The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer.
The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer.
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DOI：
10.1186/s12916-014-0141-2
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发表时间：
2014-10-08
期刊：
影响因子：
9.3
通讯作者：
American Delirium Society
中科院分区：
文献类型：
--
作者：
European Delirium Association;American Delirium Society
精神错乱是严重不适人群中常见而严重的问题。尽管与更高的死亡率、住院和痴呆症有关，但它仍然被低估了。仔细考虑它的现象学是有必要的，以提高检测，从而减轻其临床影响。《美国精神病学协会诊断和统计手册》(DSM-5)第五版的出版为我们提供了一个机会来研究作为临床实体的精神错乱的潜在结构。意识改变一直被认为是精神错乱的核心特征；由于急性疾病，意识本身应该受到生理上的干扰，这一事实证明了它的临床紧迫性。DSM-5现在将“意识”操作为“注意力的变化”。应该认识到，注意力与意识的内容有关，但唤醒与意识的水平相对应。性欲降低也与不良后果有关。注意力和唤醒是有等级关系的；唤醒的程度必须足够，才能对注意力进行合理的测试。我们对精神错乱的概念必须超越通过认知测试(注意力)可以评估的范围，并接受改变的唤醒是根本的。以这种方式明确理解DSM-5标准提供了最具包容性和临床安全性的解释。
Delirium is a common and serious problem among acutely unwell persons. Alhough 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. 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. 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.