umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer.
Umeå University, Faculty of Medicine, Department of Nursing.
2014 (English)In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 12Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Delirium is a common and serious problem among acutely unwell persons. Although linked to higher rates of mortality, institutionalisation and dementia, it remains underdiagnosed. Careful consideration of its phenomenology is warranted to improve detection and therefore mitigate some of its clinical impact. The publication of the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) provides an opportunity to examine the constructs underlying delirium as a clinical entity.

DISCUSSION: Altered consciousness has been regarded as a core feature of delirium; the fact that consciousness itself should be physiologically disrupted due to acute illness attests to its clinical urgency. DSM-5 now operationalises 'consciousness' as 'changes in attention'. It should be recognised that attention relates to content of consciousness, but arousal corresponds to level of consciousness. Reduced arousal is also associated with adverse outcomes. Attention and arousal are hierarchically related; level of arousal must be sufficient before attention can be reasonably tested.

SUMMARY: Our conceptualisation of delirium must extend beyond what can be assessed through cognitive testing (attention) and accept that altered arousal is fundamental. Understanding the DSM-5 criteria explicitly in this way offers the most inclusive and clinically safe interpretation.

Place, publisher, year, edition, pages
2014. Vol. 12
Keyword [en]
Delirium, Consciousness, Arousal, Attention, Diagnostic and Statistical Manual of Mental Disorders
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-113775DOI: 10.1186/s12916-014-0141-2PubMedID: 25300023OAI: oai:DiVA.org:umu-113775DiVA: diva2:893798
Available from: 2016-01-13 Created: 2015-12-29 Last updated: 2017-05-10

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Olofsson, Birgitta
By organisation
Department of Nursing
In the same journal
BMC Medicine
Nursing

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 75 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf