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Ray's Web Encyclopedia of Mental Health

 

 

The ICD-10 Classification of Mental and Behavioural Disorders
World Health Organization, Geneva, 1992

Delirium

 


F05 Delirium, Not Induced By Alcohol And Other Psychoactive Substances

An etiologically nonspecific syndrome characterized by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion, and the sleep-wake cycle. It may occur at any age but is most common after the age of 60 years. The delirious state is transient and of fluctuating intensity; most cases recover within 4 weeks or less. However, delirium lasting, with fluctuations, for up to 6 months is not uncommon, especially when arising in the course of chronic liver disease, carcinoma, or subacute bacterial endocarditis. The distinction that is sometimes made between acute and subacute delirium is of little clinical relevance; the condition should be seen as a unitary syndrome of variable duration and severity ranging from mild to very severe. A delirious state may be superimposed on, or progress into, dementia.

This category should not be used for states of delirium associated with the use of psychoactive drugs specified in F10-F19. Delirious states due to prescribed medication (such as acute confusional states in elderly patients due to antidepressants) should be coded here. In such cases, the medication concerned should also be recorded by means of an additional T code from Chapter XIX of ICD-10.

 

Diagnostic Guidelines

For a definite diagnosis, symptoms, mild or severe, should be present in each one of the following areas:

(a) impairment of consciousness and attention (on a continuum from clouding to coma; reduced ability to direct, focus, sustain, and shift attention);

(b) global disturbance of cognition (perceptual distortions, illusions and hallucinations - most often visual; impairment of abstract thinking and comprehension, with or without transient delusions, but typically with some degree of incoherence; impairment of immediate recall and of recent memory but with relatively intact remote memory; disorientation for time as well as, in more severe cases, for place and person);

(c) psychomotor disturbances (hypo- or hyperactivity and unpredictable shifts from one to the other; increased reaction time; increased or decreased flow of speech; enhanced startle reaction);

(d) disturbance of the sleep-wake cycle (insomnia or, in severe cases, total sleep loss or reversal of the sleep-wake cycle; daytime drowsiness; nocturnal worsening of symptoms; disturbing dreams or nightmares, which may continue as hallucinations after awakening);

(e) emotional disturbances, e.g. depression, anxiety or fear, irritability, euphoria, apathy, or wondering perplexity.

The onset is usually rapid, the course diurnally fluctuating, and the total duration of the condition less than 6 months. The above clinical picture is so characteristic that a fairly confident diagnosis of delirium can be made even if the underlying cause is not clearly established. In addition to a history of an underlying physical or brain disease, evidence of cerebral dysfunction (e.g. an abnormal electroencephalogram, usually but not invariably showing a slowing of the background activity) may be required if the diagnosis is in doubt.

Includes:
* acute brain syndrome acute confusional state (nonalcoholic)
* acute infective psychosis
* acute organic reaction
* acute psycho-organic syndrome

Differential Diagnosis
Delirium should be distinguished from other organic syndromes, especially dementia (F00-F03) from acute and transient psychotic disorders (F23.-), and from acute states in schizophrenia (F20.-) or mood [affective] disorders (F30-F39) in which confusional features may be present. Delirium, induced by alcohol and other psychoactive substances, should be coded in the appropriate section (F1x.4).

 


F05.0 Delirium, Not Superimposed On Dementia, So Described

This code should be used for delirium that is not superimposed upon pre-existing dementia.

 


F05.1 Delirium, Superimposed On Dementia

This code should be used for conditions meeting the above criteria but developing in the course of a dementia (F00-F03).

 


F05.8 Other Delirium

Includes:
* delirium of mixed origin
* subacute confusional state or delirium


ICD-10 copyright 1992 by World Health Organization.
AZ Psychiatry copyright (www.azpsychiatry.info) by Dr. Manaan Kar Ray