A. Disturbance in level of awareness and reduced ability to direct, focus, sustain, and shift attention.

B. A change in cognition, (such as deficits in orientation, executive ability, language, visuoperception, learning and memory)

-Cannot be assessed in face of severely reduced level of awareness

-Should not be better accounted for by a preexisting neurocognitive disorder

C. There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by the direct physiologic consequences of a general medical condition.

D. The disturbance develops over a short period of time (usually hours to a few days) and tends to fluctuate in severity during the course of a day.

Note: The following supportive features are commonly present in delirium but are not key diagnostic features:  sleep-wake cycle disturbance, psychomotor disturbance, perceptual disturbances (e.g., hallucinations, illusions), emotional disturbances, delusions, labile affect, dysarthria and EEG abnormalities (generalized slowing of background activity)

Coding note: If delirium is superimposed on a pre-existing Neurocognitive Disorder, indicate the delirium as follows: _______

Coding note: Include the name of the general medical condition on Axis I e.g. 293.0 Delirium Due to Hepatic Encephalopathy

If the full criteria are currently met for delirium, specify its current clinical status and/or features:

Hyperactive, hypoactive or mixed

Short term vs. persistent duration

For more information, please see the Neurocognitive Disorders Proposal for DSM-5.

• Consciousness is too nebulous a term to describe the symptoms of delirium. Awareness captures the essence of delirium much better.
• Visuospatial impairment and impairment in executive function are key symptoms of delirium; the group has also added a clarification that a preexisting neurocognitive disorder does not account for the cognitive changes.
• The order of criteria has been reversed so that duration is placed at the end of the criteria.
• The Neurocognitive Disorders Work Group has added "in severity" to improve clarity in criterion D.
• Nothing is mentioned in the current criteria about accompanying symptoms. Though not necessary or sufficient in themselves to make the diagnosis, they should be recognized as frequent symptoms of delirium.
• Evidence is questionable for a subcategory for chronic delirium.

NOTE: The Neurocognitive Disorders Work Group is still discussing whether to add subsyndromal delirium in parallel with minor neurocognitive disorder and welcomes input on this issue.

Recommendations for severity criteria for this disorder are forthcoming. We encourage you to check our Web site regularly for updates.

A.  Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.

B.  A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia.

C.  The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.

D. There is evidence from the history, physical examination, or laboratory findings that the delirium has more than one etiology (e.g., more than one etiological general medical condition, a general medical condition plus Substance Intoxication or medication side effect).

Coding note: Delirum Due to Multiple Etiologies does not have its own separate code and should not be recorded as a diagnosis. For example, to code a delirium due to both hepatic encephalopathy and withdrawal from alcohol, the clinician would list both 293.0 Delirium Due to Hepatic Encephalopathy and 291.0 Alcohol Withdrawal Delirium on Axis I and 572.2 hepatic encephalopathy on Axis III.