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A comparison of outcomes according to different diagnostic systems for delirium (DSM-5, DSM-IV, CAM, and DRS-R98)

Published online by Cambridge University Press:  14 September 2017

Dimitrios Adamis Open the ORCID record for Dimitrios Adamis [Opens in a new window] ,
David Meagher ,
Siobhan Rooney ,
Owen Mulligan  and
Geraldine McCarthy
Dimitrios Adamis*
Affiliation:
Sligo Mental Health Services, Clarion Rd Sligo, Ireland Research and Academic Institute of Athens, Athens, Greece
David Meagher
Affiliation:
Cognitive Impairment Research Group (CIRG), Limerick, Ireland Graduate-Entry Medical School, University of Limerick, Ireland
Siobhan Rooney
Affiliation:
Sligo Mental Health Services, Clarion Rd Sligo, Ireland
Owen Mulligan
Affiliation:
Sligo Mental Health Services, Clarion Rd Sligo, Ireland
Geraldine McCarthy
Affiliation:
Sligo Medical Academy, NUI Galway and Sligo Mental Health Services, Clarion Rd Sligo, Ireland
*
Correspondence should be addressed to: Dr. Dimitrios Adamis, Consultant Psychiatrist, Sligo Mental Health Services Clarion Rd Sligo, Ireland. Phone: +353719144829; Fax: +353719144177. Email: [email protected].
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Abstract

Studies indicate that DSM-5 criteria for delirium are relatively restrictive, and identify different cases of delirium compared with previous systems. We evaluate four outcomes of delirium (mortality, length of hospital stay, institutionalization, and cognitive improvement) in relation to delirium defined by different DSM classification systems.

Prospective, longitudinal study of patients aged 70+ admitted to medical wards of a general hospital. Participants were assessed up to a maximum of four times during two weeks, using DSM-5 and DSM-IV criteria, DRS-R98 and CAM scales as proxies for DSM III-R and DSM III.

Of the 200 assessed patients (mean age 81.1, SD = 6.5; and 50% female) during hospitalization, delirium was identified in 41 (20.5%) using DSM-5, 45 (22.5%) according to DSM-IV, 46 (23%) with CAM positive, and 37 (18.5%) with DRS-R98 severity score >15. Mortality was significantly associated with delirium according to any classification system, but those identified with DSM-5 were at greater risk. Length of stay was significantly longer for those with DSM-IV delirium. Discharge to a care home was associated only with DRS-R98 defined delirium. Cognitive improvement was only associated with CAM and DSM-IV. Different classification systems for delirium identify populations with different outcomes.

Keywords

deliriumclassificationDSMdiagnosiselderlyoutcome
Type
Brief Report
Information
International Psychogeriatrics , Volume 30 , Issue 4: Issue Theme: Delirium , April 2018 , pp. 591 - 596
Copyright
Copyright © International Psychogeriatric Association 2017 

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Footnotes

Part of this work has been presented in the 18th IPA International Congress San Francisco 2016.

References

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