Fish book What are the five criteria of Hallucibation

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Fishman pulmonary "hallucibation" five criteria ICU delirium

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I now have the complete answer from Fishman's Pulmonary Diseases and Disorders (the "Fish book"). The user asked about "five criteria of Hallucibation" - this is referring to the DSM-5 diagnostic criteria for Delirium (which includes hallucinations as a feature), as presented in Fishman's book, Chapter 151 on Delirium in the Critically Ill.

Five DSM-5 Diagnostic Criteria for Delirium - Fishman's Pulmonary Diseases and Disorders (Chapter 151)

The "Fish book" (Fishman's Pulmonary Diseases and Disorders) presents the American Psychiatric Association DSM-5 diagnostic criteria for delirium in the context of ICU care. These are the five criteria:

Criterion 1 - Disturbance in Attention and Awareness A disturbance in attention (reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).
Criterion 2 - Acute and Fluctuating Onset The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline in attention and awareness, and tends to fluctuate in severity during the course of a day.
Criterion 3 - Additional Cognitive Disturbance An additional disturbance in cognition, such as memory deficit, disorientation, language impairment, visual-spatial ability impairment, or perceptual disturbances.
Criterion 4 - Not Explained by Another Neurocognitive Disorder The disturbances in criteria (1) and (2) are not better explained by another pre-existing, established, or evolving neurocognitive disorder, and do not occur in the context of a severely reduced level of arousal such as coma.
Criterion 5 - Caused by a Medical Condition, Substance, or Toxin There is evidence from history, physical examination, or laboratory findings that the disturbance is a direct physiologic consequence of another medical condition, substance intoxication or withdrawal (a drug of abuse or medication), exposure to a toxin, or is due to multiple etiologies.

Important note from Fishman's: Hallucinations, delusions, perceptual disturbances, sleep-wake cycle disturbances, and psychomotor agitation/retardation are supportive features of delirium but are neither sufficient nor required to make the diagnosis on their own. This is why the term "ICU psychosis" has been deprecated - delirium should be diagnosed only when these five DSM-5 criteria are met.
The book also notes that historically, terms like "ICU psychosis," "ICU syndrome," "toxic confusional state," and "septic encephalopathy" were used - but the standardized term delirium (with the suspected etiology attached, e.g., "delirium due to sepsis") is now preferred.
  • Fishman's Pulmonary Diseases and Disorders, 2-Volume Set - Chapter 151: Diagnosis and Treatment of Pain, Agitation, and Delirium in the ICU, p. 2679-2681
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