The daily educational pearl – Is your confused patient delirious?

Your next patient is brought it for disturbing behaviour. Most likely to be an elderly patient from a nursing home with longstanding history of dementia who is now violent towards staff. But could be younger as well, with known psychiatric history.

You think it might be delirium, but could also be just usual behaviour as part of progressive dementia, or a psychotic illness. When do you investigate further for delirium?


You can use the Confusion Assessment Method (CAM). Your patient has delirium if there is:

1. Acute onset & fluctuating course AND

2. Inattention AND

3. Disorganised thinking OR

4. Altered level of consciousness


Sensitivity of 94-100% and a specificity of 90-95%.