Am J Psychiatry 1991; 148:454-457
Copyright © 1991 by American Psychiatric Association
An empirical study of diagnostic criteria for delirium
B Liptzin, SE Levkoff, PD Cleary, DM Pilgrim, CH Reilly, M Albert and TT Wetle
Division on Aging, Harvard Medical School, Boston, MA.
OBJECTIVE: The objective of this study was to determine empirically how
many patients are identified as delirious or nondelirious according to
DMS-III, DMS-III-R, and ICD-10 criteria. METHOD: Daily, a trained research
assistant using a structured instrument to detect the presence of symptoms
of delirium evaluated 325 elderly patients who were admitted to a general
hospital for acute medical problems. Each patient's symptoms were then
compared with these diagnostic criteria sets to determine if the patient
met criteria for delirium. RESULTS: DSM-III criteria were the most
inclusive: they identified 125 patients as delirious. DSM-III-R identified
a somewhat different group of 106 patients as delirious. ICD-10 criteria
identified only 30 patients as delirious. CONCLUSIONS: The development of
new criteria for delirium (e.g., DSM-IV) will have to balance the need to
define a pure group of patients for research purposes with the need to
include cases of clinical interest. Changes in criteria should be based on
data such as those presented in this paper.
