Characterising neuropsychiatric disorders in patients with C
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Researchers commend Aravinthan Varatharaj and colleagues for their study on neurological and neuropsychiatric complications of COVID-19. However, researchers are concerned by their reliance on the vague term altered mental status and the use of the term encephalopathy without reference to delirium.

The absence of delirium in the Article's case definitions is troubling and imposes considerable constraints on the interpretation of this study, because delirium is likely to be the most frequent neuropsychiatric complication of COVID-19. Consistent with the high prevalence of delirium to be present in at least a quarter of older patients (aged more than 65 years) with COVID-19 and more than two-thirds of severe cases. However, most reports have used non-standard terminology to describe the mental status phenotypes in COVID-19 (eg, dysexecutive syndrome, confusion, altered consciousness, or altered mental status). Of note, confusion was the fifth most common presenting feature of COVID-19 overall in the International Severe Acute Respiratory and Emerging Infection Consortium WHO study (n=20?133).

Altered mental status is defined as “an acute alteration in personality, behaviour, cognition, or consciousness”. Additional, undefined terms include unspecified encephalopathy, new-onset psychosis, and neurocognitive (dementia-like) syndrome. Presuming acute onset, most of these cases probably would have fulfilled DSM-5 criteria for delirium.

There are sound reasons for identifying delirium in particular; delirium is a valid, operationalised diagnostic construct with high reliability and strong utility. A diagnosis of delirium compels a standardised approach to management and, crucially, facilitates communication with patients and carers, which is essential for alleviating their distress.

According to the recent position statement, delirium describes a discrete clinical syndrome and acute encephalopathy describes the neuropathophysiology. Researchers propose that it is inadequate to use the term delirium without specifying the underlying cause or putative neuropathophysiology, or to use the term acute encephalopathy without consistently characterising the mental status phenotype.

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