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Editorial| Volume 26, ISSUE 9, P925-926, September 2018

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Unraveling Delirium: Where to Start: Top Down Versus Bottom Up?

  • Karin Neufeld
    Correspondence
    Send correspondence and reprint requests to Karin Neufeld, M.D., M.P.H., Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, A4 Center, Suite 457, 4940 Eastern Avenue, Baltimore, MD 21224.
    Affiliations
    Department of Psychiatry and Behavioral Sciences (KN), Johns Hopkins University School of Medicine, Baltimore, Maryland
    Search for articles by this author
      Oldham et al.
      • Oldham M.A.
      • Flaherty J.
      • Maldonado J.R.
      Refining delirium: a trans-theoretical model of delirium disorder with preliminary neurophysiological subtypes.
      propose a new model of delirium diagnosis in an article entitled “Refining delirium: a trans-theoretical model of delirium disorder with preliminary neurophysiological subtypes.” In this bold and provocative article, the authors propose a model for delirium that distinguishes the phenotype—the core attentional and arousal symptoms defined in the current diagnostic systems—from a delirium “disorder,” which they suggest should include consideration of specific precipitants of the syndrome, the protective baseline cognitive features, and the resultant neuropathological injury. They argue that this view is transtheoretical. Rather than advocating for one unifying model underlying the syndrome of delirium, this view allows for an interactive framework that starts with identifying precipitants as well as resilience and requires postulation as to neurophysiology and pathology.
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      References

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        • Flaherty J.
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