At the Chief Editor's re- quest, I address some issues raised in the correspondence on ODS.
The DSM-III-R precludes a diagnosis of ODS if the patient is delirious (per criterion C). Organic delusional syndrome and dementia are not mutually exclusive categories in DSM-III-R, although they were in DSM-III. Cornelius et al1 reported that 43.6% of their ODS cases had "impaired sensorium" and 66.7% had "acquired intellectual impairment." The presence of an "impaired sensorium," however mild, strongly suggests delirium rather than ODS as the appropriate diagnosis in those cases. The "acquired intellectual impairment" suggests a probable diagnosis of dementia, which would not preclude a concurrent diagnosis of ODS. Looking to DSM-IV,2 the terms "impairment of consciousness" and "the development of multiple cognitive deficits" (memory impairment and cognitive impairment) are proposed as the "A" criteria of delirium and dementia, respectively.
Problems in case definition aside,
Cornelius et al are to