Delirium Screening — MRCPsych Paper B MCQ

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EasyLiaison PsychiatryDelirium ScreeningMRCPsych Paper B

A 55-year-old man on a general medical ward develops acute, fluctuating confusion and inattention, raising concern about delirium. He is not receiving critical care and is not in postoperative recovery. Which assessment tool is recommended by NICE?

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Correct answer: B — 4AT

The correct answer is the 4AT. NICE CG103 was updated in January 2023 and recommends that a competent practitioner use the 4AT when indicators of delirium are identified in hospital or long-term care. In critical care or postoperative recovery, CAM-ICU or the Intensive Care Delirium Screening Checklist should be used instead. The standard CAM was included in the older 2010 recommendation but is no longer NICE's recommended assessment for this general ward scenario. MMSE, the Clock Drawing Test and MoCA are primarily cognitive-impairment measures rather than the recommended delirium assessment. PHQ-9 screens for depressive symptoms.

Reference: NICE. Delirium: prevention, diagnosis and management in hospital and long-term care (CG103), recommendation 1.6.1, updated 2023. https://www.nice.org.uk/guidance/cg103/chapter/Recommendations