What is It Like to be Delirious?

Abstract

The current terminology of delirium and encephalopathy is open to debate. As with any poorly understood disorder with an unknown mechanism, there is a range of opinions. Attention must be paid to a proliferation of new terms and the ease with which they were introduced. In this viewpoint article, the authors invite the readers to return to the patient and rethink linguistic usage. The meaning of terms will be determined by their use rather than by authoritative description. We conclude that the suggested terminology of delirium is subjective, unsatisfactory, and may seriously hamper scholarly work. Rather than expand the definitions of types of delirium and separate them from encephalopathy, we advocate a definition—encephalopathy with or without characteristics of delirium—with the understanding that agitated patients in a delirium are innately encephalopathic. We subscribe to the prevailing neurologic description of delirium. This would allow sufficient granularity for bedside use and prospective studies.