International psychogeriatrics
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This paper reviews the historical development of the American Psychiatric Association's Diagnostic and Statistical Manual. It presents some of the issues that the clinician has found difficult in applying DSM-III and DSM-III-R criteria for delirium. In addition it introduces some options for DSM-IV criteria for delirium based on several empirical studies. These options should be studied and debated carefully over the next year because in part, they represent radical departures from existing diagnostic criteria for delirium.
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Over the past several decades, numerous investigators have studied the syndrome of delirium. Researchers have relied on a number of different case finding methods to detect the syndrome. ⋯ We assess the validity and reliability of these instruments and compare the advantages and disadvantages of the different methods. We then present the rationale for the development of the Delirium Symptom Interview, an instrument constructed for use in the Commonwealth-Harvard Study of delirium in elderly hospitalized patients.
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This paper provides a review of research issues and findings on the epidemiology of delirium. Despite the fact that research on this important geriatric syndrome has been conducted for many decades, several methodological issues make it difficult to compare findings across studies. ⋯ A discussion of the design and preliminary results of the Commonwealth-Harvard Study of Delirium in Elderly Hospitalized Patients documents both how we responded to the methodological issues outlined and how these choices influenced our findings. We conclude with a discussion of the needs for further research on the epidemiology of delirium.
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The EEG is a useful and, at times, an essential test in the evaluation of delirium. In most patients with delirium, the EEG will show diffuse slowing and thus is helpful in differentiating organic etiologies from functional, psychiatric disorders. ⋯ Furthermore, the EEG is the only test that can identify an ongoing epileptic state (e.g., nonconvulsive status epilepticus) as being responsible for the clinical picture of confusion. Other electrophysiological tests that may prove helpful in the evaluation of delirium, such as computerized EEG spectral analysis, topographic brain mapping, and sleep studies, are briefly reviewed.