</ref> | |||
:* [[Memorial]] [[Delirium]] Assessment Scale (MDAS) | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 08:27, 22 April 2021
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Delirium Microchapters |
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Diagnosis |
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Treatment |
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Delirium On the Web |
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American Roentgen Ray Society Images of Delirium |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]; Ahmed Zaghw, M.D. [5]; Jesus Rosario Hernandez, M.D. [6]
Overview
The DSM V, and ICD-10 have provided diagnostic criteria for delirium. Definition based on DSM-5 include disturbance in attention and awareness (reduced ability to direct, focus, shift attention and reduced orientation to envinment), initiation of disturbance over a short period of time during several hours or days with fluctuation in severity over a day, disturbance in cognition (memory deficit, disorientation, language, visuospatial ability, [[perception, disturbance other than evolving neurocognitive disorder, disturbance due to medical condition, substance intoxication, or withdrawal. Other definitions of delirium include disturbance in cognition, impairment of immediate recall and recent memory, disorientation to time, place, person, disturbance in sleep wake cycle, Psychomotor disturbances,emotional disturbances in a period of less than 6 months.
Diagnostic Criteria
DSM-V Diagnostic Criteria for Paranoid Personality Disorder[1]
- A. A disturbance in attention ( reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment)
- AND
- B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.
- AND
- C. An additional disturbance in cognition (memory deficit, disorientation, language, visuospatial ability, or perception)
- AND
- D. The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.
- AND
- E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal ( due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.
Specify whether:
- Substance intoxication delirium: This diagnosis should be made instead of substance intoxication when the symptoms in Criteria A and C predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.
- OR
- Substance withdrawal delirium: This diagnosis should be made instead of substance withdrawal when the symptoms in Criteria A and C predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.
- OR
- Medication-induced delirium: This diagnosis applies when the symptoms in Criteria A and C arise as a side effect of a medication taken as prescribed.
- OR
- Delirium due to another medical condition: There is evidence from the history, physical examination, or laboratory findings that the disturbance is attributable to the physiological consequences of another medical condition.
- OR
- Delirium due to multiple etiologies: There is evidence from the history, physical examination, or laboratory findings that the delirium has more than one etiology (e.g. more than one etiological medical condition; another medical condition plus substance intoxication or medication side effect).
Specify if:
- Acute: Lasting a few hours or days.
- OR
- Persistent: Lasting weeks or months.
Specify if:
- Hyperactive:: The individual has a hyperactive level of psychomotor activity that may be accompanied by mood lability, agitation, and/or refusal to cooperate with medical care.
- OR
- Hypoactive:: The individual has a hypoactive level of psychomotor activity that may be accompanied by sluggishness and lethargy that approaches stupor.
- OR
- 'Mixed level of activity: The individual has a normal level of psychomotor activity even though attention and awareness are disturbed. Also includes individuals whose activity level rapidly fluctuates.
ICD-10 Diagnostic Criteria
To make a definite diagnosis, symptoms (mild, moderate, or severe) must be present in the following criteria:
- Curtailment in the consciousness and consciousness (as a result of clouding to coma; ( inability to direct, keep, transfer focus)
- Universal disruption in faculties of cognition (clouding of perception, illusions, and hallucinations— mostly visual; clouding of abstract thinking and comprehension, may or may not be accompanied by delusions, some degree of incoherence is likely to be present; the reduced ability of immediate recall and of disturbance in the recent memory and relatively intact remote memory; lack of orientation to time and in more severe cases, to place and person)
- Impairment in psychomotor activity (increased or decreased, which may shift from increased to decreased activity; raised reaction time; change in the flow of speech, and an enhanced startle reaction)
- Disruption of the sleep-wake cycle (which may range from complete loss of sleep, insomnia or reversal of the sleep - wake cycle; drowsiness during the day, nocturnal worsening of symptoms, nightmares, sometimes continuing as hallucinations after waking up)
- Disruption in emotional state , e.g. depressed mood, apathy to euphoria, anxiety or fear, irritability, or wondering perplexity.[2]
Diagnosis in ICU
- Patients admitted in the ICU should be screened for delirium twice a day.
- The two most widely used are the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC)..[3][4]
- These tools can be easily administered at bedside by caregivers, even if patient is not able to follow commands[5]
- This has resulted in focused care and better outcomes to patients suffering from delirium.
Confusion Assessment Method for the ICU (CAM-ICU)
Patient is accessed on following 4 features:
- Onset of symptoms, is acute(change from baseline) or fluctuating as calibrated by Richmond Agitation Sedation Scale or Glasgow Coma Scale
- Inability to focus as measured by Attention Screening Examination
- Thinking is not organized
- Altered level of consciousness if Vigilant, Lethargic, Stupor, Coma
If feature 1 and 2 are present along with 3 or 4 then patient is assessed to have delirium by CAM-ICU scale.[6]
Intensive Care Delirium Screening Checklist (ICDSC)
The criteria of the scoring system:
- Inability to focus
- Altered level of consciousness
- Not oriented to time, place and person
- Hallucination/ delusions/ psychosis
- Psychomotor agitation
- Speech or mood is not appropriate
- Disturbance in sleep-awake cycle
- Fluctuation of symptoms.
The interpretation of the scoring system:
- A score of ≥ 4 is considered positive for the delirium
- Score more than 4 shows severity.
- Scores between 1 and 3 is termed as Subsyndromal Delirium.[7][8]
Screening Instruments
Most screening tools are designed in a way nursing staff can use them, as an availability of physician can be an issue.[9]
Lay Interviewers and for Epidemiological Studies
- Delirium Symptom Interview(DSI).
Delirium Diagnostic Instruments
Delirium Symptom Severity Rating Scales
Often based both on behavioral symptoms and on confusion and cognitive impairment. They may be useful for monitoring the effect of an intervention or plotting the course of a delirium over time. These scales have also been used for the diagnosis of delirium.
References
- ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ "Delirium in elderly people. [Lancet. 2013] - PubMed - NCBI".
- ↑ Ely EW; Inouye SK; Bernard GR; et al. (December 2001). "Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU)". JAMA. 286 (21): 2703–10. doi:10.1001/jama.286.21.2703. PMID 11730446. Unknown parameter
|author-separator=ignored (help) - ↑ Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (May 2001). "Intensive Care Delirium Screening Checklist: evaluation of a new screening tool". Intensive Care Med. 27 (5): 859–64. doi:10.1007/s001340100909. PMID 11430542.
- ↑ Ely, E.W.; et al. "ICU Delirium and Cognitive Impairment Study Group".
- ↑ Khan BA, Perkins AJ, Gao S, Hui SL, Campbell NL, Farber MO, Chlan LL, Boustani MA (May 2017). "The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU". Crit Care Med. 45 (5): 851–857. doi:10.1097/CCM.0000000000002368. PMC 5392153. PMID 28263192.
- ↑ Boettger S, Garcia Nuñez D, Meyer R, Richter A, Rudiger A, Schubert M, Jenewein J (2018). "Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): a re-evaluation of the threshold for delirium". Swiss Med Wkly. 148: w14597. doi:10.4414/smw.2018.14597. PMID 29537480.
- ↑ Reade, MC.; Finfer, S. (2014). "Sedation and delirium in the intensive care unit". N Engl J Med. 370 (5): 444–54. doi:10.1056/NEJMra1208705. PMID 24476433. Unknown parameter
|month=ignored (help) - ↑ Grover S, Kate N (August 2012). "Assessment scales for delirium: A review". World J Psychiatry. 2 (4): 58–70. doi:10.5498/wjp.v2.i4.58. PMC 3782167. PMID 24175169.
- ↑ Beishuizen SJ, Festen S, Loonstra YE, van der Werf HW, de Rooij SE, van Munster BC (December 2020). "Delirium, functional decline and quality of life after transcatheter aortic valve implantation: An explorative study". Geriatr Gerontol Int. 20 (12): 1202–1207. doi:10.1111/ggi.14064. PMC 7756254 Check
|pmc=value (help). PMID 33098368 Check|pmid=value (help). - ↑ Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N (2001). "Validation of the Delirium Rating Scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium". J Neuropsychiatry Clin Neurosci. 13 (2): 229–42. doi:10.1176/jnp.13.2.229. PMID 11449030.