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A troop of newly graduated recruits parades on final review. The march past is a portrait of symmetry, save for one young soldier, whose mother nevertheless beams from the stands: “Look! They’re all out of step but my boy John”. Such misplaced parental pride finds a modern day counterpart in the routine exhortation by delirium specialists—including ourselves—for other physicians to get in step with the expert when assessing the mental state of their patients. While physician education is important, part of the pervasive under recognition of delirium must reflect the teaching—that is, how delirium is described and discussed. Here we review some current thinking about what constitutes delirium, propose an alternate operational approach and consider some implications of this synthesis.
THE CURRENT DEFINITION OF DELIRIUM AND SOME ANTECEDENTS
Can it still make sense to ask “what is delirium”? The fourth edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association1 defines delirium as a disturbance of consciousness and a change in cognition that develops acutely (table 1).
Support for delirium as a …
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