Laurila Jouko V, Pitkala Kaisu H, Strandberg Timo E, Tilvis Reijo S
Department of Medicine, Helsinki University Hospital, Geriatric Clinic, Helsinki, Finland.
Int J Geriatr Psychiatry. 2004 Mar;19(3):271-7. doi: 10.1002/gps.1079.
Different diagnostic criteria differ in their capacity to identify subjects as delirious. It is not known how DSM-IV classification, compared with the DSM-III, DSM-III-R, and ICD-10, identifies delirium among individuals with and without dementia and whether the symptom profiles differ between these two subgroups.
A cross-sectional study was performed on patients (age > or = 70 years) in seven acute geriatric wards (n = 230) and in seven nursing-homes (n = 195) in Helsinki, Finland. Delirium was diagnosed according to the operationalized criteria according to the DSM-III, DSM-III-R, DSM-IV, and clinical criteria of ICD-10. Dementia was defined according to consensus judgment among three geriatricians with concise information including: prior dementia diagnoses, Clinical Dementia Rating Scale, operationalized criteria according to the DSM-IV, nurses and/or caregivers interviews, and the results of the brain CT/MRI and prior Mini-Mental State Examination scores, when available.
According to the DSM-III, DSM-IIIR, DSM-IV and ICD-10 criteria of delirium 22.7, 23.5, 25.9 and 14.9% of the demented, and 12.9, 13.5, 23.5 and 2.9% of the non-demented, respectively, were diagnosed as delirious. In stepwise logistic regression analysis clouding of consciousness, perceptual disturbances, and disorganized thinking were the most significant contributors to delirium diagnosis according to the DSM-IV among individuals with dementia, whereas perceptual disturbances, motor disturbances, and disorientation were the most significant contributors among those without dementia.
DSM-IV criteria of delirium identify new, often non-demented, subjects as being delirious, while ICD-10 is overly restrictive. The symptom profile of delirium was slightly different among individuals with and without dementia.
不同的诊断标准在识别谵妄患者的能力上存在差异。与《精神疾病诊断与统计手册》第三版（DSM-III）、第三版修订本（DSM-III-R）和《国际疾病分类》第十版（ICD-10）相比，《精神疾病诊断与统计手册》第四版（DSM-IV）如何在患有和未患有痴呆症的个体中识别谵妄，以及这两个亚组之间的症状特征是否不同，目前尚不清楚。
对芬兰赫尔辛基7个急性老年病房（n = 230）和7个养老院（n = 195）中年龄≥70岁的患者进行了一项横断面研究。根据DSM-III、DSM-III-R、DSM-IV的操作性标准以及ICD-10的临床标准诊断谵妄。痴呆症根据三位老年病专家的共识判断来定义，简要信息包括：既往痴呆症诊断、临床痴呆评定量表、根据DSM-IV的操作性标准、护士和/或护理人员访谈，以及脑CT/MRI结果和既往简易精神状态检查得分（如有）。
根据DSM-III、DSM-IIIR、DSM-IV和ICD-10的谵妄标准，分别有22.7%、23.5%、25.9%和14.9%的痴呆患者，以及12.9%、13.5%、23.5%和2.9%的非痴呆患者被诊断为谵妄。在逐步逻辑回归分析中，意识模糊、感知障碍和思维紊乱是DSM-IV诊断痴呆患者谵妄的最重要因素，而感知障碍、运动障碍和定向障碍是诊断非痴呆患者谵妄的最重要因素。
DSM-IV的谵妄标准将新的、通常是非痴呆的个体识别为谵妄患者，而ICD-10则过于严格。患有和未患有痴呆症的个体之间谵妄的症状特征略有不同。
