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

ABSTRACTStudies 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.

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Delirium classification by the diagnostic and statistical manual – a moving target

International Psychogeriatrics ◽

10.1017/s1041610215000502 ◽

2015 ◽

Vol 27 (6) ◽

pp. 881-882 ◽

Cited By ~ 4

Author(s):

Karin J. Neufeld

Keyword(s):

Rating Scale ◽

Confusion Assessment Method ◽

Assessment Method ◽

Classification Systems ◽

Diagnostic Systems ◽

Delirium Assessment ◽

Diagnostic And Statistical Manual ◽

Dsm 5 ◽

Medical Inpatients ◽

Dsm Iv

The following paper, entitled “A Comparison of Delirium Diagnosis in Elderly Medical Inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 Criteria” by Adamis and colleagues, reports the results of a single delirium assessment of 200 medical inpatients, aged 70 years and older. The aim was to compare the prevalence of delirium using two different diagnostic classification systems (DSM-5 and DSM-IV) and two commonly used research tools (Confusion Assessment Method and the Delirium Rating Scale-Revised ‘98). This editorial focuses on the comparison of the two versions of the DSM. The authors conclude that, while both diagnostic systems identify a core concept of delirium, the DSM-IV criteria are the most inclusive of the four approaches and the DSM-5, the most restrictive, identifying a prevalence of 19.5% and 13%, respectively in this sample. Furthermore, they conclude that these two systems do not appear to detect the same patients: only 14 of 26 (54%) individuals identified as delirious by the more exclusive DSM-5 criteria were also identified as such by DSM-IV.

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Impact of classification systems (DSM-5, DSM-IV, CAM and DRS-R98) on outcomes of delirium

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.615 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s496-s497

Author(s):

G. McCarthy ◽

D. Meagher ◽

D. Adamis

Keyword(s):

Length Of Stay ◽

Diagnostic Method ◽

Hospital Length ◽

Classification Systems ◽

University Hospital ◽

Hospital Length Of Stay ◽

Discharge Destination ◽

Dsm 5 ◽

Dsm Iv ◽

Prospective Longitudinal

IntroductionPrevious studies showed different classification systems lead to different case identification and rates of delirium. No one has previously investigated the influence of different classification systems on the outcomes of delirium.Aims and objectivesTo determine the influence of DSM-5 criteria vs. DSM-IV on delirium outcomes (mortality, length of stay, institutionalisation) including DSM-III and DSM-IIR criteria, using CAM and DRS-R98 as proxies.MethodologyProspective, longitudinal, observational study of elderly patients 70+ admitted to acute medical wards in Sligo University Hospital. Participants were assessed within 3 days of admission using DSM-5, and DSM-IV criteria, DRS-R98, and CAM scales.ResultsTwo hundred patients [mean age 81.1 ± 6.5; 50% female]. Rates (prevalence and incidence) of delirium for each diagnostic method were: 20.5% (n = 41) for DSM-5; 22.5% (n = 45) for DSM-IV; 18.5% (n = 37) for DRS-R98 and 22.5%, (n = 45) for CAM. The odds ratio (OR) for mortality (each diagnostic method respectively) were: 3.37, 3.11, 2.42, 2.96. Breslow-Day test on homogeneity of OR was not significant x2= 0.43, df: 3, P = 0.93. Those identified with delirium using the DSM-IV, DRS-R98 and CAM had significantly longer hospital length of stay(los) compared to those without delirium but not with those identified by DSM-5 criteria. Re-institutionalisation, those identified with delirium using DSM-5, DSM-IV and CAM did not have significant differences in discharge destination compared to those without delirium, those identified with delirium using DRS-R98 were more likely discharged to an institution (z = 2.12, P = 0.03)ConclusionAssuming a direct association between delirium and examined outcomes (mortality, los and discharge destination) different classification systems for delirium identify populations with different outcomes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Impact of Classification Systems (DSM-5, DSM-IV, CAM and DRS-R98) on Outcomes of Delirium

10.26226/morressier.588f064ed462b8028d8923e3 ◽

2017 ◽

Author(s):

Geraldine McCarthy

Keyword(s):

Classification Systems ◽

Dsm 5 ◽

Dsm Iv

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Cognitive improvement among abstinent methamphetamine users: A 2‐year prospective longitudinal study

American Journal on Addictions ◽

10.1111/ajad.13209 ◽

2021 ◽

Author(s):

Tong‐Yu Wang ◽

Teng‐Teng Fan ◽

Julia M. Lappin ◽

Xiao‐Dong Li ◽

Yi‐Miao Zhao ◽

...

Keyword(s):

Longitudinal Study ◽

Prospective Longitudinal Study ◽

Cognitive Improvement ◽

Prospective Longitudinal

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Hebephrenia: a conceptual history

History of Psychiatry ◽

10.1177/0957154x11428416 ◽

2012 ◽

Vol 23 (4) ◽

pp. 387-403 ◽

Cited By ~ 5

Author(s):

Abdullah Kraam ◽

Paula Phillips

Keyword(s):

Emotional Expression ◽

Historical Context ◽

Classification Systems ◽

Late Nineteenth Century ◽

Conceptual History ◽

Dsm 5 ◽

History Of ◽

Dsm Iv ◽

Characteristic Features ◽

Psychiatric Establishment

This paper traces the conceptual history of hebephrenia from the late nineteenth century until it became firmly embedded into modern psychiatric classification systems. During this examination of the origins and the historical context of hebephrenia it will be demonstrated how it became inextricably linked with twentieth-century notions of schizophrenia. The first detailed description of hebephrenia in 1871 by Ewald Hecker, then a virtually unknown German psychiatrist, created a furore in the psychiatric establishment. Within a decade hebephrenia was a firmly embedded concept of adolescent insanity. Daraszkiewicz, Kraepelin’s brilliant assistant in Dorpat, broadened Hecker’s concept of hebephrenia by including severe forms. This paved the way for Kraepelin to incorporate it together with catatonia as a subtype of dementia praecox. We recognize Hecker’s hebephrenia in DSM-IV as schizophrenia, disorganized type. Although DSM-5 will probably abolish subtypes of schizophrenia, characteristic features of hebephrenia will be found within the proposed domains of disorganization, restricted emotional expression and avolition.

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Designing new diagnostic systems for the early detection of tobacco-associated chronic renal damage in patients of a primary care centre in Salamanca, Spain: an observational, prospective study protocol

BMJ Open ◽

10.1136/bmjopen-2019-032918 ◽

2020 ◽

Vol 10 (3) ◽

pp. e032918

Author(s):

Marta Prieto ◽

Laura Vicente-Vicente ◽

Alfredo G Casanova ◽

Maria Teresa Hernández-Sánchez ◽

Manuel A Gomez-Marcos ◽

...

Keyword(s):

Smoking Cessation ◽

Longitudinal Study ◽

Renal Damage ◽

Kidney Damage ◽

Diagnostic Systems ◽

Cross Sectional ◽

Prospective Longitudinal Study ◽

Gm2 Ganglioside ◽

Informed Consent Form ◽

Prospective Longitudinal

IntroductionTobacco causes kidney damage that can progress to chronic kidney disease. However, the diagnostic parameters used in clinics are not effective in identifying smokers at risk. Our first objective is to more effectively detect subclinical renal damage in smokers. In addition, we hypothesise that tobacco consumption can predispose smokers to renal damage on exposure to other potentially nephrotoxic events (drugs, diagnostic procedures and so on). We will test this hypothesis in our second objective by investigating whether certain predisposition markers (GM2 ganglioside activator protein (GM2AP), transferrin and t-gelsolin) are able to detect smokers who are predisposed to kidney damage. Finally, in our third objective, we will study whether smoking cessation reduces subclinical and/or predisposition to renal damage.Methods and analysisFor our first objective, a prospective cross-sectional study will be carried out with patients from a primary healthcare centre. The influence of tobacco on renal damage, in patients both with and without additional risk factors, will be studied using a panel of early biomarkers (albuminuria, N-acetyl-beta-D-glucosaminidase, kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin). For our second objective, a prospective longitudinal study will be carried out with patients recruited for our first objective. We will study whether certain predisposition biomarkers (GM2AP, transferrin and t-gelsolin) are able to detect smokers predisposed to renal damage. For our third objective, a prospective longitudinal study will be carried out with patients from a smoking cessation unit. We will study the evolution of the markers described above following smoking cessation.Ethics and disseminationThe study has been approved by the Clinical Research Ethics Committee of the Healthcare Area of Salamanca. All study participants will sign an informed consent form in compliance with the Declaration of Helsinki and the WHO standards for observational studies. Results will be presented at conferences and submitted to peer-reviewed journals.Trial registration numberNCT03850756.

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A comparison of delirium diagnosis in elderly medical inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 criteria

International Psychogeriatrics ◽

10.1017/s1041610214002853 ◽

2015 ◽

Vol 27 (6) ◽

pp. 883-889 ◽

Cited By ~ 23

Author(s):

Dimitrios Adamis ◽

Siobhan Rooney ◽

David Meagher ◽

Owen Mulligan ◽

Geraldine McCarthy

Keyword(s):

Diagnostic Method ◽

Correlation Coefficients ◽

Classification Systems ◽

Case Identification ◽

Significant Agreement ◽

Dsm 5 ◽

Detailed Evaluation ◽

Medical Inpatients ◽

Dsm Iv ◽

Medical Teams

ABSTRACTBackground:The recently published DSM-5 criteria for delirium may lead to different case identification and rates of delirium than previous classifications. The aims of this study are to determine how the new DSM-5 criteria compare with DSM-IV in identification of delirium in elderly medical inpatients and to investigate the agreement between different methods, using CAM, DRS-R98, DSM-IV, and DSM-5 criteria.Methods:Prospective, observational study of elderly patients aged 70+ admitted under the acute medical teams in a regional general hospital. Each participant was assessed within 3 days of admission using the DSM-5, and DSM-IV criteria plus the DRS-R98, and CAM scales.Results:We assessed 200 patients [mean age 81.1±6.5; 50% female; pre-existing cognitive impairment in 63%]. The prevalence rates of delirium for each diagnostic method were: 13.0% (n = 26) for DSM-5; 19.5% (n = 39) for DSM-IV; 13.5% (n = 27) for DRS-R98 and 17.0%, (n = 34) for CAM. Using tetrachoric correlation coefficients the agreement between DSM-5 and DSM-IV was statistically significant (ρtetr = 0.64, SE = 0.1, p < 0.0001). Similar significant agreement was found between the four methods.Conclusions:DSM-IV is the most inclusive diagnostic method for delirium, while DSM-5 is the most restrictive. In addition, these classification systems identify different cases of delirium. This could have clinical, financial, and research implications. However, both classification systems have significant agreement in the identification of the same concept (delirium). Clarity of diagnosis is required for classification but also further research considering the relevance in predicting outcomes can allow for more detailed evaluation of the DSM-5 criteria.

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Anorexia nervosa or otherwise? The usefulness of adult diagnostic systems in child and adolescent eating disorders

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700009976 ◽

2006 ◽

Vol 23 (4) ◽

pp. 156-158

Author(s):

Alma Lydon ◽

Onome Agbahovbe ◽

Brendan Doody

Keyword(s):

Anorexia Nervosa ◽

Paediatric Population ◽

Classification Systems ◽

Childhood And Adolescence ◽

Diagnostic Systems ◽

Young Males ◽

Icd 10 ◽

Inpatient Management ◽

Dsm Iv ◽

Adolescent Eating Disorders

AbstractWe report on the case of a 15-year-old boy referred to Warrenstown inpatient unit for management of what appeared to be a typical case of anorexia nervosa. Over the course of his admission however, this diagnosis was no longer considered appropriate and substituted for a food avoidance emotional disorder. This is one of a number of cases of young males who have recently been referred for inpatient management of anorexia nervosa but which emerged into something quite atypical. The limited usefulness of the ICD-10/DSM-IV criteria in the diagnosis of an eating disorder in childhood and adolescence in this case reflects a broader level of discontent with the application of such diagnostic classification systems in a paediatric population.

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