Delirium and Dementia
Dementia, delirium, amnestic and other cog-nitive
disorders: Traditionally, these conditions have been classified as organic
brain disorders to distinguish them from such diseases as schizophrenia, mania
and major depressive disorder, the so-called functional disorders. With the
publication of the DSM-IV, the distinction between functional and organic
disorders was eliminated. Significant research into the neurobiological aspects
of psychiatric disorders and the utilization of sophisticated neurodi-agnostic
tests such as positron emission tomographic scanning in individuals with
schizophrenia led to the inescapable conclusion that every psychiatric
condition has a biological component. Thus the term functional became obsolete
and even misleading.
The conditions formerly called organic are
classified in DSM-IV into three groupings: 1) delirium, dementia, and amnestic
and other cognitive disorders; 2) mental disorders due to a general medical
condition; and 3) substance-related disorders (American Psychiatric
Association, 1994). Delirium, dementia and amnestic disorders are classified as
cognitive because they feature impair-ment in such parameters as memory,
language, or attention as a cardinal symptom. Each of these three major
cognitive disorders is subdivided into categories that ascribe the etiology of
the disorder to a general medical condition, the persisting effects of a
substance, or multiple etiologies. A “not otherwise specified” category is
in-cluded for each disorder (American Psychiatric Association, 1994).
In the case of delirium, the primary disturbance is
in the level of consciousness with associated impairments in orientation,
memory, judgment and attention. Dementia features cognitive defi-cits in
memory, language and intellect. The amnestic disorder is characterized by
impairment in memory in the absence of clouded consciousness or other
noteworthy cognitive dysfunction. In gen-eral, the cognitive disorders should
represent a decline from a previ-ous higher level of function, of either acute
(delirium) or insidious (dementia) onset, and should interfere with the
patient’s social or oc-cupational functioning (American Psychiatric
Association, 1994).
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