Delirium classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Pratik Bahekar, MBBS [3]; Vishal Khurana, M.B.B.S., M.D. [4]

Overview

Delirium is classified on the basis of etiology, duration and severity.

Types of Delirium

Delirium may be classified into:

Diagnostic and Statistical Manual (DSM)-5	World Health Organization's International Classification of Diseases (10th revision)	ICD-10
Disturbance in attention and awareness (reduced ability to direct, focus, shift attention and reduced orientation to envinment Initiation of disturbance over a short period of time during several hours or days with fluctuation in severity over a day Disturbance in cognition (memory deficit, disorientation, language, [[visuospatial ability], perception Evolving neurocognitive disorder Disturbance due to medical condition, substance intoxication, or withdrawal, toxin exposure	Disturbance in cognition Impairment of immediate recall and recent memory Disorientation to time, place, person	Disturbance in sleep wake cycle Psychomotor disturbances Emotional disturbances Upper limit time: 6 months
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Classification based on	Types
Etiology	Substance intoxication delirium
	Substance withdrawal delirium
	Delirium caused by another medical condition
	Delirium caused by multiple etiologies
Duration	Acute
	Persistent
Severity	Hyperactive
	Hypoactive
	Mixed level of activity

Based on Etiology

• Substance intoxication delirium: Diagnosis of substance intoxication delirium is made rather than substance intoxication, when the symptoms in Criteria A and C predominate and are severe enough to require clinical attention.
• Substance withdrawal delirium: Diagnosis of substance withdrawal delirium is made rather than substance withdrawal, when the symptoms in Criteria A and C predominate and are severe enough to require clinical attention.
• Delirium caused by another medical condition: When delirium is caused by another medical condition.
• Delirium caused by multiple etiologies: Delirium is a consequence of multiple causes e.g. medical condition plus substance intoxication or side effect of medications.

Based on Duration

• Acute: When delirium lasts for a few hours to days.
• Persistent: When delirium lasts for weeks or months.

Based on Severity

• Hyperactive: An increased psychomotor activity, which may co-occur with, increased mood lability, agitation, and/or non cooperative attitude towards medical treatment.
• Hypoactive: A hypoactive level of psychomotor activity, which may exist along with increased sluggishness, lethargy or stupor, inattentiveness and motor slowness and is much more common among ICU admitted patients with severe disease.
• Mixed level of activity: A normal level of psychomotor activity, individuals with rapidly fluctuating activity are also included in this category.

Some authors have described a fourth type of delirium called as subsyndromal delirium, which is an incomplete form of delirium.