Delirium: The Often Overlooked Diagnosis

Abstract

Delirium is the organic mental disorder most often encountered by psychiatrists and other physicians. Early recognition and management of patients with this condition is critical. Its presence in medically ill patients is highly correlated with an increased mortality rate. In our study of patients who were referred for psychiatric consultation in a general hospital, a comparison was made of the demographic and clinical characteristics of those patients with delirium and those with other psychiatric disorders. We found that for almost all of the referrals (93%), either a physician or more frequently a nurse recorded well-known signs of delirium in their notes. The physicians indicated the possibility of an organic psychiatric condition in only one-third of the referrals, suggesting that doctors either may overlook the nurses' notes or they may not recognize the signs recorded as signs of delirium. A review of the literature suggests that physicians tend to overlook and misdiagnose this disorder. Possible reasons for this lack of recognition are discussed.